Discussion
Lichen Sclerosus Vulvar, Lichen Sclerosus, hypoestrogenism, vulvar, hyperkeratosis, vulvar signs of the disease, clinical/anatomical alterations
LICHEN SCLEROSUS, DISEASE, VULVAR LICHEN SCLEROSUS, REMISSION, HYPERKERATOSIS, REGRESSION
The great challenge for physicians lies in the management of patients with Lichen Sclerosus who do not respond to topical treatment.Symptoms often reappear after discontinuation of topical therapy, and a maintenance regimen is indicated [Although the anatomical and morphological characteristics of the vulva assessed in the study did not undergo major changes or regression after both treatments, the fractional COReduction of hyperkeratosis can be justified by the fact that laser therapy promotes the ablation of the dermo-epidermal zone with inadequate function, creating a new region with correct function, allowing the remission of the disease [A recently published study conducted in Italy evaluated 40 women with Lichen Sclerosus refractory, regarding long-acting topical high-potency corticosteroid treatment who underwent 2 sessions of COA retrospective study was also conducted, to review the short-term effects and safety of fractional COIt is believed that the higher degree of satisfaction with the fractional COVulvar Lichen Sclerosus is a disease that is difficult to treat and often requires long-term maintenance therapy. In our evaluation after 12 months of treatment, we observed that there were no statistically significant differences in terms of quality of life and in most clinical/anatomical alterations of the vulva between the compared groups. The higher degree of satisfaction with the treatment in the Laser group observed soon after the end of the treatment was also not maintained in the one-year evaluation. This may be due to the effects of laser therapy that fade over time, and a new rescue session may be required. However, the available literature still does not present well-defined protocols on the number and intervals between sessions intended for the treatment of Lichen Sclerosus Vulvar.Lichen Sclerosus also negatively affects the patient's quality of life. From all fields of life, sexual function is shown to be the most negatively affected by the disease [The association of intravaginal laser with vulvar treatment is an important point that could change some of the results of our study, considering the age range of involvement of Lichen Sclerosus, with important symptoms resulting from hypoestrogenism.The greater the occurrence of vulvar signs of the disease, the worse the patient's perception of the appearance of her genitalia. A recent study demonstrated that women with Lichen Sclerosus scored significantly lower on a genital self-image scale [Women without a sexual partner and with higher education obtained higher scores in the Psychological domain. A study showed that patients evaluated for sexual difficulties reported that many of the obstacles are related to behaviors and attitudes of their partners and the presence of disease [In Social domain, patients with a sexual partner scored better, probably due to the support network that the family formed with their partner generates for the patient [The treatment of Lichen Sclerosus has not yet evolved beyond topical corticosteroids. However, this study, as well as the others already conducted, shows positive and promising results in the use of fractional COFractional CO