Treatment Of Vulvar Lichen Sclerosus Research Articles

Evaluation of Skin Recovery after Fractional CO2 Laser Treatment of Vulvar Lichen Sclerosus Using Multimodal Optical Coherence Tomography

Evaluation of Skin Recovery after Fractional CO2 Laser Treatment of Vulvar Lichen Sclerosus Using Multimodal Optical Coherence Tomography

Vulvar skin disease in the pediatric population.

Vulvar skin disease is an underrecognized pediatric condition encompassing a wide range of conditions, from isolated vulvar disease to vulvar manifestations of systemic illnesses. This review highlights the most current research discussing clinical features, risk factors, and treatments. Recent studies confirm that labial adhesions resolve more quickly with estrogen treatment. Topical corticosteroids remain first-line for treatment of vulvar lichen sclerosus, and some procedural interventions are showing promising results. Latest evidence shows efficacy of biologic agents in hidradenitis suppurativa and vulvar Crohn's. Vaginal voiding remains an underrecognized cause of irritant vulvovaginitis. Lately vulvar aphthae have been associated with coronavirus disease 2019. Distinguishing between infantile perianal pyramidal protrusion, molluscum, and condyloma can be aided by differences in morphologic features. Vulvar dermatoses have a high impact on children's health and wellbeing. Clinician familiarity with recognition and latest advancements in vulvar dermatoses can aid in prompt diagnosis, management, and appropriate referrals. Vulvar biopsy and vaginal cultures should be used prudently. Treatments include topicals, behavioral modification, systemic medications, and procedures.

Patient satisfaction and sexual issues in vulvar lichen sclerosus treatment: a monocentric certified dysplasia unit survey analysis

ObjectiveVulvar lichen sclerosus (VLS) is an underestimated chronic disease. It can cause significant symptom burden and sexual dysfunction. This study aimed to evaluate patient satisfaction and current challenges in the management of VLS in a certified dysplasia unit, particularly during the COVID-19 pandemic.MethodsThis survey analyzed patients who had been diagnosed with VLS and treated at our DKG-certified dysplasia unit. The study was conducted during the COVID-19 pandemic in the Department of Gynecology and Obstetrics at the University of Aachen. The questionnaire contained 43 questions on general treatment, diagnostic delays, disease education, psychologic and sexual issues, and specific questions regarding the COVID-19 pandemic. The questionnaires were distributed between January 2021 and September 2023.ResultsThis study included 103 patients diagnosed with VLS, who were treated at our certified dysplasia unit. Overall, 48% of the patients were satisfied with the success of the therapy. Most participants reported psychologic problems (36.8%), fear of cancer (53.3%), or sexual restrictions (53.3%). Among the patients, 38% were bothered by the regular application of topical cortisone. However, 72% were willing to undergo treatment for more than 24 months. The COVID-19 outbreak in March 2020 had a significant negative impact on general VLS care from the patient’s perspective (3.83/5 before vs. 3.67/5 after; p = 0.046). There was a general request for booklets to inform and educate the patients about their disease. Furthermore, the respondents demanded a telephone hotline to answer the questions and wished for follow-up visits via e-mail to cope better with their current situation.ConclusionThis study highlights the need for more effective treatments for VLS and an increased awareness of psychologic and sexual distress. To ensure patient well-being and satisfaction, it is imperative to offer individualized care with adequate disease education in a team of specialists from various disciplines.

Predicting the development of vulvar lichen sclerosus

Relevance. The issue of timely diagnosis and treatment of vulvar lichen sclerosus has become especially acute in recent years due to the “rejuvenation” of the disease and the risk of its malignancy. In this regard, it is urgent to search for effective methods for predicting and early detection of the disease. The aim of the study - to develop amodel for predicting vulvar lichen sclerosus based on established clinical and anamnestic risk factors. Materials and Methods. The prospective case-control study included 404 women aged 20 to 70 years, of which 344 were patients with vulvar lichen sclerosus and 60 were women without vulvar diseases. At the first stage, acomparative statistical correlation analysis of the clinical and anamnestic data of the subjects was carried out using the Spearman correlation coefficient (R0.15), Chi-square tests, Phi and Cramer statistics, the Mann-­Whitney U test and the Student t test (p 0.05). The data obtained were used to develop aneural network model for predicting vulvar lichen sclerosus in the second stage of the study. Results and Discussion. Based on established reliably significant (p0.05) obstetric-­gynecological, somatic, infectious, hygienic and household factors influencing the risk of developing vulvar lichen sclerosus (Rindicator - from 0.16 to 0.38 confirms the statistical significance of correlations), aneural network model for predicting vulvar lichen sclerosus was developed (the percentage of correct classification on the test sample is the maximum possible value - 100%) and acomputer program was written that automates the procedure for predicting the disease. Conclusion. The neural network model for predicting the disease, developed on the basis of reliably (p0.05) significant risk factors for vulvar lichen sclerosus, has high prognostic properties, and acomputer program written on its basis allows the doctor in amatter of minutes to identify the patient at risk for the development of vulvar lichen sclerosus and give she needs preventive recommendations aimed at preventing or early detection of the disease.

Clinical efficacy analysis of 5-aminolevulinic acid photodynamic therapy for vulvar lichen sclerosus

ObjectiveThe purpose of this study is to analyze the efficacy of photodynamic therapy in the treatment of vulvar lichen sclerosus who do not respond to topical glucocorticoid therapy, analyze whether there are factors that affect the efficacy, and identify adverse reactions to the treatment. MethodThis retrospective study included 42 patients with vulval lichen sclerosis treated with ALA-PDT. Basic data of all patients were collected, and the clinical symptoms and signs of the patients before treatment were evaluated. After one year of treatment, the clinical efficacy was evaluated and analyzed whether there were any factors that affected the treatment effect. ResultOne year after the ALA-PDT treatment, the clinical effective rate was 64.29 % (27/42), the general effective rate was 19.05 % (8/42), the ineffective rate was 4.76 % (2/42), and the recurrence rate was 11.90 % (5/42). There was no correlation between menopause, number of births given, body mass index, duration of disease, treatment times and treatment effect. For patients with severe itching and atrophy, PDT was less effective. Adverse effects were minimal and no structural complications were reported. ConclusionALA-PDT can obviously alleviate itching in VLS patients, improve skin elasticity, skin color and reduce lesion area. ALA-PDT for VLS has a low recurrence rate and few side effects.

Searching for a “Window of Opportunity” in the Treatment of Vulvar Lichen Sclerosus: Evidence for Therapeutic Benefits of an Early Corticosteroid Treatment

Introduction: Vulvar lichen sclerosus (VLS) is characterized by progressive anatomical changes which become increasingly severe and irreversible. The objective of this study was to investigate if a “window of opportunity” exists in VLS, i.e., to assess if an early treatment may prevent disease progression and facilitate clearance of symptoms and/or signs. Methods: This retrospective, cohort study included VLS patients treated for the first time with a topical corticosteroid, namely with mometasone furoate 0.1% ointment, for 12 weeks (2016–2021). Scoring of subjective symptoms (global subjective score, GSS, and dyspareunia) and clinical features (global objective score [GOS] and sclerosis-scarring-atrophy) was performed at baseline (T0) and at the control visit (T1). We assessed if the achievement of clearance in GSS, GOS, sclerosis-scarring-atrophy, or dyspareunia depended on the time elapsed between VLS onset and treatment initiation. Results: Among the 168 patients (59.2 ± 13.2 years) included, the median time between VLS onset and first treatment was 14.0 months. At T1, 48.8% of patients achieved clearance of GSS, 28% of GOS and 11.9% of both GSS and GOS, 57.9% of dyspareunia, and 19.2% of sclerosis-scarring-atrophy. The logistic regression model showed that each 10-month increase in treatment initiation adversely affected the clearance of GSS while starting treatment within 6 months of disease onset was significantly associated with clearance of GOS and sclerosis-scarring-atrophy. Conclusion: Early treatment is crucial in determining a complete healing of VLS-related symptoms and signs, especially of tissue sclerosis-scarring-atrophy, which appear poorly responsive, or even unresponsive, after the earliest stages of the disease. Thus our findings provide evidence for a “window of opportunity” in VLS treatment.

Research Progress on the Combined Treatment of Vulvar Lichen Sclerosus with Traditional Chinese and Western Medicine

Research Progress on the Combined Treatment of Vulvar Lichen Sclerosus with Traditional Chinese and Western Medicine

Fat Grafting in Vulvar Lichen Sclerosus: Long Term Follow-Up.

The rationale for the use of autologous fat grafting in the treatment of vulvar lichen sclerosus (VLS) consists in reduction of inflammation, regeneration of tissues, volume increase, and pain fiber control. The main outcome of this study was the evaluation of patients' satisfaction after treatment. Secondary outcomes included modifications in symptoms, psychosexual wellbeing, vulvar hydration, and histology after surgery. Eligible for this study were women aged 18-85 years with a histological diagnosis of VLS who underwent at least one autologous vulvar fat grafting at the authors' center, between 2010 and 2019. In 2021, all women underwent a clinical reevaluation, comprehensive of vulvoscopy, vulvar biopsy, and handing out of validated questionnaires. Overall, 88.7% of patients declared themselves very satisfied/satisfied with the procedure. All symptoms were improved postsurgery; in particular, the difference was statistically significant for pruritus, burning, and dyspareunia ( p < .05). Sexual function was also improved at time of reevaluation, as were depressive and anxiety symptoms ( p < .05). No cases of vulvar intraepithelial neoplasia or cancer occurred during follow-up and vulvar architecture remained stable, although patients reported a significantly reduced need for topical steroids ( p < .0001). Lastly, in postoperative biopsies, inflammatory infiltrate was stable or reduced, and the distribution of elastic fibers was comparable or restored in most patients. Patient satisfaction with fat grafting is detectable up to 11 years after surgery, and as such, it may represent a valid therapeutic option in selected cases of VLS.

Platelet-rich plasma: a promising therapy for vulvar lichen sclerosus? A systematic review

Purpose: The aim of this systematic review is to evaluate the current evidence regarding the effectiveness of platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus (VLS).

(015) Vulvar Lichen Sclerosus is Associated with New Diagnoses of Mood Disorders

Abstract Introduction Vulvar lichen sclerosus (VLS) often presents with chronic pruritus. While VLS is associated with feelings of isolation, risk of mood disorders among females with VLS has yet to be quantified on a large scale. Objective Our objective was to assess the association of VLS with development of depressive episode, anxiety disorder, major depressive disorder (MDD), and prescription of antidepressants and benzodiazepines, and to evaluate the impact of VLS treatment. Methods A US claims database network (TriNetX Diamond Network) was queried from 2009 to 2022. Cohorts included women aged ≥18 with lichen sclerosus (LS) (ICD-10: L90.0) without prior diagnosis of MDD (F33), depressive episode (F32), or anxiety disorder (F40-F48) or previously prescribed antidepressants (VA: CN600) or benzodiazepines (CN302). We compared a control cohort of women with LS sparing the vulva with women with LS affecting the vulva (N90.4). We conducted a sub-analysis by age (18-40, 41-55, and &amp;gt;55 years). We compared women aged ≥18 with VLS who received treatment (topical steroids (DE200), vaginal estrogen (GU500), prednisone (8640), hydroxyzine (5553), amitriptyline (704), gabapentin (25480), or tacrolimus (42316)) with women aged ≥18 with VLS who did not receive treatment within 6 months of VLS diagnosis. Finally, we compared women receiving only topical VLS treatment (topical steroids, vaginal estrogen, and tacrolimus) with those receiving no treatment. Outcomes of interest were depressive episodes, anxiety disorder, MDD or prescription of antidepressants or benzodiazepines within 6 months of VLS diagnosis. Propensity score matching was performed for age, ethnicity, race, type 1 diabetes (E10), vitiligo (L80), autoimmune thyroiditis (E06.3), alopecia areata (L63), pernicious anemia (D51.0), overweight and obesity (E66), type 2 diabetes (E11), hyperlipidemia (E78), essential hypertension (I10), and alcohol abuse (F10.10). Results 124,237 patients had LS sparing the vulva and 16,676 had VLS. VLS was associated with increased risk of depressive episode (risk ratio (RR) [95% Confidence Interval] 1.62 [1.32-1.99]), anxiety disorder (RR 1.82 [1.50-2.22]), and MDD (RR 2.61 [1.69-4.03]) (Table 1) compared to LS sparing the vulva. Women with VLS were also more likely to receive antidepressants (RR 1.91 [1.60-2.29]) and benzodiazepines (RR 1.70 [1.44-2.01]). Among menopausal women, VLS was associated with increased risk of anxiety disorder (RR 2.00 [1.10-3.63]) (Table 2). Among postmenopausal women, VLS was associated with increased risk of depressive episode (RR 1.73 [1.38-2.17]), MDD (RR 2.60 [1.64-4.12]), anxiety disorder (RR 1.58 [1.29-1.94]), antidepressants (RR 1.55 [1.30-1.86]), and benzodiazepines (RR 1.48 [1.24-1.76]). Among women with VLS, VLS treatment was associated with decreased risk of depressive episode (RR 0.68 [0.47-0.98]) and increased risk of antidepressants (RR 2.00 [1.54-2.59]) and benzodiazepines (RR 1.70 [1.31-2.20]) compared to women without VLS treatment (Table 3). Stratifying by treatment type, women treated solely with topicals had numerically, but not significantly, lower risk of developing depressive episode (RR 0.73 [0.48-1.11]) compared to women without VLS treatment. Conclusions We demonstrate that women with VLS, compared to those with LS sparing the vulva, have an increased risk of antidepressant and benzodiazepine prescriptions and development of depressive episode, anxiety disorder, or MDD. Patients with VLS should be screened for these conditions, and VLS treatment should be considered. Disclosure No

O170 Open-label prospective cohort evaluating stem cell enriched lipotransfer as the treatment for vulvar lichen sclerosus

Abstract Introduction Vulval lichen sclerosus (VLS) is a chronic skin disease characterised by pain, itching, apareunia, loss of vulval architecture and scarring, resulting in poor quality of life. Stem cell enriched lipotransfer has been proposed as a treatment for patients with VLS experiencing scarring and fibrosis. Methods This study was an open-label prospective cohort aiming to assess the effectiveness of stem cell enriched lipotransfer in improving signs, symptoms and quality of life of patients with VLS. Patients were recruited from the local clinic. All patients received at least one treatment. Validated outcome measures were used to prospectively assess the sexual function, quality of life, and symptoms. Vulvar Architecture Severity Scale (VASS) was used to report physician-assessed disease signs. Results Fifty-nine patients were included. The average age was 52.9 yrs. The mean follow-up was 11.9 months. The most common symptoms included itching and pain. The most reported signs were loss of vulvar architecture and scarring. The median number of procedures was 2. The mean volume of fat injected was 11.38 cc. Patients reported a reduction in itching and burning. Lipotransfer also resulted in better sexual function and decreased distress associated with sexuality. Anxiety due to VLS was reduced by the treatment. The VASS score varied by region but there was an improvement in all affected areas. Conclusion Stem cell enriched lipotransfer improved signs, symptoms and quality of life of VLS patients in this cohort. A randomised controlled trial is needed to demonstrate its efficacy, safety and the underlying molecular mechanism of action.

The use of CO2 laser in vulvar lichen sclerosus treatment - molecular evidence.

Vulvar lichen sclerosus is chronic and difficult to treat disorder, which offer is recurrent and leads to multiple complications. The limited efficacy of pharmacologic treatment directed the search for new therapies including use of CO₂ laser. In our study we focused on collagen and elastin gene expression as well as heat shock proteins and p53 expression in two patients with vulvar lichen sclerosus who underwent CO₂ laser therapy. In both patients we observed decreased clinical symptoms observed by an experienced gynecologist as well as significant changes in gene expression before and after laser treatment.

Efficacy of injecting hybrid cooperative complexes of hyaluronic acid for the treatment of vulvar lichen sclerosus: Apreliminary study.

Lichen sclerosus is a chronic relapsing inflammatory skin disease, which involves most commonly the anogenital region. The gold standard in treatment is ultra-potent topical steroids (clobetasol propionate): it aims at controlling the symptoms, stopping further scarring and distortion, and reducing the risk of cancer. The aim of this preliminary study is to evaluate the efficacy of injecting Hybrid Cooperative Complexes of Hyaluronic Acid (HCC) for the treatment of vulvar lichen sclerosus (VLS). Twenty female adult patients (range: 21-78years), aged over 18, with histopathological diagnosis of lichen sclerosus and good general conditions were enrolled. Patients underwent HCC infiltration every month, for 3 times. Patients were evaluated at baseline (T0) and after one (T1) and six months (T2) after treatment. During every visit, each patient was studied clinically and with videothermography. Itching, burning sensation, pain, and dyspareunia were reported by patients at T0, T1, and T2. The effectiveness of the treatment on patients' quality of life and sexual function was evaluated using the Dermatology Life Quality Index (DLQI) and the Female Sexual Function Index (FSFI) at T0 and at T2. The results of this preliminary study are very promising, in fact, all patients had a significant reduction in most symptoms after 1 and 6months of HCC treatment. The reduction of patients with itching (p value ≤ 0.001), pain (p value=0.031), and burning sensation (p=0.004) at 6months is significant. The analysis of DLQI scores revealed a significant improvement in patients' quality of life. At baseline, the average score of DLQI (±SD)was 5.89±3.68 while at follow-up it was 3.42±2.36 (p=0.002). Our preliminary study has demonstrated the validity and tolerability of HCC infiltrations in patients with VLS, and the effectiveness of HCC in reducing symptoms and, thus, to improve sexuality and patient quality of life.

Treatment of vulvar lichen sclerosus with a fractional CO2 laser — case report

Vulvar lichen sclerosus (VLS) belongs to the group of autoimmune, chronic inflammatory skin disorders and is most frequent in females after their 50s. This disease might lead to vulvar scarring, sexual dysfunction and neoplasm transformation. For that reason, treatment of VLS is still considered an important clinical issue from the borderline of gynaecology and dermatology. Classical treatment includes the use of corticosteroids, which help to relieve symptoms, prevent further scarring of the vulva, reduce inflammation and reduce the risk of malignant transformation. Due to the resistance of some patients to local treatment and its complications, however, the use of fractional CO2 lasers in the treatment of VLS has been proposed. A 41-year-old female patient presented to a gynaecologist with symptoms such as itching, burning, and cracking of the vulva skin. A tissue sample was taken from the affected area and a histopathological examination confirmed the initial diagnosis. Treatment with topical glucocorticosteroids was applied, but no improvement was noticed. For that reason, a CO2 fractional laser was applied to the therapy with complementary treatment in the form of topical glucocorticosteroids. After 1.5 years, regression of lesions on the skin of the vulva was observed. This case report highlight the effectiveness of fractioned CO2 laser in the treatment of VLS resistant to glucocorticosteroid monotherapy.

Clinical study on multi-focused laser in the treatment of vulvar lichen sclerosus.

ObjectiveTo investigate the clinical effect of Multi-focused (MF) laser in the treatment of vulvar lichen sclerosus (VLS).MethodsIn this single-center, randomized controlled trial, we compared the effect of fractionated MF laser with other treatments on patients with biopsy-proven VLS. Patients with VLS were enrolled in this study and randomly divided into three groups. Patients in the experimental group were treated with a CO2 laser, control group 1 was treated with radiofrequency, and control group 2 was treated topically with glucocorticoids and soaking with Chinese patent medicine. The pruritus degree, skin elasticity, skin color, lesion scope, and total score were compared before treatment, at one month after treatment, and three months after treatment.ResultsOne month after treatment, the pruritus degree, skin elasticity, skin color, lesion scope, and total score decreased in the experimental group, and the differences were statistically significant (P < 0.05). In control group 1, the differences in pruritus degree, skin color, and total score were statistically significant (P < 0.05), but the differences in skin elasticity and lesion scope were not statistically significant (P > 0.05). In control group 2, the differences in pruritus degree and total score were statistically significant (P < 0.05), but the differences in skin elasticity, skin color, and lesion scope were not statistically significant (P > 0.05). At one month after the end of treatment, the differences in pruritus degree, skin elasticity, skin color, lesion scope, and total score among the three groups were not statistically significant. At three months after the end of treatment, the differences in the scores of the five indicators were statistically significant.ConclusionFor the three treatment methods for VLS, topical corticosteroids + traditional Chinese medicine can quickly relieve itching symptoms in patients, but it cannot significantly improve skin elasticity, skin color, and lesion scope, and VLS easily relapses after treatment. Radiofrequency can improve itching symptoms and skin color but has poor effects on the change of skin elasticity and lesion scope. Multi-focused laser treatment can alleviate the degree of pruritus, improve skin color and elasticity, and narrow the lesion scope, and VLS will not relapse within three months after treatment.

Translated article] RF - Importance of Topical Corticosteroid Treatment for Vulvar Lichen Sclerosus to Prevent Recurrences of Vulvar Carcinoma

Translated article] RF - Importance of Topical Corticosteroid Treatment for Vulvar Lichen Sclerosus to Prevent Recurrences of Vulvar Carcinoma

Autologous lipoaspirate as a new treatment of vulvar lichen sclerosus: A review on literature.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that mostly affects the genital and anal skin areas. Symptoms may vary from pruritis and pain to sexual dysfunction; however, LS can also be asymptomatic. LS occurs at all ages and in both sexes. Approximately 5% of all women affected by vulvar LS will develop vulvar squamous cell carcinoma. Topical treatment is safe but less effective resulting in chronic course in most patients, who suffer from persistent itching and pain. In severe cases of therapy‐resistant LS, there is no adequate treatment. Fat grafting is a novel regenerative therapy to reduce dermal fibrosis. The therapeutic effect of adipose tissue grafts for LS is already investigated in various pioneering studies. This review provides an overview of these studies and the putative mechanisms‐of‐action of fat grafting to treat LS.

The efficacy of injecting hybrid cooperative complexes of hyaluronic acid for the treatment of vulvar lichen sclerosus: A preliminary study.

Lichen Sclerosus is a chronic-relapsing inflammatory skin disease usually involving the anogenital region lacking a resolutive therapy. Potent to high-potent topical corticosteroids are considered to be the standard first-line treatment. The objective of this preliminary study is to evaluate the efficacy of injecting Hybrid Cooperative Complexes of Hyaluronic Acid (HCC) in the treatment of Vulvar Lichen Sclerosus (VLS). Twenty-female patients (range 21-78 years) with histopathologic diagnosis of lichen sclerosus and good general conditions were enrolled. Patients underwent HCC infiltration every month, for three times. Patients had been assessed at baseline (T0) and after 1 and 6months from treatment (T1 and T2, respectively). Clinical evaluation was executed in every visit. Itching, burning sensation, pain and dyspareunia were reported by a patient at T0, T1, and at T2. The effectiveness of the treatment on patients' quality life and sexual life was assessed using the Dermatology Life Quality Index (DLQI) at T0 and at T2. During or after the treatment no complications or side-effects were observed. All patients had a significant reduction in most symptoms after 1 and 6months of HCC treatment. The reduction of patients with itching (p ≤ 0.001), pain (p=0.031), burning sensation (p=0.004) at 6months is significant. The analysis of DLQI scores revealed a significant improvement in patients' quality of life. The DLQI mean score (±SD) at baseline and at follow-up was 5.89 ± 3.68 and 3.42 ± 2.36 (p=0.002), respectively. Our preliminary study has demonstrated the safety and tolerability of HCC infiltrations in patients with VLS, and the effectiveness of HCC in reducing symptoms and, thus, to improve patient Quality of Life.

Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies.

Topical corticosteroids are often utilized as the first-line treatment for vulvar lichen sclerosus (VLS). However, there is wide variability in dosing regimens, as well as a lack of consensus on maintenance dosing. Available guidelines on dosing frequency and regimen continuation for VLS are based on clinical expert opinion and do not necessarily reflect the pharmacokinetics of topical corticosteroids. Over the past few decades, there have been many advances in the techniques used to measure the local and systemic absorption of topical corticosteroids. These techniques have led to a greater understanding of the pharmacokinetics and bioavailabilities of these medications. However, it is not clear how this new information has been applied in evaluating dosing regimens and commonly cited risks when considering short- and long-term use in different vulvar dermatoses. This purpose of this review is to evaluate the available evidence on pharmacokinetics, absorption rates, and concentration levels of topical corticosteroids in lesional and nonlesional skin. Additionally, the evidence regarding commonly cited risks of topical corticosteroid use, including dermal thinning, adrenal suppression, systemic immunosuppression, and tachyphylaxis are reviewed. Differences in the effects of topical corticosteroids on the varied tissues of the vulva are specifically explored. Finally, these considerations are applied to evaluate the current treatment guidelines for VLS to provide direction in determining an evidenced-based dosing regimen and to inform future research in this area. Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev 2022;10:42-52.

Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus: A Randomized Controlled Trial

(Abstracted from Obstet Gynecol 2021;137:979–987) Approximately 1 in 70 women experience vulvar lichen sclerosus (VLS), a chronic skin disorder characterized by white lesions and the destruction of the vulvar architecture. Women with VLS present with intense itching, pain, burning, and painful intercourse.