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

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 trialin which participants and investigators were blinded, 37 evaluable women with LS were randomized to five sham or real laser treatments over 6 months.