Abstract

Objectives: The aim of this study was to evaluate the efficacy and safety of dual Nd:YAG/Er:YAG laser therapy in women with vulvar lichen sclerosus (LS). We assessed improvement in clinical LS scores, reduction of pain severity, and patient satisfaction. The primary outcome was the change in LS score at 6 months after treatment, while secondary outcomes included patient-reported pain (VAS), global improvement (PGI-I), and safety profile. Introduction: Lichen sclerosus (LS) is a chronic inflammatory vulvar dermatosis causing pruritus, pain, dyspareunia, and risk of carcinoma. Ultrapotent corticosteroids remain the gold standard; the 2023 EuroGuiDerm guidelines recommend potent or ultrapotent corticosteroids as first-line therapy in adults and children. They stress that laser therapy, while promising, is still experimental and cannot be recommended outside research until confirmed by large, long-term randomized trials. Materials / method: We conducted a prospective study including 50 women with clinically diagnosed LS (LS score ≥4). Participants received three sessions of dual Nd:YAG/Er:YAG laser therapy over 3 months using standardized parameters. Clinical outcomes were measured at baseline and 6 months after the last session. LS scores, pain intensity on a visual analogue scale (VAS), and patient global impression of improvement (PGI-I) were assessed. Safety and tolerability were recorded during and after treatment sessions. Results: Mean LS score decreased significantly from 6.45 ± 1.12 to 3.63 ± 1.44 (p<0.001). Pain intensity improved from 12.59 ± 6.37 to 6.75 ± 5.59 (p<0.01). At follow-up, mean PGI-I was 1.88, with 74% of patients (37/50) reporting very much or much improvement. Treatment was safe and well tolerated, with minimal discomfort and no serious adverse effects. Patients expressed high satisfaction and improved quality of life after therapy. Conclusion: Dual Nd:YAG/Er:YAG laser therapy produced significant clinical and symptomatic improvement in vulvar LS, with high patient-reported benefit and excellent tolerability. This minimally invasive outpatient procedure may represent a valuable adjunct or alternative to corticosteroids, especially in patients with limited steroid response or tolerance. Longer follow-up and larger randomized studies are warranted to confirm durability and assess long-term safety.