Photodiagnosis Photodyn Ther. 2025 Jun;53:104623. doi: 10.1016/j.pdpdt.2025.104623. Epub 2025 May 8.

ABSTRACT

BACKGROUND: Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis with limited therapeutic options for refractory or recurrent cases. This study aimed to evaluate the efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with microneedling in VLS management.

METHODS: Sixty-four VLS patients (diagnosed from January 2019 to December 2023) underwent ALA-PDT (incubation: 3 hours; irradiation: 635 nm, 100 mW/cm²) combined with microneedling (0.5 mm depth) every 2 weeks for 6 sessions. Outcomes included modified mLSSI score, ISSVD severity grading, Dermatology Life Quality Index (DLQI), dyspareunia Visual Analog Scale (VAS), adverse events, and 6-month recurrence rates.

RESULTS: At 12 weeks, the total efficacy rate reached 92.19 % (59/64). mLSSI scores significantly decreased from 9.07±2.32 to 2.42±1.79 (P < 0.001), with erosion/fissure improvement being most pronounced (86.29 % reduction). ISSVD grading showed complete resolution of severe cases (baseline: 85.94 % vs. 0 % post-treatment), with 90.63 % downgraded to mild. Subgroup analysis revealed superior outcomes in patients with disease duration <1 year (baseline mLSSI: 7.68±2.29 vs. 9.97±1.87 in a long-duration group; t = 4.382, P < 0.0001), particularly in skin texture recovery (90.59 % vs. 83.72 %). DLQI scores decreased by 73.74 % (15.04±2.80 to 3.95±2.02), and 88.89 % (24/27) of patients reported dyspareunia relief (VAS: 5.64±2.58 to 1.50±1.63). Recurrence occurred in 21.88 % (14/64) at 6 months, with no symptom exacerbation (P > 0.05). Only 5 cases (7.81 %) experienced transient erythema, and no severe adverse events were observed.

CONCLUSION: ALA-PDT combined with microneedling achieves rapid and sustained symptom remission, improves quality of life, and demonstrates excellent safety in refractory VLS. Early intervention (disease duration <1 year) correlates with superior therapeutic outcomes. This combination therapy represents a promising strategy for PDT-enhanced VLS management.

PMID:40345471 | DOI:10.1016/j.pdpdt.2025.104623