Comparison of long-term efficacy and safety of different therapeutic approaches for vulvar Lichen sclerosus: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared laser and photodynamic therapy (PDT) with topical glucocorticoids for vulvar lichen sclerosus. It included ten randomized controlled trials published between 2010 and 2025, assessing symptom improvement, safety, and long-term recurrence. The review reports that physical therapies generally improved symptoms more than glucocorticoids, with PDT showing the greatest symptom relief. Physical-therapy adverse events were mainly mild, transient local reactions, while glucocorticoids were associated with risks such as candidiasis. PDT was also reported to provide better recurrence control, whereas recurrence was high after glucocorticoid discontinuation.

Key findings

• Across ten randomized trials, physical therapies generally improved clinical symptoms more than topical glucocorticoids; PDT showed the greatest relief.
• Physical-therapy adverse events were mainly mild, transient local reactions such as burning or redness.
• The review reports better long-term recurrence control with physical therapies, particularly PDT, than with glucocorticoids, for which recurrence was high after discontinuation.

Why it matters

Vulvar lichen sclerosus may require sustained symptom control, and treatment choice involves balancing efficacy, adverse effects, and recurrence. This review suggests that laser and PDT may offer alternatives to topical glucocorticoids, with reported advantages in symptom relief and recurrence control. The findings are relevant to treatment discussions, while the abstract provides no quantitative estimates to gauge the size of these differences.

What to keep in mind

The abstract provides no pooled effect estimates or details on trial size, follow-up duration, or variation among included trials, limiting assessment of the magnitude and certainty of the reported differences.