Diagnosis and assessment of vulvar lichen sclerosus (VLS) using optical coherence tomography angiography

Lichen sclerosus (LS) is a chronic inflammatory skin condition that has a predilection for the anogenital skin in women. The true prevalence of vulvar LS is unknown, underdiagnosed, and underreported 1. Studies have estimated LS affects up to 3% of postmenopausal women, with a rising incidence 2. The disease also affects premenopausal women and children. Overall, this is an underserved condition and the related delay in diagnosis can have a profound burden on patients' quality of life and health outcomes, leading to irreversible scarring, infection, vulvar architectural distortion, genitourinary complications, itch, and pain syndromes 3. There is a limited understanding of disease pathogenesis and no FDA-approved treatment options, with current guidelines recommending lifelong treatment. In the context of Vulvar Lichen Sclerosus, Skin biopsies are considered the standard method for detecting LS. However, they have certain drawbacks, as they are invasive, particularly in the sensitive vulvar area, and can be time-consuming. Approximately 5% of women with LS eventually develop vulvar squamous cell carcinoma (SCC), and half of all vulvar cancers arise in the presence of LS 4. Therefore, patients need frequent monitoring, often requiring additional biopsies to assess the development of SCC or its precursors in long-standing LS lesions. Given the challenges associated with diagnosing VLS and monitoring SCC development in the context of an inflammatory skin condition, there is a high demand for noninvasive, high-sensitivity, real-time imaging techniques that can be performed in vivo. Hence, our study involves the design and development of a 1.7-μm optical coherence tomography angiography (OCTA) technique for diagnosing and monitoring of VLS lesions.