Two-year follow-up of women with lichen sclerosus treated with laser therapy: A prospective observational study

This prospective observational study evaluates the 2-year follow-up of a randomized controlled trial comparing a novel dual Nd:YAG/Er:YAG laser therapy with topical corticosteroid therapy for vulvar lichen sclerosus (LS). After the 6-month primary outcome assessment, observation continued with optional further treatment, including a free crossover laser therapy for the initial steroid group. At 24 months, participants were assessed for their subjective symptoms, treatment satisfaction, and maintenance therapy use. Sixty-five of 66 participants underwent four laser sessions during the 24-month follow-up period. The median interval between the final laser treatment and symptom recurrence requiring initiation of maintenance corticosteroid therapy was 7 months (interquartile range [IQR] 2.5-12.5 months). During follow-up, 40 women used maintenance corticosteroid therapy and five decided for an additional top-up laser treatment after a median interval of 18 months (IQR 16-20 months). Overall satisfaction with the treatment regimen was high, and most participants perceived laser therapy as effective. Subjective symptoms remained significantly improved compared with baseline throughout follow-up (p < 0.001). Among sexually active participants, the proportion without dyspareunia increased significantly from 4/31 at baseline to 14/31 at 24 months (p = 0.002). Dual Nd:YAG/Er:YAG laser therapy adjunct to maintenance corticosteroid therapy was well accepted and resulted in sustained symptomatic improvement in women with vulvar LS over 24 months. This combination therapy could represent a potential advance in the long-term management of LS.