Nd:YAG/Er:YAG dual laser compared with topical steroid to treat vulvar lichen sclerosus: A randomised controlled trial.
Zivanovic, I., Gamper, M., Fesslmeier, D., Walser, C., Regauer, S. & Viereck, V., 2023.Bjog: an international journal of obstetrics and gynaecology. 2023
Objective:
To evaluate the efficacy and safety of a novel non-ablative Nd:YAG/ Er:YAG dual laser treatment for vulvar lichen sclerosus (LS) in comparison with the recommended first-line therapy with topical steroid. Design: A randomised investigator-initiated active-controlled trial. Setting: Single tertiary referral centre. Population: Women with vulvar LS.
Materials and Methods:
Randomisation (2:1) to Nd:YAG/Er:YAG laser therapy or topical clobetasol proprionate therapy. Four laser treatments at 0, 1, 2 and 4months or decreasing doses of steroid for 6months. Main Outcome Measures: The primary outcome was the change in objective validated clinical LS score in the laser arm between baseline and 6months. Secondary outcomes were laser tolerability/safety, symptom scores and patient satisfaction.
Results:
Sixty-six women were included, 44 in the laser group and 22 in the steroid group. The total LS score decreased by −2.34±1.20 (95% CI −2.71 to −1.98) in women treated with laser compared with a decrease of −0.95±0.90 (95% CI −1.35 to −0.56) in those receiving steroid applications (p<0.001). Laser treatment was safe and well tolerated. Subjective severity scores (on visual analogue scale) and vulvovaginal symptoms questionnaire scores improved similarly for the laser and steroid arms without significant differences between the two treatments. Patient satisfaction was higher in the laser arm than in the steroid arm (p=0.035).
Conclusions:
Non-ablative dual Nd:YAG/Er:YAG laser therapy was safe and significantly improved clinical outcome and subjective symptoms at the 6-month follow up. This suggests that laser may be a promising alternative to corticosteroid therapy. However, the authors caution regular follow ups because of the premalignant nature of the disease.
Keywords: clobetasol propionate, laser safety, lichen sclerosus, non-ablative Nd:YAG/Er:YAG laser therapy, prospective randomised controlled trial, steroid therapy
