Available online 5 December 2023, 103924

Author links open overlay panel, , , , , , AbstractSignificance

ALA-PDT effectively treats Vulvar lichen sclerosus et atrophicus (VLSA), but it requires multiple repetitions for satisfactory results. To enhance efficacy, we employed a combination of high-frequency electrocautery therapy and ALA-PDT in treating seven VLSA patients.

Approach

Lesions and leukoplakia in the seven women with VLSA were removed using a high-frequency generator. PDT was administered after wound healing, and it was repeated six times. Follow-up assessments were carried out at 1, 3, and 6 months to evaluate the severity of pruritus and investigate lesion repigmentation.

Results

Following the combined therapy, the disappearance of pruritus was observed in all patients, and normal color and thickness were restored to their skin. Two patients reported mild pruritus with a score of 2 one month after treatment, which persisted until the 6-month follow-up, while the remaining patients remained free from pruritus. No recurrence of skin lesions was observed in any of the patients.

Conclusions

The combined therapy for the treatment of VLSA is found to be convenient, effective, and easily promotable.

Section snippetsIntroduction and Background

Vulvar lichen sclerosus et atrophicus (VLSA) is a chronic inflammatory skin condition. Despite ongoing research, the exact causes and mechanisms behind VLSA remain unknown. It has been suggested that factors such as infection, genetics, autoimmunity, or hormones may be involved [1]. VLSA can affect individuals of any age but is more common among perimenopausal and postmenopausal women. Additionally, a significant number of prepubertal girls also experience this condition [2]. The primary

Aims

Our retrospective analysis aimed to evaluate the effectiveness of the combination of high-frequency electrocautery therapy and ALA-PDT in seven VLSA patients. We assessed the level of pain experienced during treatment, the extent of improvement in clinical symptoms after treatment, and the duration until symptom remission, all of which allowed us to gauge the efficacy of this combined treatment approach.

Patients

Between January 2022 and March 2023, seven women with clinical and histological confirmation of VLSA, who had not responded positively to conventional treatments, were recruited for this clinical study. The vulvar lesions presented clinically as white, wax-like atrophic, lichenoid hyperkeratotic, or sclerotic lesions. All patients had previously undergone various standard treatments, including TCS, TCI, and vitamin E, among others. Regrettably, these treatments had only provided temporary

Results

Seven patients were included in the study, with an average age of 48 years. The duration of their illness varied from one to five years, with an average disease duration of 30 months. Before treatment, all patients reported experiencing moderate to severe itching of the vulva, with an average itching score of 4.29. Additionally, all patients presented with thickened vulvar lesions and leukoplakia. Table 1 displays the demographic and baseline characteristics of the patients.

Discussion

VLSA is a chronic inflammatory skin condition of unknown origin, characterized by severe itching. In the early stages of VLSA, distinct thin, white papules and plaques appear, primarily in the labia minora, vaginal introitus, and fork area. Due to the degeneration of fibrous tissue and vascular lesions within these skin lesions, mechanical stimuli like mild scratching or friction can easily lead to erosion, fissures, and purpura. Over time, late complications may develop, including atrophic

6 Conclusion

Our study provides strong evidence supporting ALA-PDT as a highly effective and safe method for treating VLSA. Combining high-frequency electrocautery therapy with ALA-PDT appears to enhance efficacy while maintaining good patient tolerance. However, our study's sample size is limited. Therefore, larger clinical trials should be conducted in the future to provide more comprehensive data for clinical treatment and benefit a wider range of patients.

CRediT authorship contribution statement

Shanshan Ou: Writing – original draft, Software. Huanli Wang: Investigation, Data curation. Weiyu Liu: Investigation, Data curation. Huilan Zhu: Validation. Wenjun Zhang: Resources. Huaping Li: Data curation. Huiyan Deng: Project administration.

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© 2023 Published by Elsevier B.V.