Fractional CO2 Laser and Estrogen Ointment: A Novel Combined Approach for Treating Vulvar Lichen Sclerosus in Postmenopausal Women.

BACKGROUND

Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition predominantly affecting postmenopausal women, often leading to significant discomfort and impaired quality of life. Current treatments, such as topical corticosteroids, have limitations in efficacy and long-term safety. Fractional CO2 laser therapy has emerged as a promising modality for managing VLS, but its combination with topical estrogen remains underexplored.

OBJECTIVE

This study aimed to evaluate the efficacy and safety of combined fractional CO2 laser and topical estrogen therapy in managing VLS in postmenopausal women.

METHODS

A randomized controlled trial was conducted involving 60 postmenopausal women diagnosed with VLS. Participants were divided into two groups: the intervention group received fractional CO2 laser therapy combined with topical estrogen ointment, while the control group received topical estrogen alone. Efficacy was defined as a significant reduction in vulvar lichen sclerosus symptom score (VLSSS), assessed at baseline, 3 months, and 6 months. Secondary outcomes included histopathological changes and patient-reported quality of life measures.

RESULTS

At both 3 months and 1 year after treatment, the intervention group showed a significant reduction in VLSSS compared to the control group (p < 0.001). Histopathological analysis demonstrated reduced inflammation and fibrosis. Patient-reported outcomes revealed significant improvements in sexual function (FSFI) and quality of life (CECA10) in the combined therapy group. Additionally, the recurrence rate at 1 year was significantly lower in the intervention group (17.14%) than in the control group (31.43%, p < 0.001). No severe adverse events were reported.

LIMITATIONS: The study's sample size was relatively small, and the follow-up period was limited to 6 months, which may not capture long-term outcomes. Additionally, the single-center design may limit generalizability.

CONCLUSION

Combined fractional CO2 laser and topical estrogen therapy is a safe and effective approach for managing VLS in postmenopausal women, offering significant symptom relief and improved quality of life. Further studies with larger cohorts and longer follow-up are warranted to confirm these findings.