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Non-Ablative Laser for Lichen Sclerosus

Non-Ablative Laser for Lichen Sclerosus

The Experimental Treatment Series

Introduction

In our last post, I discussed ablative laser therapy for lichen sclerosus. This looked at CO2 fractional lasers like the Mona Lisa laser at the ablative Yag laser. Today, I want to look at non-ablative laser therapy for lichen sclerosus. The truth is there are several different lasers on the market, each functioning a little differently and penetrating different skin depths. 

As a refresher, laser therapy, be it ablative or non-ablative, is considered an experimental treatment. Experimental treatments show promise in managing a condition but have yet to be thoroughly evaluated for efficacy, safety, and acceptability. 

We know our community has a lot of questions about laser therapy. I wouldn’t be doing our community justice if I looked at just one type of laser. If you read our last post on ablative laser therapy, you may be wondering, “OK, but what about non-ablative laser therapy for lichen sclerosus?” or “Is the evidence stronger for non-ablative lasers?” and “Maybe I’ll consider non-ablative laser since that sounds less invasive/painful?”  and these are great questions! Like always, we got you. We address these questions in today's post.

Our philosophy here at Lichen Sclerosus Support Network is always to present the evidence so you can make informed decisions about your body and healthcare plan.

Disclaimers

*This post is evidence-based; I draw on the medical literature to share what you need to know about laser therapy for lichen sclerosus. Importantly, what I share is my interpretation of the science and data.

**If this post is helpful to you, we’d love your support so we can continue providing important education like this. Make a donation today, volunteer with us, or share our posts in your support groups.

What is Non-Ablative Laser for Lichen Sclerosus?

If you are in any support forums or spaces online, chances are you have heard someone mention they get laser therapy for lichen sclerosus before.

However, you may wonder, “What on earth is laser therapy for lichen sclerosus?”

There are many different types of lasers out there. Today, we are looking at non-ablative lasers for lichen sclerosus.

Graphic design image of a skin sample showing the different lasers of skin - e.g., epidermis, dermis, etc. This is important because non-ablative laser for lichen sclerosus can heat different layers of skin.

According to the American Society for Dermatologic Surgery, non-ablative lasers use a beam of energy that can help regenerate the skin by heating the skin without injuring the top layer of the skin (aka the epidermis). This is different from ablative lasers, which destroy the top layer of the skin. Similar to ablative lasers, the heating aspect of non-ablative lasers allegedly does the regenerative/healing work. Non-ablative lasers deliver that heating aspect through thousands of small columns into the skin. 

What Non-Ablative for Lichen Sclerosus Involve?

Your clinician (ideally) should give you instructions on what to expect and how to prepare on the day of your visit. Be sure to follow those instructions.

While the non-ablative lasers are less invasive than the ablative kind, the heating sensation can cause mild pain or discomfort. Your clinician will often apply a topical numbing cream to the vulvar area before laser treatment. However, if you are concerned about this, ask them in advance if they can use the numbing cream. If they do not offer numbing cream, ask if it is OK for you to bring and apply your own. For example, in Canada, you can get Emla numbing cream over the counter at your local pharmacy and use it before your appointment.

After you are numbed up, they will go over the surface of the vulva with their laser machine. 

Post-Procedure Aftercare

A non-ablative laser may still result in some discomfort post-procedure. Remember, we are all different and have different pain tolerances.

If you experience pain or discomfort post-procedure, the main recommendation is to use a combination of acetaminophen (Tylenol, Paracetamol) and Ibuprofen (Advil) for 1-3 days afterward. Applying ice to the area may be another helpful option to calm inflammation and pain. 

You may also want to go commando and wear loose clothing a couple of days after if you experience sensitivity/discomfort.

You should be able to work. However, everyone is different; listen to your body. Most people can drive themselves or take public transit home after the procedure. However, if you are concerned, arranging for a lift or an Uber may be a good idea.

Cost and Frequency

Both cost and frequency are determined on a case-by-case basis. Cost depends on where you live, the clinic’s pricing structure, and whether insurance can cover some of it. I’m unsure what the cost of non-ablative laser looks like in Canada, so you need to ask your provider to provide a quote. Lasers are typically costly, though.

How often you need treatments depends on the severity of your case and how you respond to treatment. From what I’ve read, it does seem like multiple sessions are required during the first year, and then maintenance sessions are needed afterward.

What Does the Science Say about Non-Ablative Laser for Lichen Sclerosus?

Non-Ablative Neodymium: Yttrium Aluminum Garnet (Nd: YAG) Laser

The main non-ablative I see in the context of lichen sclerosus is the non-ablative neodymium Yttrium Aluminum Garnet (aka the Nd: YAG laser).

Graphic design image of a person with a blue glove holding a laser device to represent the topic of laser therapy for lichen sclerosus.

Ogrinc et al. (2019) conducted a randomized clinical trial to assess the efficacy of the Nd: YAG laser compared to topical corticosteroids for treating lichen sclerosus. The study included 40 folks with vulvar lichen sclerosus. These people were divided into two groups: the nd: YAG laser group and the control group (the steroid group). 

The authors measured how well each treatment worked by comparing pre and post-treatment biopsies, clinical photographs, and patient reporting of symptoms.

The study showed patients in the nd: YAG laser group had more improvement in symptoms and a more significant reduction in sclerosis (aka scarring and hardening of tissues) and inflammation compared to the steroid group. 

The authors conclude it could be a good option for folks who cannot tolerate steroids or do not wish to use them.

Cool…so what does this mean? Is the YAG laser better than steroids?

On a first pass, it looks like the nd: YAG laser outperformed the steroid group. However, there were several problems with the study. First, the study was not blinded; the gynecologist and the patient were not blinded (1719). This means the gynecologist and patient knew which treatment the patient was receiving. It is essential to have blinded studies because they significantly reduce the risk of bias skewing the results. 

Second, the patients in the nd: YAG group also used steroids throughout the first 3 weeks of the study (ibid). This could have skewed the results; it would have been better if they used the nd: YAG laser with no steroids to get a precise result. Otherwise, it’s not clear how much leg-work the steroids were doing to reduce inflammation and how much, if at all, the Nd: YAG laser contributed.

Finally, the authors note they had difficulty motivating the steroid group. Many folks in the steroid group were non-compliant with their steroids as they had negative associations with them. Again, this could have potentially impacted the biopsies and clinical photographs. This means we have to take this study with a grain of salt. Hopefully, more blinded studies will be conducted with better methods/protocols to reduce bias and unclear results. 

What’s the Verdict? Is Non-Ablative Laser for Lichen Sclerosus a Good Option?

Graphic design image of a person in a loose, light blue blouse, purple slacks and long brown hair. They are making a pose as if they are thinking and there are two question marks about their head.

Unfortunately, we are in a similar position with ablative lasers for non-ablative laser therapy for lichen sclerosus. 

That is, the one study I cited had too many problems to confidently say the nd: YAG laser is effective as a treatment for lichen sclerosus.

There is significantly less research on non-ablative lasers for lichen sclerosus compared to ablative lasers. It would be nice to have more robust and quality studies on both forms of laser therapy moving forward.

As with ablative lasers, non-ablative lasers may have their place as an add-on/adjunct therapy used in conjunction with treatments like steroids or calcineurin inhibitors, which have a lot of evidence supporting their use as a primary treatment. Plus, from what we see in the study above, folks did have good results combining the nd: YAG laser with their steroid medication. Ultimately, we need much more research before recommending this as a primary treatment.

A systematic review – a paper that reviews, discusses, and synthesizes information from different studies on a specific topic like lichen sclerosus – by Tasker et al., 2021, which looked at studies investigating both ablative and non-ablative lasers concluded:

In summary, there is no high-quality evidence to support the use of laser for the treatment of genital LS in males and females. Long-term data of laser are lacking including its adverse side effects. High quality RCTs are needed.

Tasker et al., 2021.

Therefore, there isn’t enough evidence to support using laser therapy as a primary treatment/monotherapy for lichen sclerosus.

Conclusion on Non-Ablative Laser for Lichen Sclerosus

In sum, the research shows laser therapy is ineffective as a primary treatment but may have its place as an add-on therapy in conjunction with steroids or calcineurin inhibitors. Always consider cost and lifestyle when deciding to pursue laser or not. At the end of the day, it is your individual decision on how you treat your LS. We at LSSN strive to share evidence-based information so you can make informed decisions about what is best for you and your body.

I do not know anyone who has done non-ablative laser therapy for lichen sclerosus. If you have, please share your experience in the comments below. 

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Reach Out to Me

Whether you are debating booking a support call with me, have a quick question, or want to share something related to my content, I can be reached via:

Email: Jaclyn@lostlabia.com

DM: @thelostlabiachronicles on Instagram, Facebook, and TikTok.

Support Resources

FREE Lichen Sclerosus Virtual Meetup hosted by myself and Kathy of Lichen Sclerosus Podcast – sign up here.

Feel free to book a 1:1 call with me if you struggle with grief and emotions. Simply click this link to learn more about lichen sclerosus peer support calls.

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LSSN Membership – sign up here.

For a more detailed list of free and paid support resources, check out my LS resources page here.

Sources Cited & Referenced

American Society for Dermatological Surgery

Belotto R, Correa L, Martins WK, Fernandes RCM, Chavantes MC. Topic corticosteroid and photobiomodulation treatment impact on vulvar lichen sclerosus: Clinical, inflammatory and reparative analysis. Laser Surg Med. 2019; 51 1: S39– S40.

Bizjak Ogrinc U, Sencar S, Luzar B, Lukanovic A. Efficacy of non-ablative laser therapy for lichen sclerosus: A randomized controlled trial. J Obstet Gynaecol Can. 2019; 41: 1717– 1725.

Tasker, Kirby, Grindlay, Lewis, and Simpson. “Laser Therapy for Genital Lichen Sclerosus: A Systematic Review of the Current Evidence-Based.” Skin Health and Disease, 2021. DOI https://doi.org/10.1002/ski2.52

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