Abstract

Objectives: To evaluate the efficacy of hyaluronic acid (HA) and intradermal peptides treatment using high-frequency ultrasound (HFUS) and line-field confocal optical coherence tomography (LC-OCT) in patients with vulvar lichen sclerosus. Introduction: Lichen sclerosus (LS) is a chronic inflammatory dermatosis affecting the anogenital area. Its prevalence and etiology are unknown. It is associated with various factors, including hormonal, immunological, and genetic factors. It can affect women of any age, but is more common during childhood and postmenopause, causing vulvar changes that result in severe morbidity, both in terms of sexual function and quality of life. Materials / method: Clinical and imaging evaluations were performed by high-frequency ultrasound (HFUS) and confocal optical coherence tomography (LC-OCT) before and after intradermal infiltration. An HFUS system with 18 and 22 MHz probes was used. LC-OCT offers three in vivo imaging modalities: vertical, horizontal and 3D histological reconstruction. Intradermal infiltration consisted of the application of 1 ml of 20 mg/ml cross-linked HA and three sessions of mesotherapy with non-cross-linked HA at 15 mg/ml, 2.5 mg/ml, organic silicon, tripeptide and tetrapeptide, with an interval of three months each. Results: Five female patients were included, with a median age of 65 years. Before treatment, all patients showed significant Doppler enhancement. After infiltration, no power Doppler enhancement was observed in the same areas evaluated, and thickening of the dermis was also evident. LC-OCT showed vacuolar alteration of the dermoepidermal junction, elongation of the ridges and papillae, loss of elastic fibers and vessels of variable thickness and ectatic. Post-treatment cell tropism was observed organized, preserved ridges and papillae, absence of sclerosis and ectatic vessels. Conclusion: Ultrasound and LC-OCT are effective non-invasive tools to assess inflammation, efficacy and follow-up in patients with Lichen Sclerosus, providing objective documentation of the response to treatment with HA and peptides.