COMMENTARY

Why Laser Therapy for Lichen Sclerosus Isn't Worth the Cost

Andrew M. Kaunitz, MD

Disclosures

June 11, 2021

This transcript has been edited for clarity.

Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatologic condition. Sequelae of LS include architectural changes to the labia minora, clitoris, anus, and introitus. Labial atrophy, scarring, and hypopigmentation often occur. A condition which characteristically causes itching, pain, and dyspareunia, vulvar LS is most commonly diagnosed following menopause.

Topical therapy with the potent corticosteroid clobetasol represents the standard of care in treating vulvar LS. However, maintaining consistent long-term compliance with applying this ointment represents a challenge that many women with LS, including my patients, face.

Two small randomized trials assessing the therapeutic value of fractionated carbon dioxide laser in women with vulvar LS were published in the June 2021 issue of the journal Obstetrics and Gynecology.

In the first trial, which was nonblinded, 51 evaluable women were randomized to receive three office laser treatments or topical clobetasol ointment. At 6 months, more improvement was noted in the laser group overall. However, when study participants were stratified by prior clobetasol use, improvement was noted only among women who had previously used this corticosteroid.

In the second trial, in which participants and investigators were blinded, 37 evaluable women with LS were randomized to five sham or real laser treatments over 6 months. Two months after participants completed treatment, minimal improvement was noted in both groups, with the differences not achieving statistical significance.

On the basis of these two trials, the efficacy of laser treatment for LS is uncertain. Moreover, since insurance companies do not cover laser treatment for vulvar LS, this therapy is financially out of reach for many women.

An editorialist stated that based on available data, she is not recommending laser treatment for her patients with vulvar LS; I agree with her perspective.

Thank you for the honor of your time. I am Andrew Kaunitz.

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