Treatment of lichen sclerosus and vulvar dysplasia with laser therapy

Treatment of lichen sclerosus and vulvar dysplasia with laser therapy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Treatment of lichen sclerosus and vulvar dysplasia with laser therapy Gina Mohmand, Ellen Christine Leth Løkkegaard, Guðbjörg Andrésdóttir, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6296245/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract A case of lichen sclerosus in an octogenarian complicated with vulvar dysplasia is presented. After four treatments with CO2 laser her symptoms were relieved, vulvar biopsies were normalized and photodocumentation before and after treatment of her skin is shown Lichen sclerosus laser treatment vulvar dysplasia Figures Figure 1 Introduction Vulvar lichen sclerosus is a chronic cutaneous disorder that affects approximately one in 70 women. Symptoms may include intense itching, pain, burning, and severe dyspareunia. The typical lesions are white plaques and papules, often with areas of ecchymosis, excoriation, and ulceration, with destruction of the vulvar architecture. Four to seven percent of women with vulvar lichen sclerosus develop vulvar carcinoma. The histopathological changes of vulvar lichen sclerosus are characteristic, making biopsy an indispensable diagnostic tool. Laser therapy is increasingly used as a treatment for dysplasia, but there is limited evidence for its use in vulvar dysplasia combined with lichen sclerosus. We present a case that highlights both the efficacy and the challenges that arise with the use of this treatment modality. This case contributes to the understanding of alternative therapeutic options for complex gynecological conditions. Case history An octogenarian woman was referred with long-standing vulvar complaints, including pain, itching, burning, infection and ulceration. Previous treatments included surgery for vulvar dysplasia (VIN 3) in 2020, followed by recurrent treatment with lymphadenectomy in 2022. The aftermath was complicated by wound infection and fluid accumulation in the vulvar area. Biopsy showed irregular hyperplasia and moderate atypia with a diagnosis of high-grade squamous intraepithelial lesion (HSIL) with dVIN in 2024. The patient also had urinary problems, which were treated with intermittent catheterization due to agglutinated genital hiatus. Treatment with Aldara® (imiquimod) was initiated, but discontinued after a few days due to significant side effects of burning sensation and pain. The patient then received CO 2 laser therapy, four treatments in total with 4-6 weeks interval (Fig.1). The treatment relieved the woman from symptoms and a biopsy showed normal histology after four months. Discussion This case supports previous studies showing laser therapy being an effective symptomatic treatment of lichen sclerosus ( 1 , 2 ). It is also a non-invasive treatment for high-grade vulvar dysplasia, as surgery in particular can lead to a high risk of infection and worsening of lichen sclerosus. Similarly, medical treatment with Aldara® often results in side effects that make it unsuitable for many patients, without adequate effect on vulvar dysplasia. Laser therapy represents a tissue-sparing alternative, but the treatment requires close follow-up and attention to the risk of recurrence. The effect on vulvar dysplasia needs further verification ( 3 ). This case highlights the need for robust studies to clarify long-term effects and optimize treatment courses. This case demonstrates the potential for individualized treatment with CO 2 laser therapy for complicated gynecological conditions such as vulvar dysplasia and lichen sclerosus. Laser therapy should be considered as a valuable alternative to surgery, especially in cases where tissue preservation is desirable and side effects from medical treatment limit options. Declarations Conflict of interest: None Funding: none Author Contribution: GM: Treated the patient, performed the photodocumentation , and achieved the written consent. Initiated the manuscript and approved the final versionECLL: Supervised the process and wrote the manuscript and approved the final versionGA: Wrote and approved the final version of the mansucriptFFL: Dealt with formalities of the treatment, applied for the permissions and the initialisation of treatment. Wrote and pproved the final version of the manuscript Data Availability: Th written consent of the patient is uploaded in original and covers all the necessary permits to publishing the case and the photodocumentation References Dieter AA, Iglesia CB, Lee JH at al. A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO2 laser therapy. Lasers Surg Med. 2023 Aug;55(6):521-527. doi: 10.1002/lsm.23669 Burkett LS, Siddique M, Zeymo A, Brunn EA, Gutman RE, Park AJ, Iglesia CB. Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):968-978. doi: 10.1097/AOG.0000000000004332. PMID: 33957642. Mitchell L, Goldstein AT, Heller D et al. Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):979-987. doi: 10.1097/AOG.0000000000004409 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6296245","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":433915928,"identity":"ac9f2c08-f85e-41bb-bdd8-081866ca7539","order_by":0,"name":"Gina Mohmand","email":"","orcid":"","institution":"Sygehus Sønderjylland","correspondingAuthor":false,"prefix":"","firstName":"Gina","middleName":"","lastName":"Mohmand","suffix":""},{"id":433915929,"identity":"ab7d27d5-e3a7-442d-a371-df2f609b10e9","order_by":1,"name":"Ellen Christine Leth Løkkegaard","email":"","orcid":"","institution":"Nordsjællands Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ellen","middleName":"Christine Leth","lastName":"Løkkegaard","suffix":""},{"id":433915930,"identity":"b2ef91fd-0c24-4926-b2b5-f7aaf6be8c69","order_by":2,"name":"Guðbjörg Andrésdóttir","email":"","orcid":"","institution":"Nordsjællands Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guðbjörg","middleName":"","lastName":"Andrésdóttir","suffix":""},{"id":433915931,"identity":"fd62acdb-2089-4035-a9ef-5dcd8bebd207","order_by":3,"name":"Finn Friis Lauszus","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYBAC9mYQWQDlfQARBxiM8WrhOQwiDSAcxhlEaTmApIWZhygt7LzHHjAY2CXO7z9j/Nl2T11i3wHmzQZ4tTDzpRswGCQnbjhwxkw659nhxJkH2IoT8GmxZ+Yxk2AwYE7cwNhjxpxz4ABQL4/xAfy2gLXUJ85v5jH+bHGgjmgthxMbjvEYSDMcYAZrweswsJYEg+PGG86wlUn2HDhsPPMwWzF+7/OfMZP4UFEtO7//8OYPPw7UyfYdb94sgU8LGCC7w7GBmaB6NGBPqoZRMApGwSgY/gAAoFRFdMlxx6cAAAAASUVORK5CYII=","orcid":"","institution":"Sygehus Sønderjylland","correspondingAuthor":true,"prefix":"","firstName":"Finn","middleName":"Friis","lastName":"Lauszus","suffix":""}],"badges":[],"createdAt":"2025-03-24 14:23:12","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6296245/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6296245/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79910638,"identity":"1c729264-609e-4cc3-add8-ac57225cf784","added_by":"auto","created_at":"2025-04-04 11:33:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1994990,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePhoto before (A) and after (B) four treatment with CO2-laser.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOral and written permission for publishing photos granted from patient\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6296245/v1/d32319d3fbe6578ab5c7901b.png"},{"id":80382835,"identity":"7fec62d7-7d16-41fe-a3e9-710c081dd716","added_by":"auto","created_at":"2025-04-11 09:23:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2211729,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6296245/v1/ad960e6c-2d97-43a5-ba8c-cf9e62ef75ae.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treatment of lichen sclerosus and vulvar dysplasia with laser therapy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVulvar lichen sclerosus is a chronic cutaneous disorder that affects approximately one in 70 women. Symptoms may include intense itching, pain, burning, and severe dyspareunia. The typical lesions are white plaques and papules, often with areas of ecchymosis, excoriation, and ulceration, with destruction of the vulvar architecture. Four to seven percent of women with vulvar lichen sclerosus develop vulvar carcinoma. The histopathological changes of vulvar lichen sclerosus are characteristic, making biopsy an indispensable diagnostic tool. Laser therapy is increasingly used as a treatment for dysplasia, but there is limited evidence for its use in vulvar dysplasia combined with lichen sclerosus. We present a case that highlights both the efficacy and the challenges that arise with the use of this treatment modality. This case contributes to the understanding of alternative therapeutic options for complex gynecological conditions.\u003c/p\u003e"},{"header":"Case history","content":"\u003cp\u003eAn octogenarian woman was referred with long-standing vulvar complaints, including pain, itching, burning, infection and ulceration. Previous treatments included surgery for vulvar dysplasia (VIN 3) in 2020, followed by recurrent treatment with lymphadenectomy in 2022. The aftermath was complicated by wound infection and fluid accumulation in the vulvar area. Biopsy showed irregular hyperplasia and moderate atypia with a diagnosis of high-grade squamous intraepithelial lesion (HSIL) with dVIN in 2024.\u003c/p\u003e\n\u003cp\u003eThe patient also had urinary problems, which were treated with intermittent catheterization due to agglutinated genital hiatus. Treatment with Aldara\u0026reg; (imiquimod) was initiated, but discontinued after a few days due to significant side effects of burning sensation and pain. The patient then received CO\u003csub\u003e2\u003c/sub\u003e laser therapy, four treatments in total with 4-6 weeks interval (Fig.1). The treatment relieved the woman from symptoms and a biopsy showed normal histology after four months.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case supports previous studies showing laser therapy being an effective symptomatic treatment of lichen sclerosus (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is also a non-invasive treatment for high-grade vulvar dysplasia, as surgery in particular can lead to a high risk of infection and worsening of lichen sclerosus. Similarly, medical treatment with Aldara\u0026reg; often results in side effects that make it unsuitable for many patients, without adequate effect on vulvar dysplasia.\u003c/p\u003e \u003cp\u003eLaser therapy represents a tissue-sparing alternative, but the treatment requires close follow-up and attention to the risk of recurrence. The effect on vulvar dysplasia needs further verification (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This case highlights the need for robust studies to clarify long-term effects and optimize treatment courses. This case demonstrates the potential for individualized treatment with CO\u003csub\u003e2\u003c/sub\u003e laser therapy for complicated gynecological conditions such as vulvar dysplasia and lichen sclerosus. Laser therapy should be considered as a valuable alternative to surgery, especially in cases where tissue preservation is desirable and side effects from medical treatment limit options.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of interest:\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003enone\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution:\u003c/h2\u003e\n\u003cp\u003eGM: Treated the patient, performed the photodocumentation , and achieved the written consent. Initiated the manuscript and approved the final versionECLL: Supervised the process and wrote the manuscript and approved the final versionGA: Wrote and approved the final version of the mansucriptFFL: Dealt with formalities of the treatment, applied for the permissions and the initialisation of treatment. Wrote and pproved the final version of the manuscript\u003c/p\u003e\n\u003ch2\u003eData Availability:\u003c/h2\u003e\n\u003cp\u003eTh written consent of the patient is uploaded in original and covers all the necessary permits to publishing the case and the photodocumentation\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDieter AA, Iglesia CB, Lee JH at al. A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO2 laser therapy. Lasers Surg Med. 2023 Aug;55(6):521-527. doi: 10.1002/lsm.23669\u003c/li\u003e\n \u003cli\u003eBurkett LS, Siddique M, Zeymo A, Brunn EA, Gutman RE, Park AJ, Iglesia CB. Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):968-978. doi: 10.1097/AOG.0000000000004332. PMID: 33957642.\u003c/li\u003e\n \u003cli\u003eMitchell L, Goldstein AT, Heller D et al. Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):979-987. doi: 10.1097/AOG.0000000000004409\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lichen sclerosus, laser treatment, vulvar dysplasia","lastPublishedDoi":"10.21203/rs.3.rs-6296245/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6296245/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"A case of lichen sclerosus in an octogenarian complicated with vulvar dysplasia is presented. 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