Use of fractional and microablative CO2 laser in cases of vulvar lichen sclerosus: a clinical-histological analysis

Objective: To evaluate the clinical and histological response of patients with vulvar lichen sclerosus (VLS) following fractional and microablative CO₂ laser treatment. Methods: This interventional clinical study included 14 patients diagnosed with VLS. The participants underwent three CO₂ laser sessions with a monthly interval. Clinical assessments and biopsies were performed at baseline and six weeks after the final session. Primary outcomes were improvement in symptoms (Visual Analog Scale – VAS) and clinical signs (Global Aesthetic Improvement Scale – GAIS), associated with histological regression. Secondary outcomes included quality of life (Skindex-29) and specific histological parameters, such as hyperkeratosis, dermal elastic fibers, and type I/III collagen ratio. Results: All patients reported vulvar pruritus at baseline. After treatment, 50% became asymptomatic (p = 0.016), with a reduction in mean VAS score from 8 to 1 (p = 0.016). Burning sensation, present in 71.4% at baseline, decreased to 28.5% at follow-up (p = 0.031), with VAS scores declining from 6 to 0 (p = 0.008). Clinical improvement assessed by GAIS was observed in up to 64.3% of patients, with high inter-rater agreement (ICC = 0.855). Histological regression occurred in 42.9% of cases (p = 0.031). Quality of life significantly improved across all Skindex-29 domains (p < 0.05). There was a reduction in hyperkeratosis (p = 0.032) and in type I/III collagen ratio (p = 0.022), along with reappearance of dermal elastic fibers (p = 0.024). Conclusion: CO₂ laser therapy reduced symptoms and improved clinical, histological, and quality-of-life outcomes, suggesting therapeutic potential for VLS. Larger controlled studies are warranted.