Comparison of long-term efficacy and safety of different therapeutic approaches for vulvar Lichen sclerosus: a systematic review and meta-analysis

Abstract

Aim: This systematic review and meta-analysis aimed to compare the long-term efficacy and safety of physical therapies (laser and photodynamic therapy) versus conventional topical glucocorticoids for the treatment of vulvar lichen sclerosus (VLS). Materials and methods: A total of ten randomized controlled trials (RCTs) published between 2010 and 2025 were included and analyzed to evaluate clinical symptom improvement, safety profiles, and long-term recurrence rates. Results: Analysis indicates that physical therapies are generally superior to topical glucocorticoids in improving clinical symptoms, with photodynamic therapy (PDT) demonstrating the most significant relief. In terms of safety, adverse events associated with physical therapies were predominantly mild and transient local reactions (e.g., burning or redness), whereas topical glucocorticoid use carried risks of secondary infections, such as candidiasis. Furthermore, physical therapies, particularly PDT, showed better long-term recurrence control compared to glucocorticoids, which had high recurrence rates after discontinuation. Conclusion: Laser therapy and PDT are effective and safer alternative treatments for VLS. These modalities offer distinct advantages in sustained symptom relief and recurrence reduction, especially for patients with refractory disease or concerns regarding long-term steroid use.