Clinical efficacy of 5-aminolevulinic acid photodynamic therapy combined with microneedling for vulvar lichen sclerosus

IF 3.1 3区医学 Q2 ONCOLOGY

Photodiagnosis and Photodynamic Therapy Pub Date : 2025-05-08 DOI:10.1016/j.pdpdt.2025.104623

Cuirong Xiao, Xiukuan Xu, Yayan Lin, Hong Kang, Honghui Zhang

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引用次数: 0

Abstract

Background

Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis with limited therapeutic options for refractory or recurrent cases. This study aimed to evaluate the efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with microneedling in VLS management.

Methods

Sixty-four VLS patients (diagnosed from January 2019 to December 2023) underwent ALA-PDT (incubation: 3 hours; irradiation: 635 nm, 100 mW/cm²) combined with microneedling (0.5 mm depth) every 2 weeks for 6 sessions. Outcomes included modified mLSSI score, ISSVD severity grading, Dermatology Life Quality Index (DLQI), dyspareunia Visual Analog Scale (VAS), adverse events, and 6-month recurrence rates.

Results

At 12 weeks, the total efficacy rate reached 92.19 % (59/64). mLSSI scores significantly decreased from 9.07±2.32 to 2.42±1.79 (P < 0.001), with erosion/fissure improvement being most pronounced (86.29 % reduction). ISSVD grading showed complete resolution of severe cases (baseline: 85.94 % vs. 0 % post-treatment), with 90.63 % downgraded to mild. Subgroup analysis revealed superior outcomes in patients with disease duration <1 year (baseline mLSSI: 7.68±2.29 vs. 9.97±1.87 in a long-duration group; t = 4.382, P < 0.0001), particularly in skin texture recovery (90.59 % vs. 83.72 %). DLQI scores decreased by 73.74 % (15.04±2.80 to 3.95±2.02), and 88.89 % (24/27) of patients reported dyspareunia relief (VAS: 5.64±2.58 to 1.50±1.63). Recurrence occurred in 21.88 % (14/64) at 6 months, with no symptom exacerbation (P > 0.05). Only 5 cases (7.81 %) experienced transient erythema, and no severe adverse events were observed.

Conclusion

ALA-PDT combined with microneedling achieves rapid and sustained symptom remission, improves quality of life, and demonstrates excellent safety in refractory VLS. Early intervention (disease duration <1 year) correlates with superior therapeutic outcomes. This combination therapy represents a promising strategy for PDT-enhanced VLS management.

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5-氨基乙酰丙酸光动力疗法联合微针治疗外阴硬化地衣的临床疗效观察

背景外阴硬化苔藓（VLS）是一种慢性炎症性皮肤病，治疗方法有限。本研究旨在评价5-氨基乙酰丙酸光动力疗法（ALA-PDT）联合微针治疗VLS的疗效和安全性。方法2019年1月至2023年12月诊断的64例VLS患者接受ALA-PDT治疗(潜伏期：3小时；辐照：635 nm， 100 mW/cm²)结合微针（0.5 mm深度），每2周6次。结果包括改良的mLSSI评分、ISSVD严重程度分级、皮肤病生活质量指数（DLQI）、性交困难视觉模拟量表（VAS）、不良事件和6个月复发率。结果12周时，总有效率为92.19%（59/64）。mLSSI评分由9.07±2.32降至2.42±1.79 (P <；0.001)，其中侵蚀/裂缝改善最为明显（减少86.29%）。ISSVD分级显示重症病例完全消退（基线：85.94% vs.治疗后0%），90.63%降级为轻度。亚组分析显示，病程+ 1年的患者预后更佳(基线mLSSI: 7.68±2.29 vs.长病程组9.97±1.87；t = 4.382, P <；0.0001)，特别是在皮肤纹理恢复方面（90.59%对83.72%）。DLQI评分下降73.74%(15.04±2.80 ~ 3.95±2.02),88.89%（24/27）的患者出现性交困难缓解（VAS: 5.64±2.58 ~ 1.50±1.63）。21.88%（14/64）患者6个月复发，无症状加重(P >；0.05)。仅有5例（7.81%）出现短暂性红斑，未见严重不良反应。结论ala - pdt联合微针治疗难治性VLS可实现快速、持续的症状缓解，改善生活质量，并具有良好的安全性。早期干预（病程1年）与较好的治疗效果相关。这种联合治疗代表了一种有希望的pdt增强VLS管理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Photodiagnosis and Photodynamic Therapy ONCOLOGY-

CiteScore

5.80

自引率

24.20%

发文量

509

审稿时长

50 days

期刊介绍： Photodiagnosis and Photodynamic Therapy is an international journal for the dissemination of scientific knowledge and clinical developments of Photodiagnosis and Photodynamic Therapy in all medical specialties. The journal publishes original articles, review articles, case presentations, "how-to-do-it" articles, Letters to the Editor, short communications and relevant images with short descriptions. All submitted material is subject to a strict peer-review process.