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Medical Science Monitor Basic Research


eISSN: 1643-3750

Efficacy of 5-Aminolevulinic Acid (ALA)-Photodynamic Therapy (PDT) in Refractory Vulvar Lichen Sclerosus: Preliminary Results

Fenghua Zhang, Daoyun Li, Lijuan Shi, Yijia Gu, Yun Xu, Changping Wu

Department of Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)

Med Sci Monit 2021; 27:e927406

DOI: 10.12659/MSM.927406

Available online: 2020-11-03

Published: 2021-01-07


BACKGROUND: As a chronic inflammatory skin disease of unknown etiology, vulvar lichen sclerosus (VLS) mainly affects postmenopausal and perimenopausal women. The main clinical manifestations of VLS include itching, burning pain, and sexual dysfunction, which can lead to a decline in quality of life. The existing treatment options include topical corticosteroid ointment, estrogen, and traditional Chinese medicine; however, their therapeutic effects on VLS remain unsatisfactory.
MATERIAL AND METHODS: Thirty patients with VLS and routine treatment failure were treated with 5-aminolevulinic acid (ALA)-photodynamic therapy (PDT). A 20% ALA water-in-oil emulsion was applied to the vulvar lesions and sealed with plastic film for 3 h. Patients were irradiated at a power density of 60 to 90 mW/cm² with a red light at a wavelength of 635±15 nm for 20 min, delivering a total dose of 100 to 150 J/cm² per session. The treatment was repeated 3 times every 2 weeks. The objective parameters, female sexual function index (FSFI) and quality of life (QoL) scores, were used before and after treatment to evaluate the clinical curative effect.
RESULTS: All patients completed 3 treatment cycles of ALA-PDT and follow-up visits. The clinical symptoms of pruritus completely disappeared in 27 cases, and itching improved from severe to mild in 3 cases. The pathological changes of all patients were objectively improved. FSFI score decreased significantly after treatment (P<0.001). The main adverse effects of ALA-PDT were pain, erythema, and swelling. These adverse effects were temporary and tolerable. The QoL score was significantly improved after treatment (P<0.001).
CONCLUSIONS: ALA-PDT is an effective and safe approach for the treatment of VLS.

Keywords: Lichen Sclerosus et Atrophicus, Photochemotherapy, vulvar lichen sclerosus