Efficacy of ablative laser therapy for vulvar lichen sclerosus: a systematic review and meta-analysis of randomized controlled trials.
Marie Line Chedid, Laurentia Fidella Averina Setia Santoso, Reina Ibrahim et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed randomized trials of fractional ablative laser therapy in adult women with confirmed vulvar lichen sclerosus. Three RCTs involving 151 patients compared fractional CO2 laser with sham laser, topical clobetasol, or a lower-dose CO2 laser protocol, with follow-up of 18 to 32 weeks. Pooled results did not show statistically significant improvement in patient-reported symptoms (VAS mean difference, 1.04; 95% CI, -4.71 to 6.79; P=0.52) or disease severity (standardized mean difference, -0.27; 95% CI, -1.47 to 0.94; P=0.44). No adverse events were reported.
Key findings
- Across three RCTs (151 patients), the VAS total mean difference was 1.04 (95% CI, -4.71 to 6.79; P=0.52; I²=58%).
- The pooled standardized mean difference in LS severity scores was -0.27 (95% CI, -1.47 to 0.94; P=0.44; I²=65%).
- No adverse events were reported in the included trials.
Why it matters
Vulvar lichen sclerosus can involve both symptom burden and visible disease severity, so treatments need evidence of benefit across these outcomes. This synthesis found no statistically significant improvement with fractional ablative laser therapy compared with the studied alternatives. The findings help clarify that current trial evidence is insufficient to establish laser therapy as an effective treatment option.
What to keep in mind
Evidence came from only three small RCTs, with follow-up of 18 to 32 weeks; the authors call for larger, adequately powered trials with standardized outcomes.