The comparison of fractional CO₂ laser and focused ultrasound for vulvar lichen sclerosus: a retrospective study

To compare the efficacy of fractional carbon dioxide laser (FxCO₂) and focused ultrasound (FUS) in treating vulvar lichen sclerosus (VLS). This single-center retrospective study included biopsy-proven VLS patients who did not respond to first-line topical corticosteroids and were treated with FxCO₂ or FUS as an alternative between January 2020 and October 2022. The efficacy was evaluated using the Cattaneo score and clinical scoring system (CSS). A subgroup analysis was conducted to compare efficacy based on VLS severity. At the 3-month follow-up, the total effective rates were similar between FxCO₂ (91.18%, 31/34) and FUS (88.57%, 31/35) (<i>p</i> &gt; 0.05). At the 6-month follow-up, the total effective rates for FxCO₂ decreased to 85.29% (29/34), while FUS remained at 88.57% (31/35) (<i>p</i> &gt; 0.05). Recurrence rates were 14.7% (5/34) for FxCO₂ and 11.4% (4/35) for FUS (<i>p</i> &gt; 0.05) at the 6-month follow-up. Although there was no significant difference in total CSS scores and clinician-administered sign scores between FxCO₂ and FUS at both follow-ups (<i>p</i> &gt; 0.05), FxCO₂ suggested superior patient-administered symptom improvement at 3-month (median: FxCO₂ 3 vs. FUS 5, <i>p</i> &lt; 0.05) and 6-month follow-ups (median: FxCO₂ 3 vs. FUS 5, <i>p</i> &lt; 0.01). FxCO₂ and FUS show similar efficacy in treating VLS, with FxCO₂ suggesting a trend toward greater symptom relief. Further studies are needed to validate these preliminary observations.