The Clinical Characteristics And The Efficacy Evaluation Of CO₂ Fractional Laser Treatment In Vulvar Lichen Simplex Chronicus

Background and ObjectiveVulvar lichen simplex chronicus（VLSC）is a subtype of hypopigmented disease of vulva,which is a kind of vulva mossy change caused by itching and scratching,with a negative recycle called“itching-scratching-more itching”.The symptoms are stubborn and easy to relapse,and can’t be cured,significantly affecting the female patient’s quality of life and mental health.Fractional carbon dioxide（CO₂）laser therapy is a kind of physical therapy for skin diseases,which has been widely used in cosmetology in recent years.More and more domestic and foreign scholars also discovered that it has a good therapeutic effect on hypopigmentation of the vulva.In this study,the general clinical data of VLSC patients and the changes of relevant scores before and after CO₂ fractional laser treatment were collected to preliminarily discuss the clinical characteristics of VLSC and the therapeutic effect of CO₂ fractional laser,so as to provide evidence for its further clinical application.Materials and MethodsA total of 91 VLSC patients who were pathologically diagnosed and treated with CO₂ laser in the department of Gynecology of Guangdong Women and Children Hospital from January 2021 to December 2021 were selected.General clinical data of patients were collected to explore the clinical characteristics of VLSC.CO₂ laser treatment was performed at an interval of 4-6 weeks.During the follow-up period,48patients received 1 treatment,20 patients received 2 treatments,and 23 patients received 3.Numerical ranking scale（NRS）was used to evaluate the severity of skin pruritus and hypopigmentation before and after treatment.Dermatological life quality index（DLQI）was used to evaluate the quality of life of patients before and after treatment.Pruritus and hypopigmentation scores were recorded 1 month after the end of the first treatment and the third treatment,respectively.DLQI scores were recorded1 month after the end of the third treatment.NRS and DLQI scores were compared before and after treatment to evaluate the efficacy of CO₂ fractional laser therapy.SPSS25.0 software was used for statistical analysis.Results1.The main symptoms of 91 VLSC patients were moderate to severe pruritus（85.71%）and mild to moderate hypopigmentation（87.91%）,with hypopigmentation mainly distributed in clitoris（78.00%）,inter-labial sulcus（62.60%）and labia majora（61.50%）.Most patients（91.21%）had two or more lesions.DLQI score was mainly more and severe（82.42%）.2.Among 91 VLSC patients,50 cases（54.95%）had definite causes,in which 34cases（37.36%）had local physical and chemical stimuli,7 cases（7.69%）had sleep,nerve and mental factors,8 cases（8.79%）had spicy stimulating food,and 14 cases（15.38%）occurred before and after menstruation or postpartum.There were 11 cases had two or more causes.3.Among 91 VLSC patients,82 patients felt pain,of whom 81 patients were mild pain and only 1 severe.The pain of 81 patients lasted for 3 to 7 days,and only 1 case lasted for half a month.4.Among 91 VLSC patients,68 cases were effective and 23 cases were ineffective1 month after the first treatment,with an effective rate of 74.73%.The mean itching relief time was（8.91±1.81）days.The scores of pruritus and hypopigmentation of vulva in 68 effective patients after treatment were lower than those before treatment,and the difference was statistically significant（all P<0.05）.Univariate and multivariate analysis both showed that pruritus score（OR:2.82,95%CI:2.59-3.06）and hypopigmentation score（OR:0.98,95%CI:0.96-0.99）before treatment were independent factors affecting the treatment effect after one treatment with CO₂fractional laser（all P<0.05）.5.Among 23 VLSC patients who received three treatments,20 were effective and3 were ineffective 1 month after the third treatment,with an effective rate of 86.96%.The scores of vulva pruritus,vulva hypopigmentation and skin disease quality of life index（DLQI）in 1 month after the end of the third treatment all decreased compared with those before treatment,and the differences were statistically significant（P<0.05）.Pruritus score and dermatological quality of life index（DLQI）were correlated with the number of treatments,showing a decreasing trend with the number of treatments increasing（r=-0.79,r=-0.63,both P<0.05）.Conclusions1.VLSC is mainly characterized by moderate to severe pruritus of vulva and mild to moderate hypopigmentation,mainly distributed in the clitoris,inter-labial sulcus and labia majora,and the quality of life of patients is much and seriously affected.Local physical and chemical stimulation,neuropsychiatric factors,spicy food stimulation,pre/post menstruation or postpartum may be the predisposing factors.2.CO₂ fractional laser is an effective method for VLSC treatment.It can relieve pruritus rapidly,improve hypopigmentation and skin quality of life significantly,and is worthy of clinical promotion.3.After the first CO₂ laser treatment,the therapeutic effect of VLSC patients was related to the degree of pruritus and hypopigmentation before treatment.