Microablative fractional radiofrequency as a therapeutic option for vulvar lichen sclerosus: a pilot study

Abstract

Objectives: To assess the clinical response to and the histomorphometric effects of microablative fractional radiofrequency (MFR) in women with symptomatic vulvar lichen sclerosus (VLS).

Methods: This was a pilot study on the use of MFR for the treatment of VLS. Upon recruitment and at each treatment session, all participants were examined and each of their symptoms were rated on a visual analog scale. After the procedure, the participants completed a satisfaction questionnaire. We compared the morphometric findings of vulvar biopsies performed at enrollment and after the last treatment session. The participants were divided into three groups according to previous treatment with corticosteroids: G1, no previous treatment; G2, treated for up to 5 years; and G3, treated for >5 years.

Results: This study included 26 women. After two to three sessions, most participants in all groups became either "asymptomatic" or "much better" than before treatment and were "very satisfied" or "satisfied" with the intervention. Pruritus and burning sensation were the most frequently reported symptoms. Nearly 40% of the participants in all groups reported complete remission of symptoms. The improvement was rated as moderate or higher by 80%, 76%, and 66% of the women in groups 1, 2, and 3, respectively. The improvement of symptoms persisted for 11 months (range, 7-16 months), on average, after the treatment. Type III collagen concentration significantly increased and was associated with important symptom improvement. Tissue trophism and vascularization also increased but did not reach statistical significance, probably because of the small number of cases.

Conclusions: MFR may be an effective and safe treatment for symptomatic VLS.

Figure 1. Clinical data of the participants after treatment compared to their baseline status, and the participants’ satisfaction with MFR. Group 1, no previous corticosteroid treatment; group 2, treated for up to 5 years; group 3, treated for >5 years.

Figure 2. Symptom intensity scores during MFR treatment (mean and standard deviation).

Figure 3. Changes in type III collagen concentration, epithelial thickness, and symptom intensity scores before and after MFR treatment.

Figure 4. Hematoxylin and eosin-stained histological slides. Pretreatment (left) and posttreatment (right) with MFR. A. Group 1 patient, age 62 years, 8 months since diagnosis: 100% improvement in pruritus, asymptomatic and satisfied. B. Group 2 patient, age 72 years, 4 years since diagnosis: 100% improvement in pruritus, persistent improvement at 12 months after treatment, much better and very satisfied. C. Group 3 patient, age 82 years, 7 years since diagnosis: 100% improvement in pruritus, much better and very satisfied.

Figure 5. A 65 year-old patient with VLS diagnosed 22 years prior, with pretreatment and posttreatment pruritus intensity VAS scores of 10 and 5, respectively. The patient reported feeling “somewhat better” but “satisfied” after MFR treatment. Upper photos: microablations in MFR sessions and the fractioned electrode. Lower photos: vulvar appearance before treatment (A), and improved skin texture and color after treatment (B).