Clinical and Dermoscopic Assessment of Vulvar Lichen Sclerosus After 5-Aminolevulinic Acid Photodynamic Therapy：A Prospective Study.

ABSTRACT

BACKGROUND: To date, there have been no satisfactory treatments to cure vulvar lichen sclerosus (LS). 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) has been introduced in the treatment of vulvar lichen sclerosus (VLS), but no dermoscopic assessment has been conducted. METHODS: The included patients received six ALA-PDT sessions at 2-week intervals. After the third and sixth treatment, all patients were evaluated for clinical and dermoscopic variables with numeric scores assigned to each parameter. RESULTS: Twenty-four VLS patiens were included in this study. Both primary objective signs (lesion size and depigmentation) and subjective symptoms (itching and burning pain) were improved remarkably after the third treatment, and further improvements were obtained after the sixth treatment. Among the dermoscopic variables, the early changes were the decreased score of bright white or white-yellowish structureless areas and the increased score of vessels, and further changes of these two dermoscopic features were observed after the sixth treatment. There were no changes in pink structureless areas, white shiny streaks, follicular plugs, brown structureless areas, purple dots, and erosions after the third treatment, but after the sixth treatment, the scores of these dermoscopic features decreased significantly except that the score of brown structureless areas increased siginificantly. There was no change in the score of peppering blue-gray dots. Both pain and erosions during the treatment could be tolerated. CONCLUSIONS: ALA-PDT is effective for VLS. In addition, dermoscopic assessment may be more precise for indicating minute changes invisible to unaided eyes which are useful to monitor the response to treatments.