Maturitas · 2026
Energy-based therapies for vulvar lichen sclerosus: A systematic review of randomized controlled trials.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Aksahin E, Theis S, Gedik K Z, Erel C T
Аннотация
BACKGROUND: Vulvar lichen sclerosus (VLS) is a chronic, relapsing dermatosis that significantly impairs quality of life. While topical corticosteroids remain the first-line therapy, recurrence and steroid-related side-effects have prompted interest in alternative options. This systematic review evaluates the efficacy and safety of laser therapies compared with other treatments for VLS.
METHODS: A systematic search was performed in MEDLINE (via PubMed), Scopus, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). Searches used Medical Subject Headings (MeSH) and free-text terms. Randomized controlled trials (RCTs) meeting predefined criteria were included. Two independent reviewers assessed study eligibility and methodological quality using the JBI critical appraisal checklist for RCTs; discrepancies were resolved by a third reviewer.
RESULTS: Seven RCTs involving 337 women were included. The majority of studies evaluated fractional CO₂ laser therapy, while others investigated Nd:YAG-based or combination laser modalities. Comparators included sham or low-dose laser, topical corticosteroids, and other active treatments. Five of the seven RCTs found improvements in patient-reported symptoms following laser therapy; however, findings were heterogeneous and not consistently superior to comparator groups. The only sham-controlled trial did not demonstrate superiority of fractional CO₂ laser over sham treatment, suggesting a substantial placebo contribution. Patient satisfaction and adherence were generally higher with laser therapy, and no serious adverse events were reported.
CONCLUSIONS: Laser therapies appear promising for VLS management, with favorable safety and patient-reported outcomes. Nevertheless, current evidence is limited by small cohorts and methodological heterogeneity. Larger randomized, sham-controlled trials are required to validate efficacy and long-term safety.
METHODS: A systematic search was performed in MEDLINE (via PubMed), Scopus, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). Searches used Medical Subject Headings (MeSH) and free-text terms. Randomized controlled trials (RCTs) meeting predefined criteria were included. Two independent reviewers assessed study eligibility and methodological quality using the JBI critical appraisal checklist for RCTs; discrepancies were resolved by a third reviewer.
RESULTS: Seven RCTs involving 337 women were included. The majority of studies evaluated fractional CO₂ laser therapy, while others investigated Nd:YAG-based or combination laser modalities. Comparators included sham or low-dose laser, topical corticosteroids, and other active treatments. Five of the seven RCTs found improvements in patient-reported symptoms following laser therapy; however, findings were heterogeneous and not consistently superior to comparator groups. The only sham-controlled trial did not demonstrate superiority of fractional CO₂ laser over sham treatment, suggesting a substantial placebo contribution. Patient satisfaction and adherence were generally higher with laser therapy, and no serious adverse events were reported.
CONCLUSIONS: Laser therapies appear promising for VLS management, with favorable safety and patient-reported outcomes. Nevertheless, current evidence is limited by small cohorts and methodological heterogeneity. Larger randomized, sham-controlled trials are required to validate efficacy and long-term safety.