Experience on the use of photodynamic therapy in vulvovaginal lichen plane

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Abstract


BACKGROUND: Lichen plane (LP) occurs in 0.5%–1% of the population. The exact epidemiology of genital LP is unknown. According to various data, LP occurs in 4–9% of all cases of vulvar lesions. The LP of the oral cavity and the vulva occurs in 19–57% of cases. The clinical forms of LP that occur in the anogenital region in women include the erosive, papulosquamous, and less often hypertrophic forms. No distinct guidelines are available for the treatment of vulvar LP. Except for the use of photodynamic therapy (PDT), no randomized controlled trials have been conducted for the treatment of erosive vulvar LP. The research results have shown that PDT can be effective in lichen plane of the oral cavity.

AIM: To evaluate the effectiveness of PDT in women with genital LP compared to topical glucocorticosteroids.

MATERIALS AND METODS: The study group included 15 patients with a diagnosis of vulvar LP. The patients were divided into two groups depending on the treatment method. Group 1 patients were treated with PDT. Group 2 patients – with topical 0.05% betamethasone cream once daily for 1.5 months.

RESULTS: Six months after the last procedure, the regression on the genital LP rating scale was 32% in group 1 patients and 25% in group 2 patients. The severity of pain, according to the visual analog scale, was 29% in group 1 and 22% in group 2. As for adverse events, in group 1, four patients experienced a burning sensation and dryness for 2–3 days after the procedure, and one patient, after two procedures, had blood discharge, which ceased after 1 day. In group 2, five patients complained of burning and dryness during treatment, two patients had acute candidiasis during treatment, and one patient had bacterial vaginosis.

CONCLUSION: The use of PDT can reduce the frequency of use of corticosteroid drugs in the genital area and accordingly reduce the frequency of steroid adverse events, such as atrophy and secondary infection.


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About the authors

Sergey I. Surkichin

FSBI DPO "Central State Medical Academy" of the Administrative Department of the President of the Russian Federation

Author for correspondence.
Email: surkichinsi24@mail.ru
ORCID iD: 0000-0003-0521-0333

Russian Federation, Moscow

Candidate of Medical Sciences, Associate Professor of the Department of Dermatovenereology and Cosmetology

Luidmila S. Holupova

FSBI DPO "Central State Medical Academy" of the Administrative Department of the President of the Russian Federation

Email: karsekals@gmail.com
ORCID iD: 0000-0002-2781-4587

Russian Federation, Moscow

Assistant at the Department of Dermatovenereology and Cosmetology

References

  1. Weston G, Payette M. Update on lichen planus and its clinical variants. Int J Womens Dermatol. 2015;1(3):140-9.
  2. Lewis FM, Bogliatto F. Erosive vulval lichen planus – a diagnosis not to be missed: a clinical review. Eur J Obstet Gynecol Reprod Biol. 2013;171(2):214-9.
  3. Helgesen AL, Gjersvik P, Jebsen P, Kirschner R, Tanbo T. Vaginal involvement in genital erosive lichen planus. Acta Obstet Gynecol Scand. 2010;89(7):966–70.
  4. Micheletti L, Preti M, Bogliatto F, Zanotto-Valentino MC, Ghiringhello B, Massobrio M. Vulval lichen planus in the practice of a vulval clinic. Br J Dermatol. 2000;143(6):1349-50.
  5. O’Keefe RJ, Scurry JP, Dennerstein G, Sfameni S, Brenan J. Audit of 114 non-neoplastic vulvar biopsies. Br J Obstet Gynaecol. 1995;102(10):780-6.
  6. Cheng S, Kirtschig G, Cooper S, Thornhill M, Leonardi-Bee J, Murphy R. Interventions for erosive lichen planus affecting mucosal sites. Cochrane Database Syst Rev. 2012;(2):CD008092. doi: 10.1002/14651858.CD008092.pub2
  7. Eisen D. The clinical features, malignant potential and systemic associations of oral lichen planus: A study of 723 patients. J Am Acad Dermatol Clin. 2002;46(2):207-14.
  8. Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(4):431-6.
  9. Belfiore P, Di Fede O, Cabibi D, Campisi G, Amaru GS, De Cantis S, et al. Prevalence of vulval lichen planus in a cohort of women with oral lichen planus: an interdisciplinary study. Br J Dermatol. 2006;155(5):994-8.
  10. Fahy CMR, Torgerson RR, Davis MD. Lichen planus affecting the female genitalia: A retrospective review of patients at Mayo Clinic. J Am Acad Dermatol. 2017;77(6):1053-9.
  11. Kirtschig G, Wakelin SH, Wojnarowska F. Mucosal vulval lichen planus: Outcome, clinical and laboratory features. J Eur Acad Dermatol Venereol. 2005;19(3):301-7.
  12. Smirnova IO, Parygina OV, Petunova YaG, Shin NV, Zhelonkina AO. Lichen planus of anogenital region: clinical spectrum and approaches to therapy. Medical Alphabet. Russian Journal. 2020;(24):5-10. (in Russian)
  13. Dorozhenok IYu, Snarskaya ES, Mikhailova М. Psychosomatic disorders associated with pruritus in patients with lichen planus (review). Russian Journal of Skin and Venereal Diseases. 2020;23(1):39-42. (in Russian)
  14. Apolikhina IA, Surkichin SI, Chernukha LV. Algorithm for the diagnosis and treatment of lichen planus of the vulva. Obstetrics and Gynecology. Russian Journal. 2020;(S9):14-8. (In Russian)
  15. Micheletti L, Preti M, Bogliatto F, Zanotto-Valentino MC, Ghiringhello B, Massobrio M. Vulval lichen planus in the practice of a vulval clinic. Br J Dermatol. 2000;143(6):1349-50.
  16. Moyal-Barracco M, Edwards L. Diagnosis and therapy of anogenital lichen planus. Dermatol Ther. 2004;17(1):38-46.
  17. Anderson M, Kutzner S, Kaufman RH. Treatment of vulvovaginal lichen planus with vaginal hydrocortisone suppositories. Obstet Gynecol. 2002;100(2):359-62.
  18. Bradford J, Fischer G. Management of vulvovaginal lichen planus: a new approach. J Low Genit Tract Dis. 2013; 17(1):28-32.
  19. Ibbotson SH. Topical 5-aminolaevulinic acid photodynamic therapy for the treatment of skin conditions other than non-melanoma skin cancer. Br J Dermatol. 2002;146(2):178-88.
  20. Olejek A, Steplewska K, Gabriel A, Kozak-Darmas I, Jarek A, Kellas-Sleczka S, et al. Efficacy of photodynamic therapy in vulvar lichen sclerosus treatment based on immunohistochemical analysis of CD34, CD44, myelin basic protein, and Ki-67 antibodies. Int J Gynecol Cancer. 2010;20(5):879-87.
  21. Kvaal SI, Angell-Petersen E, Warloe T. Photodynamic treatment of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(1):62-70.
  22. Soergel P, Loning M, Staboulidou I, Schippert C, Hillemanns P. Photodynamic diagnosis and therapy in gynecology. J Environ Pathol Toxicol Oncol. 2008;27(4):307-20.
  23. Daayana S, Winters U, Stern PL. Clinical and immunological response to photodynamic therapy in the treatment of vulval intraepithelial neoplasia. Photochem Photobiol Sci. 2011;10(2):802-9.
  24. Hillemanns P, Petry KU, Soergel P. Efficacy and safety of hexaminolevulinate photodynamic therapy in patients with low-grade cervical intraepithelial neoplasia. Lasers Surg Med. 2014;46(1):456-61.
  25. Hillemanns P, Schneider A. Response to the Letters from W. Kuhn, et al. and H. Griesser, K. Marquardt, and B. Jordan on “Comments to the Publication of Munich Nomenclature III by the Cytology Coordination Conference”. Geburtsh Frauenheilk. 2014;74(3):242-3. Geburtshilfe Frauenheilkd. 2014;74(7):637-8. doi: 10.1055/s-0034-1368643
  26. Soergel P, Wang X, Stepp H, Hertel H, Hillemanns P. Photodynamic therapy of cervical intraepithelial neoplasia with hexaminolevulinate. Lasers Surg Med. 2008;40(9):611-5.
  27. Helgesen ALO, Warloe T, Pripp AH, Kirschner R, Peng Q, Tanbо T, Gjersvik P. Vulvovaginal photodynamic therapy vs topical corticosteroids in genital erosive lichen planus: a randomized controlled trial. Br J Dermatol. 2015;173(5):1156-62. doi: 10.1111/bjd.14033

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