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

Abstract

Background: Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition predominantly affecting postmenopausal women, often leading to significant discomfort and impaired quality of life. Current treatments, such as topical corticosteroids, have limitations in efficacy and long-term safety. Fractional CO2 laser therapy has emerged as a promising modality for managing VLS, but its combination with topical estrogen remains underexplored. Objective: This study aimed to evaluate the efficacy and safety of combined fractional CO2 laser and topical estrogen therapy in managing VLS in postmenopausal women. Methods: A randomized controlled trial was conducted involving 60 postmenopausal women diagnosed with VLS. Participants were divided into two groups: the intervention group received fractional CO2 laser therapy combined with topical estrogen ointment, while the control group received topical estrogen alone. Efficacy was defined as a significant reduction in vulvar lichen sclerosus symptom score (VLSSS), assessed at baseline, 3 months, and 6 months. Secondary outcomes included histopathological changes and patient-reported quality of life measures. Results: At both 3 months and 1 year after treatment, the intervention group showed a significant reduction in VLSSS compared to the control group (p < 0.001). Histopathological analysis demonstrated reduced inflammation and fibrosis. Patient-reported outcomes revealed significant improvements in sexual function (FSFI) and quality of life (CECA10) in the combined therapy group. Additionally, the recurrence rate at 1 year was significantly lower in the intervention group (17.14%) than in the control group (31.43%, p < 0.001). No severe adverse events were reported. Limitations: The study's sample size was relatively small, and the follow-up period was limited to 6 months, which may not capture long-term outcomes. Additionally, the single-center design may limit generalizability. Conclusion: Combined fractional CO2 laser and topical estrogen therapy is a safe and effective approach for managing VLS in postmenopausal women, offering significant symptom relief and improved quality of life. Further studies with larger cohorts and longer follow-up are warranted to confirm these findings.