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

Abstract 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.