The comparison of fractional CO2 laser and focused ultrasound for vulvar lichen sclerosus: a retrospective study.

OBJECTIVES

To compare the efficacy of fractional carbon dioxide laser (FxCO2) and focused ultrasound (FUS) in treating vulvar lichen sclerosus (VLS).

METHODS

This single-center retrospective study included biopsy-proven VLS patients who did not respond to first-line topical corticosteroids and were treated with FxCO2 or FUS as an alternative between January 2020 and October 2022. The efficacy was evaluated using the Cattaneo score and clinical scoring system (CSS). A subgroup analysis was conducted to compare efficacy based on VLS severity.

RESULTS

At the 3-month follow-up, the total effective rates were similar between FxCO2 (91.18%, 31/34) and FUS (88.57%, 31/35) (p > 0.05). At the 6-month follow-up, the total effective rates for FxCO2 decreased to 85.29% (29/34), while FUS remained at 88.57% (31/35) (p > 0.05). Recurrence rates were 14.7% (5/34) for FxCO2 and 11.4% (4/35) for FUS (p > 0.05) at the 6-month follow-up. Although there was no significant difference in total CSS scores and clinician-administered sign scores between FxCO2 and FUS at both follow-ups (p > 0.05), FxCO2 suggested superior patient-administered symptom improvement at 3-month (median: FxCO2 3 vs. FUS 5, p < 0.05) and 6-month follow-ups (median: FxCO2 3 vs. FUS 5, p < 0.01).

CONCLUSIONS

FxCO2 and FUS show similar efficacy in treating VLS, with FxCO2 suggesting a trend toward greater symptom relief. Further studies are needed to validate these preliminary observations.