Carbon dioxide laser as a new valid treatment of lichen sclerosus (original) (raw)
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Fractional carbon dioxide laser in recalcitrant vulval lichen sclerosus
The Australasian journal of dermatology, 2015
Vulval lichen sclerosus is an uncommon skin condition that can usually be managed with topical corticosteroids to maintain remission. However, there is a subset of patients in whom it remains recalcitrant despite treatment with super-potent topical corticosteroids. We report a case series of four patients undergoing fractional carbon dioxide laser resurfacing and one with ablative carbon dioxide laser for severe, hyperkeratotic vulval lichen sclerosus not responding to super-potent topical corticosteroids. In these patients, carbon dioxide laser was successful in achieving remission. Their vulval lichen sclerosus was subsequently able to be maintained with topical corticosteroid treatment.
Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus
Obstetrics & Gynecology, 2021
To estimate the efficacy of fractionated carbon dioxide (CO 2) laser therapy for vulvar lichen sclerosus. METHODS: We conducted a prospective, double-blind, randomized, sham-controlled, trial conducted in a clinic specializing in vulvar disorders. The study participants were 40 women with active vulvar lichen sclerosus confirmed with biopsy who were abstaining from topical and systemic treatments for at least 4 weeks before enrollment. Women were randomized in a 1:1 ratio to receive either five sham laser treatments or five fractionated CO 2 treatments in a 24-week period. Study participants, treating clinicians, and the evaluating pathologist were blinded. The primary endpoint was the change in the histopathology scale score between pretreatment and posttreatment biopsies. We estimated 20 per group for 80% power to detect a 40% reduction in the histopathology scale score with up to 10% attrition. A secondary endpoint was the change in the validated CSS (Clinical Scoring System for Vulvar Lichen Sclerosus). RESULTS: From November 2018 to June 2020, 40 women were randomized to participate in the trial, and 37 women (19 fractionated CO 2 , 18 sham) were included in an intention-to-treat (ITT) analysis. Three women were excluded from the ITT analysis because they did not have posttreatment biopsies and, therefore, a posttreatment histopathology scale score could not be obtained. There was a 0.20 reduction (improvement) in histopathology scale score from baseline in the active treatment group (95% CI 21.1, 0.80, P5.74) and a 0.1 increase from baseline in the sham treatment group (95% CI 20.90, 1.0, P5.91). The change in histopathology scale score between the active and sham arm was not statistically significant (95% CI 21.14, 1.06, P5.76). CONCLUSION: Fractionated CO 2 is not an effective monotherapy treatment for vulvar lichen sclerosus.
2020
Objective To determine the efficacy of fractional carbon dioxide laser (FXCO2) therapy for vulvar lichen sclerosus (VLS). Design Prospective, double-blind, sham-controlled, randomized trial. Setting Clinic specializing in vulvovaginal disorders. Population Forty women with active VLS confirmed with biopsy who abstaining from topical and/or systemic treatments for at least 4 weeks. Methods Women were randomized in a 1:1 ratio to receive either five sham laser treatments or five FXCO2 treatments in a 24-week period. Pre-and post-treatment biopsies were obtained on all participants. Study participants, treating clinicians, and evaluating pathologist were blinded. Main Outcome Measures Primary: pre-and post-treatment biopsy Histopathologic Scale (HS) findings. Secondary: Clinical Scoring System for Vulvar Lichen Sclerosus (CSS) Results There was a 0.12 reduction (improvement) in HS from baseline in the active treatment group (95%CI =-1.01, 0.78, p=0.79) and a 0.06 increase from baseline in the sham treatment group (95%CI-0.81, 0.92, p=0.90). The change in HS between the active and sham arm was not statistically significant (-0.17; 95%CI =-1.14, 1.06, p=0.78). There was a 6.82-point reduction (improvement) in the patients' CSS from baseline in the active (95% CI =-11.28,-2.37, p= 0.004) and a 4.83-point reduction in the sham treatment group (95% CI =-9.16,-0.51, p=0.03). In the clinicians' CSS, there was a 0.82 increase (worsening) in the active (95% CI =-0.46, 2.11, p=0.20) and a 0.28 reduction in the sham treatment group (95% CI =-1.53, 0.97, p=0.65). Conclusions. FXCO2 is not an effective monotherapy treatment for VLS
Objective: The objective of this study was to evaluate the efficacy of rescue fractional microablative CO 2 laser treatment in women with severe symptoms and sexual dysfunction related to lichen sclerosus not responsive to long-term ultra-potent topical corticosteroid treatment. Methods: Consecutive eligible women with lichen sclerosus referred to our unit who received fractional microablative CO 2 laser treatment after failure of ultra-potent topical corticosteroid treatment were enrolled in the study. The diagnosis was confirmed by histological assessment in all cases. Patients underwent two cycles of CO 2 laser every 30 to 40 days. The severity of lichen sclerosus-related symptoms, sexual function, and procedure discomfort were evaluated with a visual analog scale in the same individual at baseline, after completion of each treatment cycle. Follow-up visits were scheduled during each treatment cycle and at least 1 month after completion of the treatment. The Friedman ANOVA test was used to evaluate differences in the visual analog scale scores of each symptom during treatment. Results: A total of 100 patients with vulvar lichen sclerosus were screened, 40 of whom fulfilled the eligibility criteria. We found a significant improvement in vulvar itching (x 2 [2] ¼ 31,182, P < 0.001), vulvar dryness (x 2 [2] ¼ 40,364, P < 0.001), superficial dyspareunia (x 2 [2] ¼ 37,488, P < 0.001), and sensitivity during intercourse (x 2 [2] ¼ 22,143, P < 0.001) after two CO 2 laser cycles. Pain related to probe movement and laser application was low and did not change significantly consequent to treatment. No systemic or local adverse effects occurred during or after laser treatment. Conclusion: Fractional microablative CO 2 laser treatment is safe and might represent an effective rescue procedure for patients suffering from lichen sclerosus who fail to respond to long-term ultra-potent topical corticosteroid treatment. These preliminary findings require further study with adequately powered randomized controlled trials.
Journal of Cosmetic and Laser Therapy, 2018
Lichen amyloidosis is a primary localized cutaneous amyloidosis. Different types of treatment have been used without complete resolution. Herein, we report a case of patient suffering from lichen amyloidosis successfully treated with fractional ablative laser CO 2. He was a 59-year-old man diagnosed lichen amyloidosis localized on the legs 10 years ago. He was treated with topical corticosteroids without any improvement. Then, we started treating the affected area with CO 2 laser (limmer*) at a setting of 5-8 J/cm 2 and 8 mm laser spot size. A considerable improvement was noticed after the first session. A total healing was reported after four sessions. To the best of our knowledge, only 11 reported cases of lichen amyloidosis have been successfully treated with laser CO 2. However, our clinical finding seems to be one of the best reported results.
Removal of oral lichen planus by CO2 laser
Brazilian Dental Journal, 2011
The aim of this case report is to present a histologically diagnosed oral lichen planus excised by the CO2 laser. Oral lichen planus is a chronic inflammatory mucocutaneous disease of unknown etiology. Different treatments have been used to manage this condition. A 46 year-old female was referred to the Laser Clinic of the Dental School of the Federal University of Bahia to excise a lesion characterized by white patches on the oral mucosa, which was causing pain and burning sensation and had not respond to treatment with triamcinolone and corticosteroids for 3 months. CO2 laser was used to remove the lesion and the conclusive histopathological diagnosis was oral lichen planus. The patient was followed up over 1year with no signs of lesion recurrence. The use of the CO2 laser was found to be useful and effective to treat lichen planus.
Fractional Carbon Dioxide Laser for Keratosis Pilaris: A Single-Blind, Randomized, Comparative Study
BioMed Research International, 2016
Objective. Keratosis pilaris (KP) is a common condition which can frequently be cosmetically disturbing. Topical treatments can be used with limited efficacy. The objective of this study is to evaluate the effectiveness and safety of fractional carbon dioxide (CO2) laser for the treatment of KP.Patients and Methods. A prospective, randomized, single-blinded, intraindividual comparative study was conducted on adult patients with KP. A single session of fractional CO2laser was performed to one side of arm whereas the contralateral side served as control. Patients were scheduled for follow-up at 4 and 12 weeks after treatment. Clinical improvement was graded subjectively by blinded dermatologists. Patients rated treatment satisfaction at the end of the study.Results. Twenty patients completed the study. All patients stated that the laser treatment improved KP lesions. At 12-week follow-up, 30% of lesions on the laser-treated side had moderate to good improvement according to physicians...
Effects of Low Level Laser Therapy on Erosive-atrophic Oral Lichen Planus
Folia medica, 2018
The erosive-atrophic form of oral lichen planus (OLP) is associated with severe pain and burning sensation and is often unresponsive to treatment. Topical corticosteroids are considered as a medication of first choice but they can produce adverse effects. Therefore, new therapeutic approaches are required. The aim of this study was to investigate the effectiveness of biomodulation with diode laser in patients presenting with long-standing erosive-atrophic OLP. Twelve patients, clinically and histologically diagnosed with OLP, participated in this study. The level of pain and the clinical scores of total 59 lesions were recorded before treatment using visual analog scale and Thongprasom sign scoring system respectively. All patients received low level laser therapy (LLLT) with diode laser (810 nm) with parameters (0.5 W, 30 s, 1.2 J/cm2) three times weekly for a month. The response rate was assessed according to the decrease in pain and sign scores. Treatment efficacy index was calcu...