Photodynamic therapy of vulvar lichen sclerosus et atrophicus in a woman with hypothyreosis – Case report

doi:10.1016/j.pdpdt.2012.02.002

Photodiagnosis and Photodynamic Therapy

Volume 9, Issue 2, June 2012, Pages 186-188

https://doi.org/10.1016/j.pdpdt.2012.02.002 Get rights and content

Summary

Lichen sclerosus et atrophicus (LSA) is disease of skin and mucosa, its pathogenesis remains unknown. Itching, pain and burning sensations and atrophy of vulva impair quality of life. Treatment is symptomatic. We report case of 30-year old woman with lesions in vulva in which series of topical PDT were carried out. We applied Levulan^®Kerastick^® for 4 h and after that lesions were illuminated with red light. Along with above treatment patient started receiving Euthyrox^®, because of recently diagnosed hypothyreosis. Significant relief from subjective symptoms was achieved and lesions in vulvar region disappeared. Combination of topical PDT with hormonal therapy allowed controlling course of disease and minimizing symptoms, and thus improved quality of life.

Introduction

Pathogenesis of lichen sclerosus et atrophicus (LSA) in skin remains unknown. This disease affects predominantly women in perimenopausal age that suggests possible role of hormonal distempers [1]. Itching, pain, atrophy of vulva and burning sensations in LSA can impair quality of life. Effectiveness of routine therapeutic strategies is hard to confirm. Results of therapy are not satisfactory. Treatment is symptomatic.

Photodynamic therapy is well known method which exploits phototoxic reactions in pathologic cells. Since 1990s number of indications for PDT in dermatological disorders increases. We report case of LSA in vulva in young woman with hypothyreosis, where topical 5-aminolevulinic acid-PDT was used.

Section snippets

Case report

The patient was 30-year old woman with confluent lesions with spontaneously bleeding erosions and crusts located in vulva (Fig. 1). Disease had started 3 years ago with severe itchings and burning sensations. LSA was confirmed histopathologically. Patient was treated earlier with local application of clobetasol propionate and tacrolimus with temporary improvement in form of disappearing of itching.

We used Levulan^®Kerastick^® (5-aminolevulinic acid HCl), (DUSA Pharmaceuticals) in patient for 4 h.

Discussion

PDT is method of treatment in dermatology which is well known [2]. Positive effects are documented in non-tumor skin diseases, infectious and autoimmune resulting in significant improvement in quality of life.

Etiopathogenesis of LSA is not completely elucidated. It is chronic disease with fibroblasts defect that leads to overproduction of collagen [3]. Immunological mechanisms play important role and also clinical data suggest relation between LSA and hormonal disorders. Mostly postmenopausal

Conflicts of interest

No conflicts of interest are declared.

References (10)

C.A. Morton
How to optimise topical photodynamic therapy in dermatology
Photodiag Photodyn Ther
(2006)
T. Biniszkiewicz et al.
Therapeutic effects of 5-ALA-induced photodynamic therapy in vulvar lichen sclerosus
Photodiag Photodyn Ther
(2005)
A. Zawislak et al.
Clinical and immunohistochemical assessment of vulval intraepithelial neoplasia following photodynamic therapy using a novel bioadhesive patch-type system loaded with 5-aminolevulinic acid
Photodiag Photodyn Ther
(2009)
A. Marini et al.
Lichen sclerosus
Hautarzt
(2005)
H.J. Strittmatter et al.
Calcineurin antagonists in vulvar lichen sclerosus
Arch Gynecol Obstet
(2006)

There are more references available in the full text version of this article.

Cited by (13)

5-Aminolevulinic acid photodynamic therapy in refractory vulvar lichen sclerosus et atrophicus: Series of ten cases
2018, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
Some lesions with depigmentation showed repigmentation at 6 months. The results were similar to those reported previously [14,18–23]. The mean VAS scores of subjective symptoms were clearly lower after treatment than before.
Vulvar lichen sclerosus et atrophicus (VLSA) is a chronic inflammatory skin disease of unknown etiology that mainly affects postmenopausal and perimenopausal women. The primary clinical symptoms of VLSA are itching, burning pain, and dyspareunia that can results in decreased quality of life. Existing therapies including topical corticosteroid ointment, topical calcineurin inhibitors, estrogens, are not very effective for treatment of VLSA.
To evaluate the effectiveness and safety of 5-aminolevulinic acid mediated photodynamic therapy (ALA-PDT) in the treatment of VLSA.
Ten patients with VLSA who had failed conventional treatment received ALA-PDT. 10% 5-ALA in an oil-in-water emulsion was applied to the lesions and occluded with plastic film for 3 h, when the lesions were irradiated with 100 mW/cm², 635 ± 15 nm red light for 20 min. Treatments were repeated three times at 2-week intervals. Objective and subjective symptoms and signs of the vulvar lesions based on horizontal visual analogue scales were recorded at each treatment and 1, 3, and 6 months after the last session. The quality of life was assessed using dermatology life quality index (DLQI) questionnaire.
All patients completed three ALA-PDT treatments and the follow-up visits. Clinical symptoms of itching disappeared completely in nine patients, one patient had itching decreased from severe to mild. All subjects showed objective improvement in lesions. The DLQI of all cases improved after treatment. The main side-effects of ALA-PDT were pain, erythema, and swelling. Side-effects were transient and tolerable. All patients reported being “satisfied” or “very satisfied” with their outcomes.
ALA-PDT is an effective and safe approach for the treatment of VLSA
Photodynamic therapy with green light for the treatment of vulvar lichen sclerosus – Preliminary results
2017, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
Moreover, long-term maintenance treatment is later needed to avoid a relapse and prolonged application may result in various side effects. Alternatively, LS can be treated by using photodynamic therapy (PDT) [5–9]. In contrast to many conventional therapeutic modalities employed against LS, the side effects for PDT are comparatively few and transient [10].
The standard treatment for lichen sclerosus (LS) is symptomatic and is primarily based on the chronic use of corticosteroids, sometimes resulting in unsatisfactory effects. Therefore, other non-pharmacological methods are being sought, which are less aggravating for the patient. LS can be treated topically by using photodynamic therapy (PDT) based on 5-aminolevulinic acid (5-ALA). Unfortunately, therapy with the red light is often connected with severe local pain during the illumination. Green light can also be characterised by its ability to turn on photodynamic reactions in cells.
The aim of this study was an evaluation into the efficacy and tolerance of 5-ALA-PDT with a green light (540 nm ± 15 nm) in 11 patients with chronic LS that were characterised by severe itching. The disease lasted from 1.5 to 4 years. All the patients were treated with three sessions of PDT.
Following treatment with PDT, a significant improvement of local status, as well as a reduction of the main symptom (pruritus), were observed. No patient complained of severe pain during the sessions that would have required an interruption of irradiation or local application of analgesics.
Our preliminary results of using green light in PDT for superficial skin non-oncological lesions are very promising but require further studies.
Proposition of standardized protocol for photodynamic therapy for vulvar lichen sclerosus
2022, Journal of Dermatological Treatment
Photodynamic therapy in the treatment of vulvar lichen sclerosus: A systematic review of the literature
2021, Journal of Clinical Medicine
Vulvar dystrophies: a modern view of the problem
2021, Journal of Obstetrics and Women's Diseases
Lichen sclerosus et atrophicus: modern view on the problem
2018, Russian Bulletin of Obstetrician-Gynecologist

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Case reportPhotodynamic therapy of vulvar lichen sclerosus et atrophicus in a woman with hypothyreosis – Case report

Summary

Introduction

Section snippets

Case report

Discussion

Conflicts of interest

Photodiag Photodyn Ther

Photodiag Photodyn Ther

Photodiag Photodyn Ther

Lichen sclerosus

Hautarzt

Calcineurin antagonists in vulvar lichen sclerosus

Arch Gynecol Obstet

Case report
Photodynamic therapy of vulvar lichen sclerosus et atrophicus in a woman with hypothyreosis – Case report