Curative Effect Analysis Of SmartXide² CO₂ Laser For Vulvar Lichen Sclerosus

Background and ObjectiveVulvar lichen sclerosus（VLS）is a rare chronic inflammatory non-neoplastic skin lesions,which predominantly occurs in the female vulva and mainly characterized by pruritus vulvae,burning pain.When it gets worse,the patient cannot bear to work and live normally,such as dysuria,sexual pain and unsatisfactory sex life caused by abnormal anatomical structure and morphology of the vulva,which causes great distress to women’s body and spirit.At present,VLS is an incurable disease,which purpose of treatment is mainly to control the patient’s subjective and objective symptoms.The treatment of VLS is mainly on topical corticosteroids（TCS）,but some patients feel that the treatment is poor efficacy,and long-term application will cause a series of adverse reactions,such as skin atrophy,telangiectasia,pigmentation,secondary infections.In recent years,fractional carbon dioxide（CO₂）laser therapy has been gradually accepted by patients due to near non-invasive treatment advantages,but which specific therapeutic effects and adverse reactions are still unclear.It is urgently needed to collect clinical data to confirm clinical efficacy and adverse reactions,and then provide patients with better treatment recommendations.Materials and methods1.Materials:Patients who were diagnosed as VLS by histopathology due to pruritus vulvae from September 2018 to September 2020 in the Second Affiliated Hospital of Zhengzhou University were divided into experimental group（laser group）and control group（drug group）according to their choice of treatment.Visual analogue score（VAS）was used to evaluate pruritus vulvae,burning pain,sexual pain,unsatisfactory sex life,the impact on quality of life,skin elasticity and skin color of the laser group and the drug group.The time of evaluation is before treatment,at the end of first treatment month,1 month and 3 months after a course of treatment.2.Statistical analysis:SPSS26.0 statistical software was used for data analysis,t test or non-parametric test was used for measurement data,andχ² test was used for count data.The test level wasα=0.05,and P<0.05 indicated that the difference was statistically significant.Results1.Comparative analysis of general data of the two groups of patientsA total of 206 patients were finally included in the statistical analysis（124 patients were treated with hydrocortisone butyrate and 82 patients were treated with Smart Xide²CO₂ laser）.There were not significant difference（P>0.05）between the two groups of patients in the general data which such as age,course of disease,whether menopause,basic disease,reproductive system-related surgery history,sexual life history,pruritus vulvae,burning pain,skin chapping and scratch.2.Comparative analysis of the treatment effect of the two groups of patientsIn the parameters examined（vulvar pruritus,vulvar burning pain and the impact on quality of life）at the end of the first drug treatment month and 1 month and 3 months after a course of drug treatment,the VAS was lessened than before treatment（P<0.005）.While there were not significant differences in sexual pain,unsatisfactory sex life,skin elasticity,skin color and lesion area compared with those before treatment（P>0.05）.At the end of the the first CO2 laser treatment month,and 1 month and 3 months after a course of CO₂ laser treatment,the symptoms of VLS which includes pruritus vulvae,burning pain,the impact of quality of life,unsatisfactory sex life and skin elasticity were more lessened than those before treatment（P<0.01）,While there was not statistically significant difference in sexual pain compared with those before treatment（P>0.05）.At the end of the first CO₂ laser treatment month,the skin color and lesion area did not change significantly compared with before treatment（P>0.05）,but at 1 month and 3 months after a course of CO₂ laser treatment,the skin color and lesion area were more improved（P<0.05）.The differences were not statistically significant in pruritus vulvae,vulvar burning pain,sexual pain,satisfactory sex life,the impact of quality of life,skin elasticity,skin color and lesion area between the two groups before treatment（P>0.05）.At the end of the first treatment month,1 month and 3 months after a course of treatment,the VAS of CO₂ laser treatment which include skin elasticity was less than drug treatment（P<0.05）,while there were not significant difference in lesion area,sexual pain and unsatisfactory sex life（P>0.05）.At the end of the first month of CO₂ laser treatment,the VAS of pruritus vulvae and the impact on quality of life were higher than that of drug treatment,while the VAS of pruritus vulvae and the impact on quality of life in one month and 3 months after the end of treatment were less than that of drug treatment（P<0.05）.In vulvar burning pain and skin color aspect,there were not significant differences between CO₂ laser and drug treatment at the end of the first treatment month（P>0.05）,while at the 1 month and 3 months after a course of treatment,the vulvar burning pain and skin color in the CO₂ laser treatment were better than the drug treatment,（P<0.05）.The effective rate of CO₂ laser treatment（85.37%）was higher than that of drug treatment（60.48%）,and the difference was statistically significant（χ²=14.661,P<0.001）.3.Adverse reactions and recurrence of patients in two groupsThe main adverse reactions of drug treatment were a slight increase in pruritus vulvae after stopping the drug（3.23%）,poor skin elasticity（6.45%）.The main adverse reactions of CO₂ laser treatment included mild pain in the treated area（2.44%）,swelling（6.10%）,a small amount of vulvar bleeding（6.10%）,pruritus vulvae（3.66%）,which symptoms were significantly relieved within 2-3 days after laser treatment.The recurrence rate of CO₂laser treatment（3.66%）was lower than that of the drug treatment group（24.19%）（χ2=15.472,P<0.001）.Conclusions1.Smart Xide² CO₂ laser can effectively relieve VLS’s pruritus vulvae,vulvar burning pain,unsatisfactory sex life,impact on quality of life,skin elasticity,skin color and lesion area.And the recurrence rate is low.2.The effective rate of hydrocortisone butyrate on VLS is lower than fractional CO₂ laser,and can relieve pruritus vulvae,vulvar burning pain and the impact on the quality of life.About a quarter of patients relapse after treatment.3.Smart Xide² CO₂ laser has the advantages of short treatment time,little pain,little damage and fast recovery.Compared with drug treatment,laser treatment which can significantly improve pruritus vulvae,vulvar burning pain,skin elasticity,skin color,and impact on quality of life,and has many advantages which include high treatment efficiency,low recurrence rate,and no severe adverse reactions,is worthy of recommendation.