09: A randomized controlled trial of clobetasol propionate versus fractionated CO2 laser for the treatment of lichen sclerosus (CURLS)

Laser therapy for genital lichen sclerosus: A systematic review of the current evidence base

Background

Lichen sclerosus (LS) is a chronic, inflammatory dermatosis. Initial treatment with superpotent topical corticosteroids is the accepted and evidence-based first-line therapy. For those who do not respond after exclusion of other potentiating factors, the best second-line therapy is unclear. Laser therapy is an emerging treatment for genital LS and despite uncertain efficacy its use is gaining popularity in the private sector.

Objectives

We aimed to review the effectiveness of laser therapy for genital LS in men, women and children.

Methods

We conducted a systematic review of all primary studies reporting the use of laser in genital LS. Ovid MEDLINE, PubMed, Ovid Embase, Cochrane CENTRAL, Web of Science, CINAHL and PsycINFO were searched from inception to February 2021. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials, ROBINS-I tool for non-randomized trials and Joanna Briggs Institute checklist for case studies.

Results

A total of 24 studies, involving 616 adults, met inclusion criteria. These were six randomized controlled trials (RCTs), one non-randomized trial, nine single arm trials and eight case series. Where assessed, most studies suggest that laser therapy in patients with LS may improve symptoms, clinical signs, quality of life and sexual function. However, results were highly heterogeneous and methodological quality was very low, therefore meta-analysis was not possible.

Conclusions

There is poor evidence to support the use of laser therapy for genital LS at present. Effectiveness of laser needs to be robustly investigated in well-conducted RCTs.

Lactobacilli Reduce Recurrences of Vaginal Candidiasis in Pregnant Women: A Randomized, Double-Blind, Placebo-Controlled Study

AIMS

The aim of this study was to investigate the effects of lactobacilli strains in preventing the recurrences of vaginal candidiasis (VC) in 78 pregnant women with VC (lactobacilli, n = 39; placebo, n = 39) and the potential benefits on quality of life.

METHODS AND RESULTS

The lactobacilli putative probiotic (SynForU-HerCare; two capsules/day of 9.5 log CFU/capsule) or placebo was administered for 8-weeks in a randomized, double-blind, and placebo-controlled study. Subjects were assessed for vaginal and gut health conditions at baseline, week-4 and week-8 via questionnaires. The vulvovaginal symptom questionnaire not only covered aspects pertaining to vulvovaginal symptoms but also the quality of life impacts such as emotional, social and sexual. The administration of lactobacilli reduced symptoms of irritation (P=0.023) and discharge (P=0.011) starting week-4 and continued after week-8 (P<0.05), accompanied by reduced symptoms for burning after week-8 (P=0.046) as compared to the placebo. Patients consuming lactobacilli also showed reduced concern about symptoms after week-4 (P=0.010) and continued after week-8 (P=0.001), accompanied by reduced impairment of daily activities attributed to vulvovaginal symptoms (P=0.012) and continued after week-8 (P=0.026). Insignificant differences were observed for sexual impacts between treatment groups. The administration of lactobacilli also reduced recurrences of both emotional and social stress as compared to the placebo at both week-4 and week-8 (P<0.05). Patients consuming lactobacilli showed higher defecation times per week at week-4 (P=0.010) and week-8 (P=0.001) as compared to the placebo group, indicating potential to reduce risks of pregnancy-induced constipation.

CONCLUSIONS

Lactobacilli probiotics are beneficial towards pregnant women, especially in reducing vulvovaginal symptoms and recurrences of VC, accompanied by improved emotional and social distress attributed to VC.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study demonstrated the preventive and modulatory roles of lactobacilli strains against VC in pregnant women. Taken altogether, our present data illustrated that lactobacilli probiotics are beneficial towards pregnant women, especially in reducing vulvovaginal symptoms and recurrences of VC, accompanied by improved emotional and social distress attributed to VC, thus could be a potential strategy for the maintenance of vaginal health during pregnancy.