Efficacy of ablative laser therapy for vulvar lichen sclerosus: a systematic review and meta-analysis of randomized controlled trials

To evaluate the efficacy of ablative laser therapy, compared to sham laser or topical corticosteroids, or an alternative laser treatment protocol for improving symptom burden and disease severity in women with vulvar lichen sclerosus (VLS). Systematic review and meta-analysis of RCTs. PubMed, Embase, Cochrane Library, Scopus, and Web of Science were searched for RCTs evaluating fractional ablative lasers in adult women with confirmed VLS. Primary outcomes were change in patient-reported symptom burden (visual analog scale [VAS]) and objective disease severity (LS Score, Clinical Scoring System, vulvar-appearance VAS). Mean differences and standardized mean differences were pooled using a random-effects model with restricted maximum-likelihood (REML) estimation of between-study variance and Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment of confidence intervals; heterogeneity was assessed with I²; risk of bias was assessed with Cochrane RoB 2.0. Three RCTs (151 patients) evaluating fractional CO2 laser versus sham laser, topical clobetasol propionate 0.05%, or low-dose CO2 laser were included, with follow-up of 18 to 32 weeks. Laser therapy produced a non-significant reduction in VAS total (mean difference, 1.04; 95% CI, -4.71 to 6.79; P=0.52; I²=58%) and LS severity scores (standardized mean difference, -0.27; 95% CI, -1.47 to 0.94; P=0.44; I²=65%). No adverse events were reported. Current evidence from three small, short-duration RCTs does not demonstrate a statistically significant benefit of fractional ablative laser therapy for vulvar lichen sclerosus. Larger, adequately powered trials with standardized outcomes are needed before laser therapy can be recommended as primary or adjunct treatment. PROSPERO CRD420261385742. Not applicable.