Photodynamic therapy in the treatment of vulvar lichen sclerosus

doi:10.1016/j.pdpdt.2017.05.011

Photodiagnosis and Photodynamic Therapy

Volume 19, September 2017, Pages 135-139

https://doi.org/10.1016/j.pdpdt.2017.05.011 Get rights and content

Highlights

•
Photodynamic therapy has a good therapeutic effect, with the 87.25% improvement rate in patients suffering from lichen sclerosus.
•
Patients demonstrated positive responses to photodynamic therapy and the treatment was well tolerated.
•
Photodynamic therapy used to treat lichen sclerosus yields excellent cosmetic results.

Abstract

Background

Vulvar lichen sclerosus is a chronic and incurable disease that causes various unpleasant symptoms and serious consequences.

Objective

The purpose of the study was to assess the effectiveness of photodynamic therapy in the treatment of vulvar lichen sclerosus.

Methods

Participants in the study included 102 female patients aged 19–85 suffer from vulvar lichen sclerosus. The patients underwent photodynamic therapy (PDT). In the course of PDT the 5% 5- aminolevulinic acid was used in gel form. The affected areas were irradiated with a halogenic lamp PhotoDyn 501 (590–760 nm) during a 10-min radiation treatment. The treatment was repeated weekly for 10 weeks.

Result

PDT has brought about a good therapeutic effect (complete or partial clinical remission), with 87.25% improvement rate in patients suffering from lichen sclerosus. The greatest vulvoscopic response was observed in the reduction of subepithelial ecchymoses and teleangiectasia (78.95%), and the reduction of erosions and fissures (70.97%). A partial remission of lichenification with hyperkeratosis was observed in 51.61% of cases. The least response was observed in the atrophic lesions reduction (improvement in 37.36% of cases).

Conclusion

Our patients suffering from vulvar lichen sclerosus demonstrated positive responses to photodynamic therapy and the treatment was well tolerated. Photodynamic therapy used to treat lichen sclerosus yields excellent cosmetic results.

Introduction

Lichen sclerosus (LS) of the vulva is a chronic dermatosis of atrophic inflammatory character, accompanied by a lymphocytic response [1], [2].

Most frequently (in 85–98% of the cases) LS occurs in the area of external genitalia and the anus. In 15–20% of the cases LS occurs in other (not genital) parts of the body: on the skin of the upper torso, in the armpits, as well as on the buttocks and thighs [3]. Women suffer from LS ten times more often than men do. LS affects all age groups, with an increased frequency in post-menopausal women [4]. However, as much as 10% of all cases occurs in children under six years of age. LS usually causes many chronic ailments and conditions [3], [4].

The etiology of this disease has not yet been fully explained. Among a plethora of pathogenic factors mentioned in literature, the most likely source of LS is autoimmunologic and genetic. This hypothesis is proved by a more frequent occurrence of tissue-specific antibodies, co-existence of LS with other autoimmunologic diseases, in particular autoimmune thyroid disease and vitiligo, as well as associations with the HLA class II antigene DQ7 [3], [4], [5]. LS is a chronic and incurable disease [4]. Treatment usually leads to improvement, which can be temporary, but there can be times when treatment does not bring desired results (Fig. 1, Fig. 2, Fig. 3).

Section snippets

Materials and methods

Participants in the study included 102 female patients aged 19–85 (the average age was 55.08), who were undergoing treatment for LS in the Department of Oncological Gynecology at the Oncology Center in Warsaw, Poland, in 2012–2014. Each patient underwent a biopsy of the vulva; following histopathology, LS was diagnosed.

Prior to the study, all patients had been qualified for treatment with clobetasol propionate (0.05% ointment). However, for a variety of reasons this therapy did not bring

Results

The study group consisted of 102 female patients aged 19–85 (on average 55.08 years old). The patients suffered from LS for the duration of 1–29 years (on average 4.59 years).

76 patients (74.50%) were post-menopausal. Menopause took place on average at 50.9 years of age.

32 patients (31.37%) suffered from other autoimmunologic disorders in addition to LS. Table 1 shows the autoimmunologic diseases that accompanied LS in the study sample.

To participate in the study we chose patients who were

Discussion

Lichen sclerosus of the vulva may have various unpleasant symptoms, such as itching, pain, and burning. In the aftermath of progressing atrophic lesions and scarring, with time, dyspaurenia can develop. The main causes of dyspaurenia include chafing, erosions, and narrowing of the vagina opening. These ailments and sex life issues, which accompany LS, significantly deteriorate quality of life in patients [3].

Macroscopy shows white, wax-like, multi-sided papules, which merge into shiny bundles,

Conclusions

1.
Our patients suffering from vulvar lichen sclerosus demonstrated positive responses to photodynamic therapy and the treatment was well tolerated.
2.
Photodynamic therapy used to treat lichen sclerosus yields excellent cosmetic results.

Conflicts of interest

The authors have no conflict of interest to declare.

Funding

This article has no funding source.

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Cited by (31)

Clinical efficacy analysis of 5-aminolevulinic acid photodynamic therapy for vulvar lichen sclerosus
2024, Photodiagnosis and Photodynamic Therapy
The purpose of this study is to analyze the efficacy of photodynamic therapy in the treatment of vulvar lichen sclerosus who do not respond to topical glucocorticoid therapy, analyze whether there are factors that affect the efficacy, and identify adverse reactions to the treatment.
This retrospective study included 42 patients with vulval lichen sclerosis treated with ALA-PDT. Basic data of all patients were collected, and the clinical symptoms and signs of the patients before treatment were evaluated. After one year of treatment, the clinical efficacy was evaluated and analyzed whether there were any factors that affected the treatment effect.
One year after the ALA-PDT treatment, the clinical effective rate was 64.29 % (27/42), the general effective rate was 19.05 % (8/42), the ineffective rate was 4.76 % (2/42), and the recurrence rate was 11.90 % (5/42). There was no correlation between menopause, number of births given, body mass index, duration of disease, treatment times and treatment effect. For patients with severe itching and atrophy, PDT was less effective. Adverse effects were minimal and no structural complications were reported.
ALA-PDT can obviously alleviate itching in VLS patients, improve skin elasticity, skin color and reduce lesion area. ALA-PDT for VLS has a low recurrence rate and few side effects.
Combination of high-frequency electrocautery therapy and ALA-PDT in hyperkeratotic vulvar lichen sclerosus: Series of seven cases
2024, Photodiagnosis and Photodynamic Therapy
ALA-PDT effectively treats Vulvar lichen sclerosus et atrophicus (VLSA), but it requires multiple repetitions for satisfactory results. To enhance efficacy, we employed a combination of high-frequency electrocautery therapy and ALA-PDT in treating seven VLSA patients.
Lesions and leukoplakia in the seven women with VLSA were removed using a high-frequency generator. PDT was administered after wound healing, and it was repeated six times. Follow-up assessments were carried out at 1, 3, and 6 months to evaluate the severity of pruritus and investigate lesion repigmentation.
Following the combined therapy, the disappearance of pruritus was observed in all patients, and normal color and thickness were restored to their skin. Two patients reported mild pruritus with a score of 2 one month after treatment, which persisted until the 6-month follow-up, while the remaining patients remained free from pruritus. No recurrence of skin lesions was observed in any of the patients.
The combined therapy for the treatment of VLSA is found to be convenient, effective, and easily promotable.
Chinese expert consensus on the clinical applications of aminolevulinic acid-based photodynamic therapy in female lower genital tract diseases (2022)
2022, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
For lesions with hyperpigmentation or hyperkeratosis, surgery or physical therapy can be used to remove the superficial lesions to improve the permeability of ALA, and then 1-2 courses of treatment can be used. Recent studies suggest that ALA-PDT can achieve good efficacy in the treatment of VLS [24]. A systematic review shows that the improvement rates of clinical symptoms range between 52% and 87.5%.
With the younger onset age of female lower genital tract diseases, there are increasing demands for protecting organ and tissue structures to preserve fertility and, therefore, effective fertility-sparing treatments that cause minimal normal tissue damage and less adverse reactions are urgently needed.
This study is aimed at reviewing information and achieving consensus on recommendations on the clinical applications of aminolevulinic acid-based photodynamic therapy (ALA-PDT) in female lower genital tract diseases.
Members of the expert panel held online and in-person meetings to discuss and revise drafts created by the steering committee based on the literature review and the clinical experiences of the expert panel. Opinions of the experts were transcribed and discussed in detail to ensure that the consensus statement best reflects the current advances in the field and the experts’ view.
After numerous rounds of meetings, experts unanimously agreed on the importance of ALA-PDT in the treatment of cervical squamous intraepithelial lesions (SIL), vaginal SIL, vulvar SIL, vulvar lichen sclerosus (VLS), and condyloma acuminatumon (CA). Experts also reached consensus on the recommended treatment regimen and treatment methods.
This consensus aimed to provide practical basis and guidance for the clinical applications of ALA-PDT in female lower genital tract diseases in China. Of note, this is the only expert consensus prepared by board-certified specialists in gynecology and obstetrics in China. More evidence-based clinical studies should be made to update and expand the current recommendations.
Does HPV infection have impact on results of photodynamic treatment of vulvar lichen sclerosus?
2021, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
Reduction of symptoms was obtained in 10 out of 12 patients, and the mean time until recurrence was 6.1 months, which was half of the time in our study. Maździarz et al. similar to our study, used non-laser light, with a high rate of symptoms’ reduction [13]. Vano-Galvan et al. and Romero et al. effectively used PDT for the treatment of patients with LS with multiple vulvar symptoms [14,15].
The association between lichen sclerosus (LS) and human papilloma virus (HPV) infections remains unclear. The co-occurrence of both pathologies may impact treatment and prognosis.
This study aimed to assess the results of photodynamic therapy (PDT) for vulvar LS and the effect of incidence of HPV infection on the results of treatment and duration of remission.
A total of 73 patients with LS were included in the study. In each patient, 14 types of HPV were detected. PDT was performed using the PhotoDyn 501, which emits light at 630 nm wavelength and power density of 204 mW/cm². Focal lesions were exposed for 10 min once weekly for a total of 10 weeks. The complete treatment cycle was repeated after 3 months, whenever required. The biopsy was repeated after completion of treatment.
The number of treatment cycles for HPV-positive and HPV-negative patients were not statistically different (cases after one or two PDT cycles). An exception was a group of patients with LS requiring three PDT cycles. Analysis of remission period considering HPV results (positive vs. negative) did not reveal a significant statistical difference. Mean remission period among HPV-negative patients was longer in comparison to remission time for those with positive HPV results (14 ± 9 vs. 11 ± 9 months).
PDT may be a promising, effective, and safe method for the treatment of LS regardless of HPV infection.
A fluorescent Zn(II)-based coordination polymer for selective detection of Fe<sup>3+</sup> ion and treatment effect and mechanism against B.burgdorfert induced vulvar lichen sclerosus
2020, Journal of Molecular Structure
A new Zn(II)-based coordination polymer (CP) [Me₂NH₂][Zn₃(OH) (L)₂(H₂O)₃]·6H₂O (1) has been successfully prepared utilizing a ligand of 4,4′,4″-s-triazine-1,3,5-triyltri-m-aminobenzoate (H₃L) with triazine backbone. Complex 1 could be applied as a Fe³⁺ sensor with high sensitivity and selectivity. Furthermore, the treatment activity of 1 against vulvar lichen sclerosus (VLS) was assessed and its particular mechanism was discussed in the study. Firstly, the titer of the Borrelia burgdorferi (B.burgdorfert) was measured. Then the flow cytometry was carried out to determine the relative content of the T cell subset in peripheral blood. The superoxide dismutase (SOD) and malondialdehyde (MDA) method was used to measure the level of the SOD activity and MDA. Reverse transcription-polymerase chain reaction (RT-PCR) was carried out for the determination of the inflammatory genes nf-κb and p53 relative expression. The apoptosis of the vulvar disease tissue was evaluated.
Treatment of Hyperkeratotic Vulvar Lichen Sclerosus with combination of holmium laser therapy and ALA-PDT:case report
2020, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
In this case, considering its recalcitrant history,the hyperkeratotic lesions with symptoms of pruritus and odynuria,PDT and holmium laser therapy are applicable options used for the patient. ALA-PDT has brought about good therapeutic effects and yield excellent cosmetic results in patients suffering from vulvar lichen sclerosus [4,6]. After application and incubation of 5-ALA with VLS,PpIX was generated and accumulated,then the production of toxic photochemical reactions under the irradiation of light destructs cellular structures in the pathologically altered area.In our study,in situ observation of PpIX fluorescence showed that the distribution of PpIX matched the location of the VLS lesions.
A 72-year old woman who has a history of refractory vulvar lichen sclerosus(VLS) was treated with ALA-PDT for 3 times every other week,then holmium laser and ALA-PDT were combined to treat the same areas at a time.Satisfactory result was noted without any unbearable adverse effects.The combination of holmium laser therapy and ALA-PDT may further improve the efficacy with good tolerance of VLS patients.

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Photodynamic therapy in the treatment of vulvar lichen sclerosus☆

Highlights

Abstract

Background

Objective

Methods

Result

Conclusion

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusions

Conflicts of interest

Funding

Actas Dermosifiliogr.

J. Am. Acad. Dermatol.

J. Sex. Med.

Clin. Dermatol.

J. Am. Acad. Dermatol.

British Association of Dermatologists’ guidelines for the management of lichen sclerosus

Br. J. Dermatol.

The effect of topical pimecrolimus on inflamatory infiltrate in vulvar lichen sclerosus

Am. J. Obstet. Gynecol.

The association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease: a case–control study

Arch. Dermatol.

Successful treatment of vulvar lichen sclerosus with topical tacrolimus

Arch. Dermatol.

Diseases and disorders of the anogenitalia of females

Does treatment of vulvar lichen sclerosus influence the prognosis?

Arch. Dermatol.