Clinical, histological and epithelial morphological analysis in Vulvar Lichen Sclerous treated with Photodynamic therapy compared to topical corticosteroid

Vulvar Lichen Sclerosus (VLS) is a non-neoplastic, non-infectious, chronic inflammatory dermatosis by unknown etiology that causes intense pruritus and genital stenosis. VLS can cause pain for evacuation and urination, limiting the social-sexual life. At present, the most accepted treatment is the topical ultra-potent corticosteroids, which  decrease clinical symptoms, but may cause several side effects. The literature indicates to chronic dermatosis that Photodynamic therapy (PDT) is an effective treatment, due to its anti-inflammatory and immunomodulatory effects. The aim of this study was to evaluate and compare PDT and topical Corticosteroid (CG) responses in VLS by clinical (pruritus), histological and epithelial morphological analysis. A prospective, randomized, controlled clinical study in VLS diagnosed by 23 patients at the Perola Byington Hospital was performed. Twelve women were allocated at  topical steroid group and eleven at PDT group. Immunohistochemical analysis by Cytokeratins 10 and 14, Laminin , as well as Mast cells (anti-inflammatory response) were verified. Statistical analyzes among groups evaluation by significant statistically (p< 0.05) were considered. Histological pattern changed in all treatments (p=0,001). Hydropic degeneration, hyperkeratosis exhibited diminution post treatments. All therapies reduced the inflammatory process, CG in 58%, PDTgroup in 30% .Mast cells indicated reduction in all groups, but more significantly in the PDT group (p= 0.405). CK10 increased in both groups ( p= 0.425) and CK14 increased more significantly in PDT group ( p=0.174) . Laminin increased post treatments : CG  (p= 0.019) and PDTgroup ( p=0.018). Pruritus reduced in all groups, showing no statistical difference. Recurrences were considered in 18 months of follow up and varied according to the groups: CG recurred in 60%, PDTG in 36.3% .The PDT in VLS could be a promising and safe treatment option, especially compared to the continuous use of topical corticosteroids and their adverse effects.