1
|
Schulmeyer CE, Koch MC, Dietl AK, Stuebs FA, Behrens A, Renner SK, Mehlhorn G, Geppert CC, Hartmann A, Beckmann MW, Gass P. Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program. Geburtshilfe Frauenheilkd 2023; 83:1031-1042. [PMID: 37588259 PMCID: PMC10427204 DOI: 10.1055/a-1934-1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/25/2022] [Indexed: 08/18/2023] Open
Abstract
Introduction Gynecologic dysplasia units and dysplasia consultations are obliged to offer diagnosis and treatment in accordance with the guidelines. The organization of the consultation process, management of patient appointments, diagnosis, and treatment algorithms are heterogeneous. The legislation arising from the new Federal Joint Committee decision, dated 22 November 2018, concerning the organized cervical cancer screening program has been in force since 1 January 2020. In this article we provide an overview of the existing structures and interdisciplinary cooperation of specialized dysplasia units incorporated in certified gynecologic cancer center. Materials and Methods We carried out a retrospective database search of data collected prospectively from 1 July 2014 to 31 December 2019 at the dysplasia unit at the Department of Gynecology and Obstetrics, Erlangen University Hospital, which was the first dysplasia unit to be certified in 2014. Results A total of 5594 patients presented at the unit, and 16061 colposcopic, vulvoscopic, and anoscopic examinations were performed. Approximately 4100 examinations of the cervix, vagina, vulva, and anus are carried out each year, 1600 of these were exclusively cervix colposcopies. A total of 12197 cytology results were assessed, as well as 4850 histology results, and 8193 high-risk HPV tests. The quality indicators required by the dysplasia unit for annual recertification were met each year. Conclusion Certified dysplasia units and consultations form the central component in the algorithm for further investigating abnormal screening results; but they are also the first point of contact for a large number of patients with acute or chronic complaints in the genital region.
Collapse
Affiliation(s)
- Carla E. Schulmeyer
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Martin C. Koch
- Klinik für Gynäkologie und Geburtshilfe, ANregiomed Klinikum Ansbach, Ansbach, Germany
| | - Anna K. Dietl
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Frederik A. Stuebs
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Annika Behrens
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Simone K. Renner
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Sindelfingen-Böblingen, Böblingen, Germany
| | - Grit Mehlhorn
- Frauenarztpraxis, DKG und AGCPC zertifizierte Dysplasiesprechstunde, Frauenarztpraxis Erlangen, Erlangen, Germany
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Carol C. Geppert
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Arndt Hartmann
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Matthias W. Beckmann
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Paul Gass
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| |
Collapse
|
2
|
Abstract
IMPORTANCE AND OBJECTIVES Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women. METHODS This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia. FINDINGS Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists. CONCLUSIONS Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.
Collapse
Affiliation(s)
- Lauren F Streicher
- From the Northwestern Medicine Center for Sexual Medicine and Menopause, Northwestern Medicine, Chicago, IL
| |
Collapse
|
3
|
Salgado HC, Drumond DG, Pannain GD, de Melo E Costa LG, Sampaio FS, Leite ICG. Randomized clinical trial with fractional CO 2 laser and Clobetasol in the treatment of Vulvar Lichen Sclerosus: a clinic study of feasibility. BMC Res Notes 2023; 16:33. [PMID: 36894959 PMCID: PMC9999649 DOI: 10.1186/s13104-023-06300-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES The main objective of the study was to describe and compare the feasibility of using fractional CO2 laser to the usual treatment with Clobetasol. Randomized clinical trials brought together 20 women from a Brazilian university hospital, 9 of them were submitted to Clobetasol treatment and 11 to laser therapy. Sociodemographic data were obtained and quality of life parameters, vulvar anatomy, self-perception and histopathological analysis of vulvar biopsies were evaluated. Evaluations were made before the beginning of the treatment, during its implementation, right after its completion (3 months), and 12 months after. The SPSS 14.0 software was used, obtaining descriptive measurements. The level of significance adopted was 5%. RESULTS The clinical/anatomical characteristics of the vulva did not differ between the treatment groups, as much before as after its performance. There was no statistically significant difference between the treatments performed regarding the impact on the life quality of the patients. A higher satisfaction degree with the treatment was obtained with the patients in the Laser group in the third month of evaluation. Laser therapy also revealed higher occurrence of telangiectasia after treatment completion. Fractional CO2 laser has proven to be well accepted and is a promising therapeutic option. Registration number and name of trial registry The institutional review board status was approved by the Research Ethics Committee of HU/ UFJF under advisory number 2881073 and registered in the Brazilian Clinical Trials, with consent under registration RBR-4p9s5y. Access link: https://ensaiosclinicos.gov.br/rg/RBR-4p9s5y.
Collapse
Affiliation(s)
| | - Denise Gasparetti Drumond
- Department of Surgery Medical School, Federal University of Juiz de Fora, Juiz de Fora, MG, 36036-110, Brazil
| | - Gabriel Duque Pannain
- Medical Residency, Institute of Medical Assistence to State Public Servants, São Paulo, SP, 04039-000, Brazil
| | | | - Fernanda Souza Sampaio
- Gynecology Service, University Hospital of the Federal University of Juiz de Fora, Juiz de Fora, MG, 36036-110, Brazil
| | | |
Collapse
|
4
|
Laser Therapy for Recalcitrant Vulvar Lichen Sclerosus: A Review of the Literature. Clin Obstet Gynecol 2022; 65:768-774. [PMID: 35385852 DOI: 10.1097/grf.0000000000000700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Vulvar lichen sclerosus (LS) is a chronic vulvar dermatosis potentially impacting quality of life and sexual function. While most women with LS respond to topical corticosteroids and/or calcineurin inhibitors, some require additional therapy. Systemic therapies have been used successfully in oral and vulvovaginal lichen planus with minimal data in the setting of LS. Likewise, while vaginal laser therapy has shown potential benefit for genitourinary syndrome of menopause, there is a paucity of data in the setting of LS. We review retrospective and prospective studies along with randomized controlled trials utilizing vulvovaginal laser for LS therapy.
Collapse
|
5
|
Guo JQ, Chen SY, Chen XM, Lu JQ, Song Y, Liu HY, Hu LN, Zhu ZY. Clinical study on multi-focused laser in the treatment of vulvar lichen sclerosus. Front Surg 2022; 9:919135. [PMID: 36189386 PMCID: PMC9520200 DOI: 10.3389/fsurg.2022.919135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
|
6
|
Tasker F, Kirby L, Grindlay DJC, Lewis F, Simpson RC. Laser therapy for genital lichen sclerosus: A systematic review of the current evidence base. SKIN HEALTH AND DISEASE 2022; 1:e52. [PMID: 35663131 PMCID: PMC9060003 DOI: 10.1002/ski2.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 11/12/2022]
Abstract
Background Lichen sclerosus (LS) is a chronic, inflammatory dermatosis. Initial treatment with superpotent topical corticosteroids is the accepted and evidence-based first-line therapy. For those who do not respond after exclusion of other potentiating factors, the best second-line therapy is unclear. Laser therapy is an emerging treatment for genital LS and despite uncertain efficacy its use is gaining popularity in the private sector. Objectives We aimed to review the effectiveness of laser therapy for genital LS in men, women and children. Methods We conducted a systematic review of all primary studies reporting the use of laser in genital LS. Ovid MEDLINE, PubMed, Ovid Embase, Cochrane CENTRAL, Web of Science, CINAHL and PsycINFO were searched from inception to February 2021. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials, ROBINS-I tool for non-randomized trials and Joanna Briggs Institute checklist for case studies. Results A total of 24 studies, involving 616 adults, met inclusion criteria. These were six randomized controlled trials (RCTs), one non-randomized trial, nine single arm trials and eight case series. Where assessed, most studies suggest that laser therapy in patients with LS may improve symptoms, clinical signs, quality of life and sexual function. However, results were highly heterogeneous and methodological quality was very low, therefore meta-analysis was not possible. Conclusions There is poor evidence to support the use of laser therapy for genital LS at present. Effectiveness of laser needs to be robustly investigated in well-conducted RCTs.
Collapse
Affiliation(s)
- F Tasker
- King's College London St John's Institute of Dermatology London UK
| | - L Kirby
- Centre of Evidence Based Dermatology University of Nottingham Nottingham UK
| | - D J C Grindlay
- Centre of Evidence Based Dermatology University of Nottingham Nottingham UK
| | - F Lewis
- King's College London St John's Institute of Dermatology London UK
| | - R C Simpson
- Centre of Evidence Based Dermatology University of Nottingham Nottingham UK
| |
Collapse
|
7
|
Mortensen OE, Christensen SE, Løkkegaard E. The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state-of-the-art review. Acta Obstet Gynecol Scand 2022; 101:657-692. [PMID: 35484706 DOI: 10.1111/aogs.14353] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
In recent years, LASER has been introduced as a minimally invasive treatment for a broad range of vaginal and vulvar symptoms and diseases. However, the efficacy and safety of vaginal and vulvar LASER has continuously been questioned. The aim of this study is to create an overview of the current literature and discuss the controversies within the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus. A search string was built in PubMed. The search was commenced on August 25, 2021 and closed on October 27, 2021. Two authors screened the studies in Covidence for inclusion according to the eligibility criteria in the protocol. The data were extracted from the studies and are reported in both text and tables. This review included 114 papers, of which 15 were randomized controlled trials (RCTs). The effect of LASER as a vaginal treatment was investigated for genitourinary syndrome of menopause in 36 studies (six RCTs), vulvovaginal atrophy in 34 studies (four RCTs) and urinary incontinence in 30 studies (two RCTs). Ten studies (three RCTs) investigated the effect of vulvar treatment for lichen sclerosus. Half of the included RCTs, irrespective of indication, did not find a significant difference in improvement in women treated with vaginal CO2 or Er:YAG LASER compared with their respective controls. However, most non-comparative studies reported significant improvement after exposure to vaginal or vulvar LASER across all indications. Included studies generally had a short follow-up period and only a single RCT followed their participants for more than 6 months post treatment. Adverse events were reported as mild and transient and 99 studies including 51 094 patients provided information of no serious adverse events. In conclusion, this review found that the effect of vaginal and vulvar LASER decreases with higher study quality where potential biases have been eliminated. We therefore stress that all patients who are treated with vaginal or vulvar LASER should be carefully monitored and that LASER for those indications as a treatment should be kept on a research level until further high-quality evidence is available.
Collapse
Affiliation(s)
- Olivia Engholt Mortensen
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Institute of Clinical Medicine, University of Copenhagen, Hillerød, Denmark
| | - Sarah Emilie Christensen
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Institute of Clinical Medicine, University of Copenhagen, Hillerød, Denmark
| | - Ellen Løkkegaard
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Institute of Clinical Medicine, University of Copenhagen, Hillerød, Denmark
| |
Collapse
|
8
|
Simms-Cendan J, Hoover K, Marathe K, Tyler K. NASPAG Clinical Opinion: Diagnosis and Management of Lichen Sclerosis in Pediatric and Adolescent Patients. J Pediatr Adolesc Gynecol 2022; 35:112-120. [PMID: 34610442 DOI: 10.1016/j.jpag.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 12/18/2022]
Abstract
This Clinical Opinion replaces the NASPAG Clinical Recommendation: Pediatric Lichen Sclerosus published in 2014. The objective of this document is to provide guidance in the diagnosis and management of vulvar lichen sclerosus (LS) in the pediatric and adolescent patient in order to treat patient symptoms and reduce long-term sequelae. LS is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, loss of pigmentation and vulvar adhesions with loss of normal vulvar architecture. Management includes topical agents for induction and maintenance therapy, as well as long-term follow-up for identification and treatment of recurrence and sequelae. This document is intended for use by both primary and specialty pediatric and adolescent gynecology (PAG) providers, including specialists in pediatrics, gynecology, adolescent medicine, and dermatology.
Collapse
Affiliation(s)
- Judith Simms-Cendan
- Division of Pediatric Adolescent Gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Kimberly Hoover
- Division of Pediatric Adolescent Gynecology, Department of Women's Reproductive Health, University of Alabama, Birmingham, Alabama
| | - Kalyani Marathe
- Division of Dermatology, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Kelly Tyler
- Departments of Dermatology and Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
9
|
Yuan Y, Wang CJ, Li H. Extragenital Bullous Lichen Sclerosus Treated with Fractional CO 2 Laser (FxCO 2) and Wet Dressing of Halcinonide Solution: A Case Report. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:427-431. [PMID: 35300434 PMCID: PMC8921669 DOI: 10.2147/ccid.s355111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
Lichen sclerosis (LS) is an insidious, chronic, relapsing skin disease characterized by atrophic, porcelain-appearing plaques. It usually arises in the anogenital area, but some cases can present in extragenital regions with a variety of presentations, including a bullous variant. Topical corticosteroids are a first-line therapy and are usually the most effective treatment to induce remission of LS. However, there is a subset of patients that does not respond well to topical steroids. Herein, we report an extragenital bullous LS case successfully treated with a fractional CO2 laser (FxCO2) and subsequent wet dressing of halcinonide solution.
Collapse
Affiliation(s)
- Yunyan Yuan
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Caroline J Wang
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Houmin Li
- Department of Dermatology, Peking University People's Hospital, Beijing, People's Republic of China
| |
Collapse
|
10
|
Kherlopian A, Fischer G. Does compliance to topical corticosteroid therapy reduce the risk of development of permanent vulvar structural abnormalities in pediatric vulvar lichen sclerosus? A retrospective cohort study. Pediatr Dermatol 2022; 39:22-30. [PMID: 34738263 DOI: 10.1111/pde.14840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis of the genital skin, with up to 20% of cases in the pediatric age group. Limited data exist concerning the prognosis of pediatric VLS, particularly the likelihood of permanent architectural change and whether this can be prevented by compliance with topical corticosteroid treatment (TCS). OBJECTIVE To evaluate the extent to which compliance to TCS treatment influences the risk of developing vulvar structural abnormalities, including clitoral phimosis and diminutive or fused labia minora. METHODS A retrospective chart review of case records of pediatric-age females with VLS between January 31, 2004 and January 31, 2021. RESULTS One hundred eighteen cases of VLS were identified, with a mean age at diagnosis of 7.25 years and a mean follow-up period of 42.7 months. Thirty-four girls were "partially compliant," whereas 84 were "compliant." The risk ratio (RR) of developing any vulvar structural abnormality or clitoral phimosis was 5.76 (95% CI 2.96-11.3) and 21.2 (95%CI 5.23-85.9) times higher, respectively, in partially compliant compared with compliant subjects. The RR of a partially compliant female with pre-pubertal onset VLS having a vulvar structural abnormality persisting beyond menarche was increased 3.54-fold relative to compliant females (95% CI 1.75-7.17). LIMITATIONS The retrospective nature of our data, lack of a control group, wide variability in follow-up duration, and nonstandardized method of stratifying compliance. CONCLUSION Vulvar structural abnormalities are common in prepubertal onset VLS. Compliance to TCS appears to be critical in the prognosis of pediatric VLS although attitudes underpinning noncompliance to TCS treatment require further elucidation.
Collapse
Affiliation(s)
- Ashod Kherlopian
- Department of Dermatology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Gayle Fischer
- Department of Dermatology, Royal North Shore Hospital, Sydney, NSW, Australia
| |
Collapse
|
11
|
Filippini M, Sozzi J, Farinelli M, Verdelli A. Effects of Fractional CO 2 Laser Treatment on Patients Affected by Vulvar Lichen Sclerosus: A Prospective Study. Photobiomodul Photomed Laser Surg 2021; 39:782-788. [PMID: 34878932 DOI: 10.1089/photob.2021.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Fractional carbon dioxide (CO2) lasers are today considered the most effective and efficient treatment for many vulvovaginal disorders, providing mini-invasive procedures without side effects. Previous studies demonstrated the efficacy of fractional CO2 lasers in vulvar lichen sclerosus (VLS), a chronic skin disorder characterized by itching and painful lesions. Complications include pain, sexual and/or urinary dysfunction, with a negative quality of life, and an increased risk of squamous cell carcinoma. A definitive VLS treatment is still lacking. Objectives: This is a prospective, single-center study aimed at evaluating the effect of fractional microablative CO2 laser treatment on women affected by VLS. Materials and methods: Patients with histologically confirmed VLS underwent three fractional microablative CO2 laser treatments, 4 weeks apart, on the genital affected areas. Clinical and VLS-related symptoms, side effects, and patient satisfaction index were assessed and recorded for all the patients using the visual analog scale (VAS). Results: Data from a total of 70 patients were included, paired at different time points and analyzed. VLS-related symptoms and other relevant parameters (pH, vaginal introitus discomfort, dyspareunia, vaginal dryness, itching, and burning) showed a statistically significant improvement (p < 0.001) after the first laser treatment and kept improving after second and third sessions. According to VAS, the two most common symptoms, vaginal introitus discomfort and dyspareunia, went from (mean ± standard deviation) 8.2 ± 2.3 and 8.3 ± 2.2, respectively, at baseline, to 3.6 ± 2.6 and 3.8 ± 2.6, respectively, 1 month after the last treatment. Vaginal dryness, itching, and burning were significantly improved as well. Most patients declared to be very satisfied with the results of the treatment. A total of 62.8% of the women expressed a satisfaction score ≥8 on a scale from 0 to 10. Conclusions: Fractional microablative CO2 laser treatment seems to be safe and effective to treat VLS and improve VLS-related symptoms.
Collapse
Affiliation(s)
- Maurizio Filippini
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Jessica Sozzi
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Miriam Farinelli
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Alice Verdelli
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| |
Collapse
|
12
|
Campolmi P, Cannarozzo G, Bennardo L, Clementi A, Sannino M, Nisticò SP. Fractional Micro-ablative CO2 Laser as Therapy in Penile Lichen Sclerosus. J Lasers Med Sci 2021; 12:e61. [DOI: 10.34172/jlms.2021.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/16/2021] [Indexed: 01/04/2023]
Abstract
Introduction: Topical steroids remain the first-line therapy to treat lichen sclerosus (LS), but circumcision may be curative in most cases. Positive results have been obtained by using a fractional micro-ablative CO2 laser to treat genital LS. This study aims to assess the safety and efficacy of the fractional micro-ablative CO2 laser in the treatment of penile LS. Case Presentation: Five treatments with the fractional CO2 laser were performed on one 69-year-old man affected by penile LS. A significant improvement in symptomatology was noted after the first treatment session. Complete clinical remission was achieved 14 weeks after the last treatment. Conclusion: The fractional micro-ablative CO2 laser may represent a practical therapeutic approach in penile LS.
Collapse
Affiliation(s)
- Piero Campolmi
- Department of Dermatology, Università di Firenze, Florence, Italy
| | | | - Luigi Bennardo
- Department of Health Sciences, Unit of Dermatology, – Magna Graecia University, Catanzaro, Italy
| | | | - Mario Sannino
- Department of Dermatology, Tor Vergata University, Rome, Italy
| | - Steven Paul Nisticò
- Department of Health Sciences, Unit of Dermatology, – Magna Graecia University, Catanzaro, Italy
| |
Collapse
|
13
|
Stewart K, Javaid S, Schallen KP, Bartlett S, Carlson NA. Fractional CO 2 laser treatment as adjunctive therapy to topical steroids for managing vulvar lichen sclerosus. Lasers Surg Med 2021; 54:138-151. [PMID: 34541702 PMCID: PMC9292242 DOI: 10.1002/lsm.23476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 01/13/2023]
Abstract
Objectives Uncontrolled vulvar lichen sclerosus (VLS) is often associated with distressful symptoms of genital itch, irritation, and pain and can lead to a pathological process including anatomical changes, scarring, and an elevated risk of cancer in the genital area. First‐line topical corticosteroid as monotherapy is frequently not adequate to fully suppress disease activity and control symptoms. This study evaluated the efficacy of fractional CO2 laser treatments as adjunctive therapy where recalcitrant VLS had been improved, but not adequately controlled, with topical corticosteroid treatment. Outcomes were evaluated up to 12 months after a series of CO2 laser treatments delivered via a fractional handpiece. Materials and Methods Women with a diagnosis of VLS supported by histologic findings on biopsy and/or clinical signs on physical examination received up to five monthly laser treatments. Subjects maintained existing topical corticosteroid and any exogenous hormone treatment during the study. Investigators assessed severity (0 = not present, 1 = mild, 2 = moderate, or 3 = severe) of clinical signs and architectural changes present before adjunctive study interventions and at follow‐up visits. Subjects reported the presence of clinical symptoms and impact on quality of life on 4‐ or 5‐point Likert scales. The validated Female Sexual Function Index (FSFI) was used to assess changes in sexual function. Four subjects were biopsied before adjunctive laser treatment and at follow‐up. Results Twelve females, 11 postmenopausal, with a mean age of 57 ± 10 years received three to five monthly CO2 laser treatments. Significant improvement in all prominent clinical signs and architectural changes were reported at the 3‐ and 6‐month follow‐ups after the treatment series. Significant improvement was maintained at the 12‐month follow‐up, with 89% of subjects showing at least one‐point improvement in elasticity compared to baseline; 86% in lichenification; 88% in sclerosis; and 80% in whitening and parchment‐like skin. Labial fusion and the extent of disease improved in 50% of patients. Ulcerations present in three subjects at baseline resolved after treatment. Subjects reported 86% improvement in dyspareunia and 83% in skin tearing. Quality of life improved significantly after treatment (p < 0.01). The 6‐month follow‐up FSFI showed significant improvement in sexual function compared to baseline (p < 0.05), with a mean point improvement of 4.5. Histology findings after treatment showed some positive improvement, as a decrease in dermal hyalinized zone thickness. There were no treatment complications or adverse events related to the treatment. Conclusions Fractional CO2 laser treatment outcomes showed improvement in predominant clinical signs and architectural changes in VLS recalcitrant to topical corticosteroid treatment. Adjunctive laser treatment relieved symptoms and improved quality of life as well as sexual function. Fractional CO2 laser treatment may provide an advanced treatment modality for the management of recalcitrant VLS with improved patient care and sustainable outcomes. Further study in a larger population and with CO2 laser treatment to both vulvar tissue and the vaginal canal should be explored.
Collapse
Affiliation(s)
| | - Sunbal Javaid
- HERmd; Somi Javaid M.D. & Associates, Cincinnati, Ohio, USA
| | | | - Sarah Bartlett
- HERmd; Somi Javaid M.D. & Associates, Cincinnati, Ohio, USA
| | | |
Collapse
|
14
|
Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects. Biomedicines 2021; 9:biomedicines9080950. [PMID: 34440154 PMCID: PMC8394941 DOI: 10.3390/biomedicines9080950] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Vulvar lichen sclerosus (VLS) is a chronic, distressing, inflammatory disease with an enormous impact on quality of life. Treatment goals are relieving symptoms, reversing signs and preventing anatomical changes. Despite the availability of numerous therapeutic options, treatment outcome may not be entirely satisfactory and a definitive cure does not exist. This may be due to the fact that the exact VLS etiopathogenesis remains unknown. The objectives of this paper were to review the most up-to-date knowledge on VLS etiopathogenesis and to consider the available therapies through the lens of a plausible pathogenetic model. An electronic search on both VLS etiopathogenesis and its treatment was performed using the National Library of Medicine PubMed database. Based on current knowledge, it is conceivable that various, heterogeneous environmental factors acting on a genetic background trigger an autoimmune, Th-1 response, which leads to a chronic inflammatory state. This, in turn, can determine both tissue and micro-vascular injury and activation of signaling pathways involved in fibroblast and collagen metabolism. This pathogenetic sequence may explain the effectiveness of anti-inflammatory treatments, mostly topical corticosteroids, in improving VLS clinical-pathological changes. Further deepening of the disease pathways will presumably allow key mediators to become new therapeutic targets and optimize the available treatments.
Collapse
|
15
|
Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol 2021; 137:979-987. [PMID: 33957648 PMCID: PMC8132913 DOI: 10.1097/aog.0000000000004409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022]
Abstract
Fractionated carbon dioxide is not an effective monotherapy treatment for vulvar lichen sclerosus. OBJECTIVE: To estimate the efficacy of fractionated carbon dioxide (CO2) 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 CO2 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 CO2, 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 −1.1, 0.80, P=.74) and a 0.1 increase from baseline in the sham treatment group (95% CI −0.90, 1.0, P=.91). The change in histopathology scale score between the active and sham arm was not statistically significant (95% CI −1.14, 1.06, P=.76). CONCLUSION: Fractionated CO2 is not an effective monotherapy treatment for vulvar lichen sclerosus. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03665584. FUNDING SOURCE: Additional funding for this study was supplied by El.En Group, Florence, Italy, the manufacturer of the laser used in this study. In addition, El.En Group supplied the laser used in the study.
Collapse
|
16
|
Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol 2021; 137:968-978. [PMID: 33957642 DOI: 10.1097/aog.0000000000004332] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare 6-month safety and efficacy outcomes of fractionated CO2 laser (laser) with topical clobetasol propionate (steroid) for treatment of symptomatic vulvar lichen sclerosus. METHODS We conducted a single-center randomized controlled trial that compared fractionated CO2 laser with steroid treatment for patients with biopsy-proven lichen sclerosus. Randomization was stratified by prior clobetasol propionate use. The primary outcome was mean change in Skindex-29 score at 6 months. A total sample size of 52 participants were recruited to detect a mean difference of 16 points on the Skindex-29 (SD±22) with 80% power, based on a one-sided two-sample t test with α=0.05, accounting for 10% attrition. Secondary outcomes included validated subjective and objective measures. Intention-to-treat, per protocol, and regression analysis based on prior steroid exposure were performed. RESULTS From October 2015 to July 2018, 202 women were screened, 52 were randomized, and 51 completed a 6-month follow-up. No significant difference was found in baseline demographics, symptoms, and physician assessment scores. There was greater improvement in the Skindex-29 score in the laser arm at 6-months (10.9 point effect size, 95% CI 3.42-18.41; P=.007). Overall, 89% (23/27) of patients in the laser group rated symptoms as being "better or much better" compared with 62% (13/24) of patients in the steroid group, P=.07. More patients (81%, 21/27) were "satisfied or very satisfied" with laser treatment compared with steroid treatment (41%, 9/24); P=.01. After stratification for previous steroid use, the significant change of Skindex-29 score was only seen in the previously exposed group. There was one adverse event in each group: minor burning and blistering at the laser site and reactivation of genital herpes 1 week after starting steroid. CONCLUSION Fractionated CO2 laser treatment showed significant improvement in subjective symptoms and objective measures compared with clobetasol propionate, without serious safety or adverse events at 6 months. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02573883.
Collapse
|
17
|
|
18
|
Ferrara F, Filippi F, Messori S, Iommi M, Patrizi A, D'Antuono A, Gaspari V, Chessa MA, Baraldi C, Bardazzi F. Fractional CO2 laser and vulvar lichen sclerosus: an alternative resource during maintenance therapy? A prospective study. Ital J Dermatol Venerol 2021; 157:247-253. [PMID: 34282866 DOI: 10.23736/s2784-8671.21.07066-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lichen sclerosus is an autoimmune dermatosis that in women typically involves vulvar area. This condition can strongly impact on the quality of life.To date, topical steroids are the most effective treatment, although adverse effects are possible, especially in long-term application. The aim of this study is to investigate the efficacy of fractional CO2 laser in reducing symptoms of vulvar lichen sclerosus (VLS) during maintenance therapy with topical steroids (application twice weekly or less);(ii) to assess how long this reduction of symptoms persists during followup; (iii) histological comparison before and after treatment.To our knowledge, this is the first prospective study evaluating this treatment in women with VLS. METHODS Women with a diagnosis of VLS were prospectively enrolled and treated with fractional CO2 laser every 2 months, for a total of 3 sessions.Four questionnaires were periodically administered: the Dermatology Quality of Life Index (DLQI), the Female Sexual Functional Index (FSFI) and 2 specific questionnaires created to assess the severity of disease. RESULTS 23 adult women were enrolled. The fractional CO2 laser treatment significantly improved the scores of all scales from baseline to T4 questionnaires. CONCLUSIONS Fractional CO2 laser proved to be effective on VLS symptoms and can be considered an alternative to corticosteroids during maintenance therapy. Larger studies with a control group and randomization are needed to safely generalize our findings.
Collapse
Affiliation(s)
- Francesca Ferrara
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Federica Filippi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy -
| | - Stefano Messori
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonietta D'Antuono
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Valeria Gaspari
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco A Chessa
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlotta Baraldi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Dermatology Unit, IRCSS di Policlinico S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
19
|
Treatment with Theresienöl - a new option in the management of vulvar leukoplakia. MENOPAUSE REVIEW 2021; 20:72-75. [PMID: 34321984 PMCID: PMC8297633 DOI: 10.5114/pm.2021.106220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
Introduction The term vulvar leukoplakia encompasses a variety of non-inflammatory diseases that lead to skin discoloration of the external genitalia and white colouration. Most commonly, these are vulvar lichen sclerosus (VLS) and squamous cell hyperplasia of the vulva (SCHV). They have similar aetiology, clinical presentation, and treatment but different anatomical pathology. Aim of the study The study aims to determine the effect of Theresienöl herbal oil treatment in patients with clinically proven diagnosis of VLS and SCHV. Material and methods This prospective study includes 17 patients with a diagnosis of VLS and SCHV, who underwent a 3-month treatment course with Theresienöl herbal oil. All patients were followed up for 1 year after therapy initiation, and the effect of treatment was reported using a visual analogue scale (VAS) for genital itching. Results The median age of patients enrolled was 60.6 years (range 42–74); 2 patients dropped out due to failure to attend follow-up visits. The mean score of the VAS taken at the beginning of treatment was 1.65 (0–5); at the 3rd month the mean score was 9 (8–10) and it remained similar at the 12th month – 8.67 (7–10). Conclusions Theresienöl herbal oil treatment of vulvar leukoplakia is effective and safe, but studies should be continued.
Collapse
|
20
|
Papini M, Russo A, Simonetti O, Borghi A, Corazza M, Piaserico S, Feliciani C, Calzavara-Pinton P. Diagnosis and management of cutaneous and anogenital lichen sclerosus: recommendations from the Italian Society of Dermatology (SIDeMaST). Ital J Dermatol Venerol 2021; 156:519-533. [PMID: 33913663 DOI: 10.23736/s2784-8671.21.06764-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lichen sclerosus (LS) is a disabling chronic inflammatory disease of skin and genital mucous membrane causing itch, pain, dysuria and restriction of micturition, and significant sexual dysfunction and dyspareunia both in women and men. If left untreated, LS is associated with a high degree of sclerosis and scarring, as well as with an elevated risk of cancer in the genital area. Although a central role of autoimmunity is suggested, the pathogenesis of LS is still not clearly understood and the disease remains difficult to treat. The goals of treatment of LS are to alleviate symptoms and discomfort, prevent anatomical changes and prevent malignant transformation. This guideline has been developed by an Italian group of experts. It summarizes evidence-based and expert- based recommendations. The highest level of evidence favors the use of topical high potency corticosteroids; second and third lines' treatments include topical calcineurin inhibitors and topical retinoids, respectively. Surgical treatment has become the treatment of choice in male genital LS with persistent phimosis not responsive to medical treatment. The aim of this paper is to offer evidencebased and easily applicable recommendations for the management of LS.
Collapse
Affiliation(s)
- Manuela Papini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Ada Russo
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Oriana Simonetti
- Department of Clinical and Molecular Sciences-Dermatology, Polytechnic University of Marche, Ancona, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Claudio Feliciani
- Dermatology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy -
| | | | | |
Collapse
|
21
|
Mendieta-Eckert M, Torrontegui Bilbao J, Zabalza Estévez I, Landa Gundin N. Treatment of Vulvar Lichen Sclerosus et Atrophicus With Fractional Carbon Dioxide Laser Therapy: A Report of 4 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
22
|
Mendieta-Eckert M, Torrontegui Bilbao J, Zabalza Estévez I, Landa Gundin N. Tratamiento de liquen escleroso y atrófico vulvar con láser de dióxido de carbono fraccionado. Presentación de cuatro casos. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:85-88. [DOI: 10.1016/j.ad.2019.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 10/23/2022] Open
|
23
|
Kamilos MF, Aguiar LM, Batista VH, Roa CL, Aguiar FN, Soares JM, Baracat EC. Microablative fractional radiofrequency as a therapeutic option for vulvar lichen sclerosus: a pilot study. Clinics (Sao Paulo) 2021; 76:e2567. [PMID: 33787656 PMCID: PMC7978666 DOI: 10.6061/clinics/2021/e2567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/20/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To assess the clinical response to and the histomorphometric effects of microablative fractional radiofrequency (MFR) in women with symptomatic vulvar lichen sclerosus (VLS). METHODS This was a pilot study on the use of MFR for the treatment of VLS. Upon recruitment and at each treatment session, all participants were examined and each of their symptoms were rated on a visual analog scale. After the procedure, the participants completed a satisfaction questionnaire. We compared the morphometric findings of vulvar biopsies performed at enrollment and after the last treatment session. The participants were divided into three groups according to previous treatment with corticosteroids: G1, no previous treatment; G2, treated for up to 5 years; and G3, treated for >5 years. RESULTS This study included 26 women. After two to three sessions, most participants in all groups became either "asymptomatic" or "much better" than before treatment and were "very satisfied" or "satisfied" with the intervention. Pruritus and burning sensation were the most frequently reported symptoms. Nearly 40% of the participants in all groups reported complete remission of symptoms. The improvement was rated as moderate or higher by 80%, 76%, and 66% of the women in groups 1, 2, and 3, respectively. The improvement of symptoms persisted for 11 months (range, 7-16 months), on average, after the treatment. Type III collagen concentration significantly increased and was associated with important symptom improvement. Tissue trophism and vascularization also increased but did not reach statistical significance, probably because of the small number of cases. CONCLUSIONS MFR may be an effective and safe treatment for symptomatic VLS.
Collapse
Affiliation(s)
- Márcia Farina Kamilos
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Lana Maria Aguiar
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Valéria Holmo Batista
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Cristiane Lima Roa
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fernando Nalesso Aguiar
- Patologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Maria Soares
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
24
|
Yordanov A, Tantchev L, Kostov S, Slavchev S, Strashilov S, Vasileva P. Vulvar leukoplakia: therapeutic options. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2020; 19:135-139. [PMID: 33100949 PMCID: PMC7573333 DOI: 10.5114/pm.2020.99570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/10/2020] [Indexed: 11/20/2022]
Abstract
Vulvar leukoplakia is not a histological diagnosis and involves several diseases. Most commonly, these are vulvar lichen sclerosus and squamous cell hyperplasia of the vulva. These two conditions have similar aetiology, clinical presentation and treatment but different histopathological changes. They both lead to significant impairment of quality of life, risk of malignancy, as well as recurrence after treatment. Treatment of these conditions includes topical corticosteroids as a first-line therapy, but they have their side effects and not all patients are receptive to this therapy. This requires the use of alternative therapeutic options such as topical calcineurin inhibitors, topical and systemic retinoids, other steroid creams, various destructive techniques and, as a last resort, surgical removal of affected tissues. Surgical treatment should be avoided, despite the malignant potential, because of recurrence risk in both diseases New therapeutic approaches are coming into effect in gynaecological practice due to potential risks of the above-mentioned methods. Platelet-rich plasma therapy, ablative and non-ablative laser treatment, and new topical medicines, are some of the new options applied to improve the efficacy of treatment avoiding the side effects of conventional medications. A number of them are still in their initial phase of application and time will tell their effectiveness.
Collapse
Affiliation(s)
- Angel Yordanov
- Department of Gynaecological Oncology, Medical University of Pleven, Bulgaria
| | - Latchezar Tantchev
- Obstetrics and Gynaecology Clinic, Acibadem City Clinic Hospital “Tokuda”, Sofia, Bulgaria
| | - Stoyan Kostov
- Department of Gynecology, Medical University of Varna, Bulgaria
| | | | - Strahil Strashilov
- Department of Plastic Restorative, Reconstructive and Aesthetic Surgery, Medical University of Pleven, Bulgaria
| | - Polina Vasileva
- Department of Obstetrics and Gynaecology, Medical University of Pleven, Pleven, Bulgaria
| |
Collapse
|
25
|
Phan M, Sou E, Al Sannaa G, Erwin M, Sanchez R. Dermal Hemorrhage: A Clue to Lichen Sclerosus et Atrophicus. Cureus 2020; 12:e9343. [PMID: 32850217 PMCID: PMC7444889 DOI: 10.7759/cureus.9343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Lichen sclerosus et atrophicus (LSA) may present in a rare bullous and hemorrhagic form that is often difficult to recognize both clinically and histopathologically. Clinically, the lesions may be characterized by atrophic and ivory-white sclerotic plaques in both genital and extragenital regions. Histologically, fully developed lesions of LSA are characterized by a thinned, effaced epidermis with interface change, a wide band of hyalinization in the upper dermis, and a lymphohistiocytic infiltrate below the hyalinized area. Extensive vacuolar degeneration weakens the integrity of the dermoepidermal junction, which contributes to the development of marked edema in the papillary dermis and subepidermal vesiculation. With increased fragility of dermal capillaries, hemorrhage can accumulate within the bullae. Recognizing prominent upper dermal hemorrhage as a secondary change may lead to a prompt diagnosis of LSA. We present a case of extragenital LSA that mimics a dermal hemorrhage clinically and histologically in a 71-year-old Caucasian woman.
Collapse
|
26
|
Ferrara F, Messori S, Abbenante D, Patrizi A, Bardazzi F. Fractional CO2 laser therapy of lichen sclerosus in males: a new therapeutic opportunity? J DERMATOL TREAT 2020; 33:941-945. [DOI: 10.1080/09546634.2020.1793886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Francesca Ferrara
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefano Messori
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Diego Abbenante
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| |
Collapse
|
27
|
Cuellar-Barboza A, Bashyam AM, Ghamrawi RI, Aickara D, Feldman SR, Pichardo RO. Methotrexate for the treatment of recalcitrant genital and extragenital lichen sclerosus: A retrospective series. Dermatol Ther 2020; 33:e13473. [PMID: 32347617 DOI: 10.1111/dth.13473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Adrian Cuellar-Barboza
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Arjun M Bashyam
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rima I Ghamrawi
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Divya Aickara
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
| | - Rita O Pichardo
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
28
|
Eftekhar T, Forooghifar T, Khalili T, Shariat M, Haghollahi F. The Effect of the CO 2 Fractional Laser or Premarin Vaginal Cream on Improving Sexual Function in Menopausal Women: A Randomized Controlled Trial. J Lasers Med Sci 2020; 11:292-298. [PMID: 32802290 DOI: 10.34172/jlms.2020.49] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction: Sexual dysfunction is a complex problem in postmenopausal women with a prevalence rate of 68%-86%. This study aimed to evaluate the effect of a fractional CO2 laser or vaginal cream on the improvement of sexual function in menopausal women. Methods: This is a two-group clinical trial study. Postmenopausal women with the inclusion criterion were enrolled and randomly divided into 2 groups of intervention (n=25) and control group (n=25). In the intervention group, CO2 laser therapy was performed every month for three months, and in the control group, Premarin vaginal cream was applied (0.625 mg, 3 nights a week for 3 months. Vaginal health index (VHI) scoring and Female Sexual Function Index (FSFI) questionnaires were completed before and three months after the treatment. Results: The effects of the laser treatment were greater than the Premarin group with respect to improvement in sexual desire, orgasms, sexual satisfaction, less pain during sexual relations, and overall sexual function (P <0.05). Conclusion: It seems that the fractional CO2 laser may be more effective than hormonal therapy in improving sexual function in postmenopausal women.
Collapse
Affiliation(s)
- Tahereh Eftekhar
- Associate Professor, Vali-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Forooghifar
- Urogynecology Fellowship, Baharloo Hospital, Department of Pelvic Floor (Urogynecology), Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Khalili
- M.D, Vali-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Professor, Maternal, Fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fedyeh Haghollahi
- MSC, Vali-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
29
|
Geisler A, Lacouture ME, Goldfrank D, Noor S. Vulvar lichen sclerosus in the setting of cancer treatment – A case series and review of the literature. Int J Womens Dermatol 2020. [DOI: 10.1016/j.ijwd.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
30
|
Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L. Vulvar diseases. J Am Acad Dermatol 2020; 82:1287-1298. [DOI: 10.1016/j.jaad.2019.10.077] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022]
|
31
|
|
32
|
Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid: a prospective longitudinal study. ACTA ACUST UNITED AC 2020; 27:418-422. [DOI: 10.1097/gme.0000000000001482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Krapf JM, Mitchell L, Holton MA, Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int J Womens Health 2020; 12:11-20. [PMID: 32021489 PMCID: PMC6970240 DOI: 10.2147/ijwh.s191200] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022] Open
Abstract
Vulvar lichen sclerosus (LS) is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. LS affects women of all ages and often goes unrecognized and underreported. Uncertainty continues to exist around its pathogenesis, histologic diagnosis, and treatment. However, there have been great advances in our understanding of autoimmunogenic targets in disease formation and progression. In addition, there has been recent investigation of potential non-steroid-based treatments, including platelet-rich plasma therapy and energy-based modalities such as the fractional CO2 laser, photodynamic therapy, and high intensity focused ultrasound. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. This review summarizes current perspectives on the pathogenesis, symptomatology, diagnosis, and treatment for vulvar lichen sclerosus.
Collapse
Affiliation(s)
- Jill M Krapf
- The George Washington University, Washington, DC, USA
- The Centers for Vulvovaginal Disorders, Washington, DC, USA
| | - Leia Mitchell
- The Centers for Vulvovaginal Disorders, Washington, DC, USA
| | - Michelle A Holton
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Andrew T Goldstein
- The George Washington University, Washington, DC, USA
- The Centers for Vulvovaginal Disorders, Washington, DC, USA
| |
Collapse
|
34
|
Gómez-Frieiro M, Laynez-Herrero E. Use of Er:YAG laser in the treatment of vulvar lichen sclerosus. Int J Womens Dermatol 2019; 5:340-344. [PMID: 31909154 PMCID: PMC6938928 DOI: 10.1016/j.ijwd.2019.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this research was to evaluate the efficacy and safety of Er:YAG lasers to improve signs and symptoms of vulvar lichen sclerosus. Methods The study population consisted of 28 women with symptomatic vulvar lichen sclerosus. Three nonablative, thermal-only Er:YAG laser treatment sessions (7 J/cm2, 2 Hz, 7 mm spot) were performed at 4-week intervals. Each patient was asked about the presence of symptoms, such as itching, pain, and coital pain. Clinical diagnosis was established on the basis of the presence of lesions such as hypopigmentation, ecchymosis, hyperkeratosis, excoriations, or fissures. The affected areas were divided by zones (clitoris, introitus, labia minora, labia majora, perineum, labial fusion, and effacement) and were visually evaluated. Based on the presence of symptoms, lesions, and affected zones, a scale with a maximum of 14 scores was established for use before and after treatment. The impact of lichen sclerosus on patients' lives before and after treatment was evaluated with an 11-point visual analogue scale, and treatment discomfort was assessed at each session. Results After analysis of each scoring component, individual statistically significant reductions were observed in itching, pain, ecchymosis, excoriations, and hypopigmentation. Conclusion The Er:YAG laser is a safe, well tolerated, and effective method for the adjuvant treatment of vulvar lichen sclerosus. Three sessions with monthly intervals using the indicated parameters can quantifiably reduce the impact of lichen sclerosus on patients' lives.
Collapse
|
35
|
Bizjak Ogrinc U, Senčar S, Luzar B, Lukanović A. Efficacy of Non-ablative Laser Therapy for Lichen Sclerosus: A Randomized Controlled Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1717-1725. [PMID: 30981618 DOI: 10.1016/j.jogc.2019.01.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/25/2019] [Accepted: 01/30/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this randomized controlled trial was to evaluate the safety and efficacy of neodymium: yttrium aluminum garnet laser treatment of lichen sclerosus (LS) by comparing it with topical corticosteroid treatment. METHODS A total of 40 female patients with vulvar LS were randomized 1:1 into a study (laser) group and a control (topical corticosteroids) group. The laser group received three laser treatments. Blinded evaluators evaluated biopsies and graded improvement on clinical photographs at baseline and at 3 months. Patients graded the intensity of symptoms on a 0 to 10 visual analogue scale at baseline and 1-, 3-, and 6-month follow-up. Patients also rated the tolerability of laser treatments, and side effects were monitored. (Canadian Task Force classification I) RESULTS: Laser treatment discomfort was on average 1.5 of 10 on the visual analogue scale. At 1- and 3-month follow-up, patients in the laser group had significantly greater improvement in LS symptoms (burning, itching, pain, and dyspareunia), better patient satisfaction, and greater reduction of sclerosis than patients in the topical corticosteroid group. At 6-month follow-up, the improvement of symptoms in the laser group was still significant. The correct order of photographs (before and after treatment) was assigned significantly more often in the laser-treated patients compared with the control group. CONCLUSION Laser therapy for LS caused minimal patient discomfort during the treatment, with no adverse effects, and demonstrated better efficacy than in the control group, with significant improvement lasting up to 6 months. Laser therapy is a promising option for patients not responding to topical corticosteroid therapy or patients wishing to reduce long-term corticosteroid maintenance use.
Collapse
Affiliation(s)
| | | | - Boštjan Luzar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Adolf Lukanović
- Department of Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
36
|
Preti M, Vieira-Baptista P, Digesu GA, Bretschneider CE, Damaser M, Demirkesen O, Heller DS, Mangir N, Marchitelli C, Mourad S, Moyal-Barracco M, Peremateu S, Tailor V, Tarcan T, De EJB, Stockdale CK. The Clinical Role of LASER for Vulvar and Vaginal Treatments in Gynecology and Female Urology: An ICS/ISSVD Best Practice Consensus Document. J Low Genit Tract Dis 2019; 23:151-160. [PMID: 30789385 PMCID: PMC6462818 DOI: 10.1097/lgt.0000000000000462] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. Most of the available studies are limited by their design; for example, they lack a control group, patients are not randomized, follow-up is short term, series are small, LASER is not compared with standard treatments, and most studies are industry sponsored. Because of these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration after LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, although short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. Therefore, at this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.
Collapse
Affiliation(s)
- Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | | | - Carol Emi Bretschneider
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic
| | - Margot Damaser
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic
- Glickman Urological and Kidney Institute and Department of Biomedical Engineering Lerner Research Institute, Cleveland Clinic
- Advanced Platform Technology Center Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Oktay Demirkesen
- Istanbul University Cerrahpaşa Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - Debra S Heller
- Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
| | - Naside Mangir
- Kroto Research Institute, Department of Material Science and Engineering, University of Sheffield
- Royal Hallamshire Hospital, Department of Urology, Sheffield, UK
| | - Claudia Marchitelli
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sherif Mourad
- Ain Shams University, Department of Urology, Cairo, Egypt
| | | | - Sol Peremateu
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Visha Tailor
- Imperial College Healthcare, Department of Urogynaecology, London, UK
| | - Tufan Tarcan
- Marmara University School of Medicine, Department of Urology, Istanbul, Turkey
| | - Elise J B De
- Department of Urology, Massachusetts General Hospital-Harvard Medical School Boston, MA
| | | |
Collapse
|
37
|
Preti M, Vieira-Baptista P, Digesu GA, Bretschneider CE, Damaser M, Demirkesen O, Heller DS, Mangir N, Marchitelli C, Mourad S, Moyal-Barracco M, Peremateu S, Tailor V, Tarcan T, De EJB, Stockdale CK. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document. Neurourol Urodyn 2019; 38:1009-1023. [PMID: 30742321 DOI: 10.1002/nau.23931] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology is controversial. AIMS In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. MATERIALS & METHODS This project was developed between January and September 2018. The development of this document followed the ICS White Paper Standard Operating Procedures. RESULTS Most of the available studies are limited by their design; for example they lack a control group, patients are not randomized, follow up is short term, series are small, LASER is not compared with standard treatments, and studies are industry sponsored. Due to these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration following LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. DISCUSSION The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, while short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. CONCLUSION At this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.
Collapse
Affiliation(s)
- Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal.,Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | | | - Carol Emi Bretschneider
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Margot Damaser
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.,Glickman Urological and Kidney Institute and Department of Biomedical Engineering Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Oktay Demirkesen
- Faculty of Medicine, Department of Urology, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Debra S Heller
- Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Naside Mangir
- Kroto Research Institute, Department of Material Science and Engineering, University of Sheffield, Sheffield, UK.,Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - Claudia Marchitelli
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sherif Mourad
- Department of Urology, Massachusetts General Hospital-Harvard Medical School Boston, Boston, Massachusetts
| | | | - Sol Peremateu
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Visha Tailor
- Department of Urogynaecology, Imperial College Healthcare, London, UK
| | - Tufan Tarcan
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Elise J B De
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
| |
Collapse
|
38
|
Hendrix N, Ollendorf DA, Chapman RH, Loos A, Liu S, Kumar V, Linder JA, Pearson SD, Veenstra DL. Cost-Effectiveness of Targeted Pharmacotherapy for Moderate to Severe Plaque Psoriasis. J Manag Care Spec Pharm 2018; 24:1210-1217. [PMID: 30479197 PMCID: PMC10398188 DOI: 10.18553/jmcp.2018.24.12.1210] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Newer classes of targeted drugs for moderate to severe plaque psoriasis are more effective and more expensive than older classes, posing a difficult and potentially costly decision about whether to use them as initial targeted treatments. OBJECTIVE To estimate the clinical and economic outcomes of initial targeted treatment for the following drugs: adalimumab, etanercept, and infliximab (TNFα inhibitors); apremilast (PDE4 inhibitor); ustekinumab (IL-12/23 inhibitor); and ixekizumab, secukinumab, and brodalumab (IL-17 inhibitors). METHODS We developed a Markov model to simulate patient outcomes as measured by quality-adjusted life-years (QALYs) and health care costs over a 10-year period. We assumed that patients who fail initial targeted treatment either proceed to subsequent therapy or discontinue targeted treatment. Effectiveness estimates for initial treatment were defined as improvement in Psoriasis Area and Severity Index (PASI) from baseline and derived from a 2018 network meta-analysis. Wholesale acquisition drug costs were discounted by a class-specific, empirically derived rebate percentage off of 2016 costs. We conducted one-way and probabilistic sensitivity analyses to assess uncertainty in results. RESULTS The incremental benefits compared with no targeted treatment were, in descending order: ixekizumab 1.68 QALYs (95% credible range [CR] = 1.11-2.02), brodalumab 1.64 QALYs (95% CR = 1.08-1.98), secukinumab 1.51 QALYs (95% CR = 1.00-1.83), ustekinumab 1.43 QALYs (95% CR=0.94-1.74), infliximab 1.27 QALYs (95% CR = 0.89-1.55), adalimumab 1.15 QALYs (95% CR = 0.76-1.44), etanercept 0.97 QALYs (95% CR = 0.61-1.25), and apremilast 0.87 QALYs (95% CR = 0.52-1.17). Costs of care without targeted treatment totaled $66,451, and costs of targeted treatment ranged from $137,080 (apremilast) to $255,422 (ustekinumab). Probabilistic sensitivity analysis results indicated that infliximab and apremilast are likely to be the most cost-effective initial treatments at willingness-to-pay thresholds around $100,000 per QALY, while IL-17 drugs are more likely to be cost-effective at thresholds approaching $150,000 per QALY. Acquisition cost of the initial targeted drug and utility of clinical response were the most influential parameters. CONCLUSIONS Our findings suggest that initial targeted treatment with IL-17 inhibitors is the most effective treatment strategy for plaque psoriasis patients who have failed methotrexate and phototherapy. Apremilast, brodalumab, infliximab, ixekizumab, and secukinumab are cost-effective at different willingness-to-pay thresholds. Additional research is needed on whether the effectiveness of targeted agents changes when used after previously targeted agents. DISCLOSURES Funding for this study was contributed by the Institute for Clinical and Economic Review (ICER). Ollendorf, Chapman, Pearson, and Kumar are current employees, and Loos and Liu are former employees, of ICER, an independent organization that evaluates the evidence on the value of health care interventions, which is funded by grants from the Laura and John Arnold Foundation, Blue Shield of California Foundation, and the California HealthCare Foundation. ICER's annual policy summit is supported by dues from Aetna, AHIP, Anthem, Alnylam, AstraZeneca, Blue Shield of California, Cambia Health Solutions and MedSavvy, CVS Caremark, Editas, Express Scripts, Genentech, GlaxoSmithKline, Harvard Pilgrim Health Care, Health Care Service Corporation, OmedaRx, United Healthcare, Johnson & Johnson, Kaiser Permanente, Premera Blue Cross, Merck, National Pharmaceutical Council, Takeda, Pfizer, Novartis, Lilly, Humana, Prime Therapeutics, Sanofi, and Spark Therapeutics. Linder owns stock in Amgen, Biogen, and Eli Lilly; has contingent value rights in Sanofi Genzyme (related to alemtuzumab for multiple sclerosis); has received grant support from Astellas Pharma not related to this study and Clintrex, which was supported by AstraZeneca on an unrelated topic; and has received an honorarium from the Society of Healthcare Epidemiology of America (SHEA) as part of the SHEA Antimicrobial Stewardship Research Workshop Planning Committee, an educational activity supported by Merck. No other authors have potential conflicts of interest.
Collapse
Affiliation(s)
- Nathaniel Hendrix
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| | | | | | - Anne Loos
- Institute for Clinical and Economic Review, Boston, Massachusetts
| | - Shanshan Liu
- Institute for Clinical and Economic Review, Boston, Massachusetts
| | - Varun Kumar
- Institute for Clinical and Economic Review, Boston, Massachusetts
| | - Jeffrey A. Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - David L. Veenstra
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| |
Collapse
|
39
|
Lee A, Fischer G. Diagnosis and Treatment of Vulvar Lichen Sclerosus: An Update for Dermatologists. Am J Clin Dermatol 2018; 19:695-706. [PMID: 29987650 DOI: 10.1007/s40257-018-0364-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vulvar lichen sclerosus is an important skin disease that is common in women in their 50 s and beyond; however, it can also affect females of any age, including children. If not treated, it has the potential to cause significant and permanent scarring and deformity of the vulvar structure. In addition, if untreated, it is associated with a 2-6% lifetime risk of malignant squamous neoplasia of the vulva. Lichen sclerosus has been considered a difficult to manage condition; however, both serious complications can potentially be prevented with early intervention with topical corticosteroid, suggesting that the course of the disease can be treatment modified.
Collapse
Affiliation(s)
- Andrew Lee
- Department of Dermatology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- Sydney Medical School Northern, The University of Sydney, St Leonards, NSW, Australia
- Department of Dermatology, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Gayle Fischer
- Department of Dermatology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- Sydney Medical School Northern, The University of Sydney, St Leonards, NSW, Australia.
- Department of Dermatology, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.
| |
Collapse
|
40
|
Tedesco M, Pranteda G, Chichierchia G, Paolino G, Latini A, Orsini D, Cristaudo A, Foddai M, Migliano E, Morrone A. The use of PRP (platelet-rich plasma) in patients affected by genital lichen sclerosus: clinical analysis and results. J Eur Acad Dermatol Venereol 2018; 33:e58-e59. [DOI: 10.1111/jdv.15190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Tedesco
- Department of Plastic and Reconstructive Surgery; San Gallicano Dermatologic Institute, IRCCS - IFO; Rome Italy
| | - G. Pranteda
- Department of Plastic and Reconstructive Surgery; San Gallicano Dermatologic Institute, IRCCS - IFO; Rome Italy
| | - G. Chichierchia
- Musculo-Skeletal Tissue Bank; Lazio, Rome Italy
- Immunohaematology and Transfusion Medicine; IRCCS Regina Elena National Cancer Institute; Rome Italy
| | - G. Paolino
- Unit of Dermatology; San Raffaele Hospital; Milano Italy
| | - A. Latini
- Infective Dermatologic Department; San Gallicano Institute of Dermatology, IRCCS-IFO; Rome Italy
| | - D. Orsini
- Infective Dermatologic Department; San Gallicano Institute of Dermatology, IRCCS-IFO; Rome Italy
| | - A. Cristaudo
- Infective Dermatologic Department; San Gallicano Institute of Dermatology, IRCCS-IFO; Rome Italy
| | - M.L. Foddai
- Immunohaematology and Transfusion Medicine; IRCCS Regina Elena National Cancer Institute; Rome Italy
| | - E. Migliano
- Department of Plastic and Reconstructive Surgery; San Gallicano Dermatologic Institute, IRCCS - IFO; Rome Italy
| | - A. Morrone
- San Gallicano Institute of Dermatology, IRCCS-IFO; Rome Italy
| |
Collapse
|
41
|
Abstract
Lichen sclerosus is a chronic, inflammatory dermatosis that usually affects the anogenital area. Early diagnosis and subsequent long-term anti-inflammatory treatment may reduce symptoms and signs and the risk of a mutilating course and the development of carcinomas.
Collapse
Affiliation(s)
- G Kirtschig
- Hautklinik, Universitätsklinikum Marburg & Gießen, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| |
Collapse
|
42
|
LaRosa C, Chiaravalloti A, Jinna S, Berger W, Finch J. Laser treatment of medical skin disease in women. Int J Womens Dermatol 2017; 3:131-139. [PMID: 28831422 PMCID: PMC5555278 DOI: 10.1016/j.ijwd.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/01/2023] Open
Abstract
Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.
Collapse
Affiliation(s)
- C. LaRosa
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - A. Chiaravalloti
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - S. Jinna
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - W. Berger
- Frank H. Netter MD School of Medicine, Quinnipiac University, North, Haven, CT
| | - J. Finch
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| |
Collapse
|
43
|
Arroyo C. Fractional CO 2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women. Int J Womens Health 2017; 9:591-595. [PMID: 28894392 PMCID: PMC5584900 DOI: 10.2147/ijwh.s136857] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study investigated a novel fractional carbon dioxide (CO2) laser for treatment of symptoms associated with vulvovaginal atrophy (VVA) in perimenopausal women. METHODS The study included 21 perimenopausal women (mean age 45±7 years) treated three times by CO2 laser resurfacing and coagulation of the vaginal canal tissue and mucosal tissue of the introitus. Vaginal health index (VHI) scores were computed by the investigator at baseline and follow-ups. Subjects reported on sexual function, satisfaction, and improvement with treatment. A visual analog scale was used to measure discomfort with treatment. RESULTS Vaginal health and subject assessment of vaginal symptoms improved with successive treatments. At 12 weeks following the third treatment, 82% of the patients showed a statistically significant improvement in VHI (P<0.05). Additionally, 81% of subjects reported improvement in sexual gratification, 94% reported improvement in vaginal rejuvenation, and 100% reported satisfaction with treatment. VHI improvement remained significant at 6-8 months after treatments (P<0.01). Most patients (97%) reported no to mild discomfort with treatment. Responses were mild and transient following treatment, with itching being the most commonly reported (20%) side effect. CONCLUSION In this study, fractional CO2 laser treatment was associated with improvement of vaginal health and amelioration of symptoms of VVA, resulting in improved sexual function in perimenopausal women. Treatment time was quick, and there was minimal discomfort associated with treatment. Investigation of clinical outcome in a larger study population is warranted.
Collapse
Affiliation(s)
- César Arroyo
- HM Montepríncipe University Hospital Laser Unit, Madrid, Spain
| |
Collapse
|
44
|
Origoni M. Fractional carbon dioxide laser in recalcitrant vulvar lichen sclerosus. Australas J Dermatol 2017; 58:e157-e158. [PMID: 28664558 DOI: 10.1111/ajd.12538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Massimo Origoni
- Department of Gynaecology and Obstetrics, San Raffaele Scientific Institute, Vita Salute San Raffaele University School of Medicine, Milan, Italy
| |
Collapse
|
45
|
Olejek A, Gabriel I, Bilska-Janosik A, Kozak-Darmas I, Kawczyk-Krupka A. ALA-Photodynamic treatment in Lichen sclerosus-clinical and immunological outcome focusing on the assesment of antinuclear antibodies. Photodiagnosis Photodyn Ther 2017; 18:128-132. [PMID: 28219801 DOI: 10.1016/j.pdpdt.2017.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/22/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lichen sclerosus (LS) is a difficult to treat, often relapsing disease with unknown background. Autoimmune diseases also coexist with LS. Over recent years photodynamic therapy (PDT) has been shown to be a noninvasive and successful therapeutic approach for the effective treatment of many conditions. However, the change of immune status of the patients based on ANA antibodies has not been yet reported. Our aim was to observe the clinical response followed by possible changes in autoimmune antibodies levels before and after PDT for LS. MATERIAL AND METHODS We enrolled 100 women with Lichen sclerosus with or without a concomitant autoimmune disease. All patients received 10 cycles of PDT (65 treated with DIOMED Light, 35 with PhotoDYN Light). We assessed autoimmune antibodies before and after PDT in addition to the clinical response evaluation.Two-year prospective controlled before-and-after study. RESULTS Following PDT, patients showed a significant attenuation in symptoms' intensity (itching, pruritus, vulvar discomfort). After therapy 41% of patients had partial response, 51% of patients had no symptoms and 8% had persistent or worsened symptoms. The most frequent autoimmune disease were thyroid disorders, followed by vitiligo and arthritis. 57% patients with an additional autoimmune disease before PDT had ANA antibodies. The mean level of ANA in this group diminished significantly after PDT treatment (261.74 IU/ml before vs. 123.20 IU/ml after treatment). CONCLUSION Based on our results, we assume that PDT may influence the immune status of patients with Lichen sclerosus.
Collapse
Affiliation(s)
- Anita Olejek
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland
| | - Iwona Gabriel
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland; Division of Urogynecology, Brigham and Women's Hospital, Boston, USA
| | - Anna Bilska-Janosik
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland
| | - Iwona Kozak-Darmas
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland
| | - Aleksandra Kawczyk-Krupka
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Batorego 15, 41-902, Bytom, Poland.
| |
Collapse
|
46
|
Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, Bader A, Calligaro A, Elias JA, Gambaciani M, Gaviria JE, Iglesia CB, Selih-Martinec K, Mwesigwa PL, Ogrinc UB, Salvatore S, Scollo P, Zerbinati N, Nelson JS. Light and energy based therapeutics for genitourinary syndrome of menopause: Consensus and controversies. Lasers Surg Med 2017; 49:137-159. [PMID: 28220946 DOI: 10.1002/lsm.22637] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 11/09/2022]
Abstract
Gynecologist and plastic surgeons pioneered the application of lasers in medicine and surgery almost 5 decades ago, initially used to treat cervical and vaginal pathologies. Ever since, energy-based devices have been deployed to treat pelvic pathologies and improve fertility. Recent technological developments triggered an unprecedented wave of publications, assessing the efficacy of fractional laser, and radiofrequency on the vaginal wall in reversing natural aging processes. Studies have shown that a certain degree of thermal energy deposited on the vaginal wall stimulates proliferation of the glycogen-enriched epithelium, neovascularization, and collagen formation in the lamina propria, and improves natural lubrication and control of urination. This review aimed to review such data and to guide future research. A unique assembly of experts from around the globe, compiled and edited this manuscript based on a thorough literature review and personal experience. Lasers Surg. Med. 49:137-159, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Yona Tadir
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| | - Adrian Gaspar
- Department of Laser Surgery, Mendoza Hospital, Mendoza, Argentina
| | - Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Macrene Alexiades
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Red Alinsod
- South Coast Urogynecology, Laguna Beach, California
| | - Alex Bader
- Reconstruction & Cosmetic Gynecology, London, UK
| | - Alberto Calligaro
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Jorge A Elias
- Urogynecology and Aesthetic Gynecology Clinic, Boenos Aires, Argentina
| | - Marco Gambaciani
- Department of Obstetrics and Gynecology, University Hospital Pisa, Pisa, Italy
| | - Jorge E Gaviria
- Aesthetics and Laser Medical Educational Center, Korpo Laser, Caracas, Venezuela
| | - Cheryl B Iglesia
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Patricia L Mwesigwa
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Stefano Salvatore
- Department of Obstetrics and Gynecology, San Raffaele University, Milan, Italy
| | - Paolo Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy
| | - Nicola Zerbinati
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - John Stuart Nelson
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| |
Collapse
|