What is lichen sclerosus?
Lichen Sclerosus is a chronic, inflammatory disorder of the skin that most commonly affects post-menopausal women. It can affect any area of the body but is mostly seen on the female anogenital epithelium. Lichen sclerosus can be classified as an autoimmune disease and can present with other autoimmune diseases. It can also be genetic and is seen among family members. Sometimes lichen sclerosus can go unrecognized or misdiagnosed for several years, but over time it can lead to scarring, sexual dysfunction, and malignancy. Lichen sclerosus is not contagious and cannot be spread during sexual intercourse.
What is lichen sclerosus?
Lichen Sclerosus is a chronic, inflammatory disorder of the skin that most commonly affects post-menopausal women. It can affect any area of the body but is mostly seen on the female anogenital epithelium. Lichen sclerosus can be classified as an autoimmune disease and can present with other autoimmune diseases. It can also be genetic and is seen among family members. Sometimes lichen sclerosus can go unrecognized or misdiagnosed for several years, but over time it can lead to scarring, sexual dysfunction, and malignancy. Lichen sclerosus is not contagious and cannot be spread during sexual intercourse.
What is lichen sclerosus?
Lichen Sclerosus is a chronic, inflammatory disorder of the skin that most commonly affects post-menopausal women. It can affect any area of the body but is mostly seen on the female anogenital epithelium. Lichen sclerosus can be classified as an autoimmune disease and can present with other autoimmune diseases. It can also be genetic and is seen among family members. Sometimes lichen sclerosus can go unrecognized or misdiagnosed for several years, but over time it can lead to scarring, sexual dysfunction, and malignancy. Lichen sclerosus is not contagious and cannot be spread during sexual intercourse.
What are the symptoms of lichen sclerosus?
Lichen sclerosus can present as the following:
Are there long-term complications of lichen sclerosus?
Lichen sclerosus is a chronic condition and can lead to scarring, causing other complications including
What is the treatment for lichen sclerosus?
The standard treatment for lichen sclerosus has included a 3-month application of potent topical corticosteroids, which have been shown to prevent malignant transformation but can produce side effects and ultimately lead to damage of the anogenital epithelium. In addition, due to inconsistent prescribing, topical steroids do not often adequately treat lichen sclerosus. Recently, practitioners and researchers have started evaluating the effectiveness of using a fractional micro-ablative CO2 laser called the Mona Lisa to treat lichen sclerosus. Recent studies have shown CO2 laser therapy results in symptom resolution, return to normal skin texture and color, and reduced risk of vulvar cancer. In addition, when compared to the standard corticosteroid treatment, the CO2 laser resulted in greater improvement in symptoms and better patient satisfaction.
What is MonaLisa Touch?
The MonaLisa Touch is a laser treatment that promotes the production of collagen and elastic fibers to help restore epithelial structure and vascularization. The MonaLisa Touch is used to treat lichen sclerosus, as well as to treat breast cancer patients and post-menopausal women with a diagnosis of vaginal atrophy. It is an effective, non-invasive, and hormone-free treatment for the symptoms of lichen sclerosus and vaginal atrophy.
Is the MonaLisa Touch safe?
The MonaLisa Touch has been available in the United States since 2014 and is currently approved for use in a variety of medical specialties, including gynecology, dermatology, plastic surgery, and many others. A recent randomized control trial, published in the Obstetrics & Gynecology Green Journal, compared steroid use with fractionated carbon dioxide laser for lichen sclerosus treatment. After 6 months of treatment, patients who received laser treatment had greater improvement in symptoms compared to patients who received steroid treatment. Additionally, there were no significant safety concerns or adverse effects demonstrated by the CO2 laser during the 6 month trial period.
Overall, the MonaLisa Touch is a well-tolerated treatment that occurs in the office using local anesthesia. There are minimal side effects without any downtime after treatment. Previous patients have reported only slight discomfort (2 out of 10 on a 10-point scale) during the procedure, as well as irritation after treatment, minor spotting lasting 1-2 days after treatment, and discharge lasting 2-3 days after treatment. Please speak with your provider regarding your medical history as there are some contraindications to receiving CO2 laser therapy.
What does MonaLisa Touch treatment look like?
Each treatment with the MonaLisa Touch lasts for less than 5 minutes. The recommended therapy includes 3 initial treatments 6 weeks apart with a possibility for 2 additional treatments for a total of 5 initial treatments. Some women can see a treatment effect after a single treatment. Because lichen sclerosus is a chronic condition, it requires long-term treatment to attain remission. Remission is not the same as a cure, so maintenance treatment is recommended. Maintenance therapy typically occurs one year after initial treatment.
How much does the MonaLisa Touch treatment cost?
While prices may vary among practices, the cost of one treatment at Peninsula Women’s Care is $400. As stated above, multiple treatments (normally 3, totaling $1,200) are usually required to attain remission and an annual maintenance treatment ($400) is recommended to remain in remission. Please note that insurance companies do not currently cover the costs of MonaLisa Touch therapy. These are out-of-pocket expenses.
What does MonaLisa Touch treatment look like?
Each treatment with the MonaLisa Touch lasts for less than 5 minutes. The recommended therapy includes 3 initial treatments 6 weeks apart with a possibility for 2 additional treatments for a total of 5 initial treatments. Some women can see a treatment effect after a single treatment. Because lichen sclerosus is a chronic condition, it requires long-term treatment to attain remission. Remission is not the same as a cure, so maintenance treatment is recommended. Maintenance therapy typically occurs one year after initial treatment.
How much does the MonaLisa Touch treatment cost?
While prices may vary among practices, the cost of one treatment at Peninsula Women’s Care is $400. As stated above, multiple treatments (normally 3, totaling $1,200) are usually required to attain remission and an annual maintenance treatment ($400) is recommended to remain in remission. Please note that insurance companies do not currently cover the costs of MonaLisa Touch therapy. These are out-of-pocket expenses.
MonaLisa Touch Therapy at Peninsula Women’s Care
Peninsula Women’s Care is fortunate to provide MonaLisa Touch therapy to women suffering from the chronic and inflammatory symptoms of lichen sclerosus. The therapy also offers a valuable addition to the standard treatment for vaginal atrophy for breast cancer patients and patients who cannot or prefer not to, receive estrogen therapy. If you are experiencing any of these symptoms or have noticed any changes in your anogenital epithelium, please speak with your provider.
References:
- Bizjak Ogrinc, U., Senčar, S., Luzar, B., & Lukanović, A. (2019). Efficacy of non-ablative laser therapy for lichen sclerosus: A randomized controlled trial. Journal of Obstetrics and Gynaecology Canada, 41(12), 1717–1725. https://doi.org/10.1016/j.jogc.2019.01.023
- Burkett, Linda S. MD; Siddique, Moiuri MD, MPH; Zeymo, Alexander MS; Brunn, Elizabeth A. MD; Gutman, Robert E. MD; Park, Amy J. MD; Iglesia, Cheryl B. MD Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus, Obstetrics & Gynecology: June 2021 – Volume 137 – Issue 6 – p 968-978 doi: 10.1097/AOG.0000000000004332
- Krapf JM, Mitchell L, Holton MA, Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int J Womens Health. 2020 Jan 15;12:11-20. doi: 10.2147/IJWH.S191200. PMID: 32021489; PMCID: PMC6970240.
- Pagano, T., Conforti, A., Buonfantino, C., Schettini, F., Vallone, R., Gallo, A., . . . Sopracordevole, F. (2020). Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid. Menopause, 27(4), 418-422. doi:10.1097/gme.0000000000001482
Additional references are listed below if additional research is desired:
- American College of Obstetrics & Gynecology: Disordered of the Vulva
- Baggish, M. S. (2016). Fractional CO2 laser treatment for vaginal atrophy and vulvar lichen sclerosus. Journal of Gynecologic Surgery, 32(6), 309–317. https://doi.org/10.1089/gyn.2016.0099
- Sokol, E. R., & Karram, M. M. (2016). An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of Vulvovaginal Atrophy. Menopause, 23(10), 1102–1107. https://doi.org/10.1097/gme.0000000000000700
