The Application Of Fractional CO₂ Laser In The Treatment Of Common Vulva White Lesions

Objective: To collect clinical data of patients with white lesions of the vulva,and to analyze disease-related factors.To investigate the feasibility of fractional CO₂ laser in the treatment of common Vulva White Lesions.Methods: A total of 43 patients with white lesions of the vulva who were diagnosed pathologically in the vulvar disease clinic of Dalian Maternal and Child Health Hospital and choose the treatment of fractional CO₂ laser were selected from 2018.10 to 2019.10.Collect clinical data of patients and analyze the factors related to the disease.Take 3times of treatment as the node of the treatment cycle,and record the scores of the two types of patients before treatment,1 month after the end of the first treatment,1 month after the end of the third treatment,and 1 month after the end of the treatment cycle.Effective means that the degree of pruritus is reduced by 1 degree or more after treatment;ineffective means that the degree of pruritus has not improved or worsened.The degree of relapse refers to a recovery or an increase in the degree.A dermatological quality of life index（DLQI）and anxiety self-assessment scale（SAS）survey were performed before treatment and 1 month after the end of the treatment cycle,respectively,to assess whether the patients’ quality of life and mental state had changed.Results: Among the 43 patients,there are 20 vulvar lichen sclerosus and 23 vulvar lichen simplex chronicus.The average age of 20 vulvar lichen sclerosus patients was 45.79±13.55 years,and the average course of disease was 6.79±8.23 years.The average age of 23 vulvar lichen simplex chronicus was 38.78±15.78 years,and the average course was 4.91±7.03 years.Lesions in patients with vulvar lichen sclerosus are symmetrically distributed.Among them,50% of patients have lesions that extend or gradually extend to the perianal skin,forming "8" shaped lesions;62.5% of patients with vulvar lichen simplex chronicus are limited to unilateral lesions.The score of night pruritus after the first treatment of 20 cases of vulvar lichen sclerosus was statistically significant compared with that before the treatment（P <0.05）.Compared the score of day and night pruritus 1 month after the end of the treatment cycle was with that before the treatment,The differences were statistically significant（P <0.05）;the scores of day and night pruritus after the end of the first treatment in 23 patients with vulvar lichen simplex chronicus were statistically significant compared to before treatment（P <0.05）,and after the end of the treatment cycle the day and night pruritus scores were statistically significant compared with those before treatment（P <0.05）.Compared the one month after the end of the treatment cycle with the one month after the end of the first treatment,the P value of each group showed a downward trend.15 patients with vulvar lichen sclerosus who completed the cycle treatment within fractional CO₂ laser with the increase in the number of treatments during the day and night itching Both the degree and the elasticity of the skin showed a decreasing trend;the skin color did not change significantly.The 16 cases of patients with vulvar lichen simplex chronicus who completed the cycle treatment showed a trend of reduction in each observation index of patients with laser treatment cut-off point as the number of treatments increased.Among of 20 patients with vulvar lichen sclerosus,35.00% of patients have varying degrees of anxiety,and 80.00% of patients’ lives are affected to varying degrees.Compete the dermatological quality of life index（DLQI）grade 1 of 1month after the treatment cycle withthe level 2 before treatment was statistically significant（P <0.05）;Among of 23 patients with vulvar lichen simplex chronicus,13.04% were associated with varying degrees of anxiety,and 86.95% of the patients’ lives were affected to varying degrees.Compete the dermatological quality of life index（DLQI）grade 1 of 1 month after the treatment cycle withthe level 1 before treatment was statistically significant（P <0.05）.20 cases of vulvar lichen sclerosus were treated once in 3 cases,2 cases were in 3 cases,3 cases were in 4 cases,and more than 3 times were in 10 cases,the median treatment was 3 times;23 cases were treated with vulvar lichen simplex chronicus 2 cases were treated once,5 cases were treated twice,10 cases were treated 3 times,and 6 cases were treated more than 3 times.The median treatment was 3.5 times.15 patients with lichen sclerosus who completed the treatment cycle had a statistically significant difference in nighttime pruritus scores 1 month after the first treatment（P <0.05）;There was a statistically significant difference in the nighttime pruritus score 1 month after the 3rd treatment compared with that before the treatment（P <0.05）;Compare with one month after the third treatment compared with one month after the first treatment,There was a statistically significant difference in nighttime pruritus scores（P <0.05）.16 patients with vulvar lichen simplex chronicus who completed the treatment cycle had a statistically significant difference in daytime pruritus scores 1 month after the end of the first treatment（P <0.05）;There was a statistically significant difference in nighttime pruritus scores 1 month after the end of the 3rd treatment compared with that before treatment（P <0.05）.20 patients with vulvar lichen sclerosus had an effective rate of 95.00% 1 month after the end of the first treatment,1 month after the third treatment had an effective rate of 100.00%,and 23 patients with vulvarlichen simplex chronicus had a first The effective rate was 82.60%one month after the end of treatment;the effective rate was 86.90% one month after the end of the third treatment.All patients developed slight edema within 1-2 days after treatment,with occasional slight swelling and no other discomfort;all patients had slight desquamation ranging from 7-25 days after treatment was completed;Most patients report severe paroxysmal itching within 7-20 days after the end of treatment,and the degree of itching at night is basically the same;The symptoms improved spontaneously for 1-2 days,and no serious adverse reactions occurred.Conclusion: Most of the vulvar lichen sclerosus of vulva are symmetrical and gradually develop into "8" shaped lesions.vulvar lichen simplex chronicus of vulva usually develop unilaterally and gradually spread to the surrounding and contralateral sides.The treatment of fractional CO₂ laser in vulva White lesions have a significant effect in one treatment,and stubborn symptoms are better in three treatments.It can significantly improve the pruritus symptoms and skin condition of patients,improve the quality of life,and have good patient compliance,which is feasible;In terms of improvement in pruritus symptoms,the treatment response of vulvar lichen sclerosus to fractional CO₂ laser is better than that of vulvar lichen simplex chronicus;In the improvement of vulvar color,the response of vulvar lichen simplex chronicus to fractional CO₂ laser is better than vulvar lichen sclerosus.