| BackgroundVulvar lichen sclerosus(VLS)is a chronic inflammatory non-neoplastic vulvar disease.The pathogenesis and current treatment of VLS remains unclear.Various treatment approaches have been proposed by clinicians around the world.Topical use of glucocorticoids is currently suggested as the first-line treatment,but better alternative therapies have been sought because long-term use of glucocorticoids can lead to a series of adverse events such as drug tolerance and skin thinning.Among them,calciumregulated phosphatase inhibitors have already taken their place in the alternative treatments of VLS.In addition,laser therapy,physical therapy,as well as platelet-rich plasma injection and local injection of human adipose stem cells are gradually emerging,but a complete cure of VLS is still lacking.ObjectiveThe aim of this study was to compare the safety and efficacy of Er: YAG laser and0.05% clobetasol propionate cream in the treatment of vulvar lichen sclerosus.Materials and MethodsForty-one female patients with VLS diagnosed by experienced dermatologists and pathologists from the First Affiliated Hospital of Anhui Medical University and Anhui Fei Rui Institute of Dermatology from October 2019 to November 2020 were enrolled,and patients with tendency to malignancy diagnosed by dermoscopy or histopathological examination were excluded.Then patients were divided into the Er: YAG treatment group(treatment group,n=20),and the 0.05% clobetasol propionate cream glucocorticoids treatment group(control group,n=21)for a 3-month treatment cycle and a 3-month follow-up cycle.Changes of vulvar quality of life index,Xie-Kawashima pruritus severity score,objective skin physiological indexes(transepidermal water loss,stratum corneum water content,skin elasticity,skin melanin and hemochromatosis,laser scattered blood perfusion values,and advanced glycation end products)before and after treatment in two groups were observed,and the efficacy of the two-treatment strategy was compared.Two independent samples t-test,chi-square test and Fisher’s exact test were also used to statistically analyze the measured and counted data,and P value < 0.05 was considered statistically different.ResultsBoth treatment strategies were effective in relieving symptoms of VLS.The VQLI and Xie-Kawashima score in both two groups decreased significantly after treatments,and the degree of declines showed no statistical difference between two groups(p>0.05).However,the incidence of adverse events with regard to the physiological function of skin in the treatment group was significantly lower than those of the control group.After three months of treatment,transepidermal water loss,stratum corneum water content,skin elasticity,skin melanin and hemochromatosis,laser scattered blood perfusion values,and advanced glycation end products all improved substantially in the treatment group.Whereas in the control group,all indices aggravated except skin melanin ameliorated modestly.The change of skin physiological indices before and after three months treatment showed significant difference between two groups(p < 0.05 for all items).ConclusionThis study shows that the Smooth mode using Er: YAG laser can effectively treat vulvar lichen sclerosus and ameliorate patients’ conditions in terms of painful intercourse,pruritus condition,elasticity,melanin,hemosiderin,skin barrier function and advanced glycation end products without developing other adverse effects during the treatment period and follow-up.Er: YAG laser is a non-invasive,minimally painful,safe and effective treatment for VLS. |
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