Lichen Planus, Lichen Sclerosus Et Atrophicus
Conditions
Brief summary
Primary aim of the trial is to compare improvement of lichen symptoms according to a composite VAS scale (burning, itching and pain) between women with vulvovaginal laser therapy vs. sham laser therapy at three months.
Detailed description
Background: Lichenoid Disorders (LD) include VLS (Vulvar lichen sclerosus) and LP (Lichen planus). VLS and LP are chronic skin diseases that usually affect the anogenital region. Both can cause vulvar itching, burning and pain and can lead to urinary and sexual dysfunction. Current treatment options are unsatisfactory. Vulvovaginal laser therapy might be an effective treatment option. Study aim: To study the effectiveness of non-ablative vulvovaginal laser therapy for women with lichenoid disorders. Design: Randomized double-blinded placebo- controlled clinical study Study Population: Women diagnosed with LD will be recruited from a specialized University outpatient clinic. Study groups: Participants will be randomized (1:1). Intervention group: Laser therapy (2 treatments), plus ongoing therapy Control group: Sham laser therapy (2 treatments) plus ongoing therapy Sample size Total 40 patients Primary study outcome: Visual analogue scale (VAS) composite score in regard to LD Secondary study outcomes: quality of life (QoL) (Skindex questionnaire); Treatment discomfort/ pain (VAS); Patient treatment satisfaction (Questionnaire to ask for treatment satifsaction: ZUF-8); Subjective improvement (Patient global impression of improvement- PGI-I), clinical LS score, histological appearance
Interventions
DEVICELaser
real laser beam administered
DEVICEPlacebolaser
no laser beam admitted
Sponsors
Medical University of Graz
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Masking description
The person who performs the laser treatment is unaware of the treatment given The laser devices can be used as a placebo laser by blocking the laser beam with a plug
Intervention model description
Randomized double-blinded placebo- controlled clinical study
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 99 Years
Healthy volunteers
Yes
Inclusion criteria
* women age \>18 years * diagnosed with LD (VLS or LP histologically proven) * Clinical LS score ≥ 4 based on the score of Günthert et al. \[1\] * Normal Pap-smear within 24 months * negative clinical and microscopic evaluation of vaginal fluid * Negative test for STD (sexually transmitted diseases) pathogens (chlamydia, gonorrhea, genital mycoplasma and trichomonas) if symptomic including abdominal pain or abnormal vaginal fluid * Good German language skills * written informed consent * preceding local corticoid therapy of at least 12 weeks according to the current guideline for LD
Exclusion criteria
* women with contraindications for the use of laser on the skin * pregnancy * presence of vulvar pathology (other than lichen) * any vulvar/ vaginal infection * immunocompromised women * swollen lymph nodes * genital malignant disease * allergy to topical anaesthesia * connective tissue disease * keloid formation * Patients with a legal guardian * Body Mass Index \> 35 kg/m² * History of transvaginal mesh implant (excluding sling or sacrocolpopexy mesh) * Coagulopathy * patients using anticoagulants * patients with renal, hepatic or pulmonary-cardiovascular failure * patients who have undergone any kind of organ transplantation in the last three years.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| subjective bother of lichenoid disorders (LD) | 3 months | A visual analogue scale (VAS) is used for assessment for the subjective bother of LD symptoms. Patients are asked to indicate the degree of each of the three following LD symptoms on a scale ranging from 0 (no symptoms) to 10 (worst possible symptoms): genital symptoms of itching, burning and vaginal pain resulting in a composite VAS score |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| subjective symptoms of lichenoid disorders | 3 months | The Skindex questionnaire will be used to evaluate patients' subjective symptoms of lichenoid disorders |
| Patient Global Impression of Improvement- PGI-I | 3 months | The PGI-I scales are robust and valid instruments to assess disease severity, bother and improvement after treatment in women and will be used to determine the Patient Global Impression of Improvement. The PGI-I consists of a 7-likert-scale with 7 being the worst bother. |
| Patient Global Impression of Severity- PGI-S | 3 months | The Patient Global Impression of Severity (PGI-S) is a global index that may be used to rate the severity of a specific condition (a single-state scale). The PGI scales are robust and valid instruments to assess disease severity, bother and improvement after treatment and will be used to determine the Patient Global Impression of Severity. The PGI scales are robust and valid instruments to assess disease severity, bother and improvement after treatment. The patient can choose from 4 answers including none, mild, moderate and severe. |
| Treatment discomfort / pain | 3 months | patients are asked to indicate the degree of discomfort or pain during laser therapy on a visual analogue scale (VAS) ranging from 0 (no discomfort/pain) to 10 (worst possible discomfort/pain) |
| Histological analysis of LD | 3 months | Lichenoid disorders show epidermic atrophy, sclerosis and a lymphocytic based dermal inflammation. Hyperkeratosis and dermal inflammation will be evaluated both from the histological probe before and after treatment. Each item will be scored from 1-3, mild, moderate and severe. A higher score indicates more severe expression of LD. |
| Patient satisfaction with treatment/ inpatient management | 3 months | Patient satisfaction will be evaluated with the Fragebogen zur Patientenzufriedenheit - ZUF8. The German version of the original Client Satisfaction Questionnaire-CSQ8, is a validated tool for measuring global patient satisfaction at the end of inpatient treatment. he Zuf-8 is an 8-items questionnaire to assess satisfaction in patients undergoing inpatient treatment. At 3 months treatment satisfaction will be assessed using an adopted version of the questionnaire. The lower the score the higher is the patient satiscation. |
| architectural changes | 3 months | The vulva will be inspected and structural changes due to LD will be recorded. The score is based on the publication from Günthert et al. The score records signs of erosions, hyperkeratosis, rhagades, synechia, stenosis, and atrophy of the vulva. The questionnaires is based on a 29-item version; the higher the score the more pronounced are the clinical signs. |
Countries
Austria
Outcome results
None listed