Optical Coherence Tomography Angiography in the Assessment of Vulvar Lichen Sclerosus Vascularity and Epithelial Thickness In Vivo

Vulvar lichen sclerosus is a chronic inflammatory skin condition that leads to scarring and an increased risk of squamous cell carcinoma. It presents clinically as atrophic white patches or plaques, often with associated fissures, erosions, hyperkeratosis, purpura or ecchymoses. The chronic inflammation in vulvar lichen sclerosus leads to permanent scarring, resulting in pain syndromes and genitourinary complications. While diagnosis is often made clinically, skin biopsies are considered the gold standard for diagnosis. Additionally, biopsies are often required throughout the course of the disease to monitor for the development of malignancy. Thus, there is a need for noninvasive, high-sensitivity, real-time imaging to evaluate vulvar lichen sclerosus changes. This study presents a proof-of-concept evaluation of a 1.7-μm optical coherence tomography (OCT)/OCT angiography (OCTA) system with enhanced penetration depth and high resolution for characterizing the structural and microvascular features of VLS. The primary objective was to evaluate the feasibility of using this imaging technology to quantitatively measure vulvar epithelial thickness and vascular changes across different anatomical sites (labia majora, labia minora, and interlabial sulci) in both VLS patients and healthy controls. By leveraging the increased penetration depth of the 1.7-μm OCT system, we aimed to provide a deeper understanding of VLS-associated tissue alterations and explore its potential as a non-invasive alternative to biopsies for disease assessment and monitoring.