4.04] CO2-laser treatment of patients with anogenital lichen sclerosus

Abstract

Objective The lichen sclerosus is a non-inflammatory, chronic disease most probably with auto-immunological genesis. Different conservative therapies exist: the local or systemic treatment with estrogens, corticosteroids and immunomodulators. The clinical presentation and the subjective complaints are not persistently improved by these conservative methods. For several years we have used laser skin ectomy as an alternative to the vulvectomy that has now become obsolete. In this presentation we will demonstrate the surgical technique and show the results achieved with our technology. Material and methods During the last 8 years we treated 184 patients aged between 17 and 84 years, who were suffering from an anogenital lichen sclerosus. After histological confirmation of the diagnosis, we performed the laser skin ectomy with a CO2 laser. The postoperative healing, the clinical course of the subjective complaints and the recurrence rate were evaluated. We investigated the spectrum of age, the duration of conservative therapy as well as the findings of genital synechiae and atrophies at the initial stage of our therapy. We furthermore investigated the occurrence of squamous cell carcinomas amongst our patients. Results The number of treatments per patient was between zero (recommendation of conservative treatment prior to laser surgery was successful) and ten treatments. The average number of treatments was 1.7. Fifteen percent of incoming patients showed synechiae; genital atrophies were seen on 20% of our new patients. Using laser skin ectomy a precise separation of pre-existing synechiae was possible. The ablation of the affected layers maintaining the papillary region can also be achieved with high precision. With the laser ablation a large wound area results and is subject to intensive wound treatment. The average healing time was 3 weeks. Two patients suffered retarded healing with subsequent super infection due to adiposity-related difficulties in wound treatment. The super infection was successfully treated with a five-day medication with oral cephalosporin. Success of the treatment was seen in all of our patients. A clear improvement of objective and subjective symptoms such as itching, erosions, rhagades and hemorrhage was achieved. The recurrence period was 6 months to 4 years. Not all patients returned for follow-up check-up. Four patients suffered vulvar and perianal squamous cell carcinomas after a long-term persisting recurrent lichen sclerosus. Conclusion Laser therapy is an effective option with good results showing clear improvement of objective and subjective symptoms, in particular for those patients where a conservative treatment had not been successful. The main advantage of our treatment is the precise ablation of only the directly affected zones. The patients did not have to undergo additional mutilating treatments. With beginning recurrence, single affected zones could be ablated in outpatient treatment. Our treatment method is relatively simple and helps our patients have long periods of time without recurrence of symptoms.