Efficacy and safety of 5-aminolevulinic acid photodynamic therapy in refractory genital lichen sclerosus

Genital lichen sclerosus (GLS) is a chronic inflammatory skin disease affecting the genital and anal areas. Treatment of refractory remains a challenge in clinical practice. This study evaluated the efficacy and safety of 5-aminolevulinic acid photodynamic therapy (5-ALA PDT) for refractory GLS. Thirty-five patients (32 females, 3 males) underwent 5-ALA PDT with lesion pretreatment and fluorescence-guided therapy. Most experienced significant pruritus relief, improved skin elasticity and color, and lesion reduction. After six sessions, 31.43% achieved complete pruritus resolution, and 8.57% achieved remission after three sessions. Cattaneo scores significantly decreased (P < 0.05). Mild pain was the primary adverse reaction, alleviated by ice compression or analgesics. 5-ALA PDT demonstrated strong efficacy and safety, improving GLS symptoms and warranting broader clinical application.