CO2 laser treatment of patients with anogenital lichen sclerosus – A retrospective study

Abstract

Abstract Objective The lichen sclerosus is an inflammatory chronic disease most probably with autoimmunological genesis. Different conservative therapies exist, but the clinical presentation and the subjective complaints in some cases are not effectively improved by these conservative methods. Laser skin ectomy has been used in our department as an alternative to the now almost obsolete vulvectomy for several years. This article demonstrates the surgical technique and results achieved using this technology. Material and methods During the last eight years, 184 patients, aged between 17 and 84, have been treated who were suffering from anogenital lichen sclerosus. After histological confirmation of the diagnosis, the laser skin ectomy was performed with a CO 2 laser. The post-operative healing, the clinical course of the subjective complaints and the recurrence rate were evaluated. In the initial stages of the therapy the age spectrum, duration of conservative therapy as well as the diagnostic findings of genital synechiae and atrophies were determined. Furthermore, the occurrence of squamous cell carcinomas among our patients was investigated. Results The number of laser treatments per patient was between 1 and 10 treatments, i.e. 1.96±1.80 treatments on average. Fifteen percent of incoming patients showed synechiae, and genital atrophies were seen in 20% of the patients. Using laser skin ectomy, a precise separation of pre-existing synechiae was possible. The ablation of the affected layers maintaining the papillary region could also be achieved with high precision. A large wound results after laser ablation which is subject to intensive wound treatment. The average healing time was three weeks. A clear improvement in objective and subjective symptoms such as itching, erosions, rhagades and hemorrhage was achieved in most of the patients. A symptom-free interval of six months up to four years could be achieved. Four patients developed vulvar and perianal squamous cell carcinomas after a long-term persistently recurring lichen sclerosus. Conclusion Laser therapy is an effective option with good results showing clear improvement of objective and subjective symptoms, particularly in those patients where a conservative treatment was not successful. The main advantage of the treatment is the precise ablation of only those zones which are directly affected. With beginning recurrence, isolated affected zones can be ablated in the outpatient clinic. Our treatment method is simple to handle, shows no significant side-effects and helps our patients to obtain long symptom-free periods.