New therapeutic approaches in the treatment of anogenital lichen sclerosus: does PDT represent a novel option?

Abstract Lichen sclerosus et atrophicus (LSA) is an inflammatory, mucocutaneous disorder that affects male and especially female with a debilitating impact on the quality of life. Common localization is the anogenital area. If not treated LSA can leave scars, functional impairment and can evolve in squamous cell carcinoma. The first line of treatment is represented by topical, ultra-potent corticosteroids, but often patients are unresponsive; moreover this therapy is frequently associated to relapses of the disease after discontinuation. In this prospective observational study, we: 1) evaluated the efficacy of 3 different treatments: i. topical calcineurin inhibitors, ii. avocado and soya beans extracts, iii. Photodynamic Therapy (MAL-PDT); 2) tried to define the therapeutic algorithm according with the severity of the disease. Of 150 patients, who referred to the outpatient clinic for dermatological and gynecological visit, 33 responded to the inclusion criteria. Sixteen (88%) patients showed an improvement of the lesion, and reduction of the itching; 3 (16,7%) patients, with sever itch and fissurating lesions were evaluated for the MAL-PDT therapy. A total of 9 patients, after accurate evaluation of the lesions, were treated with MAL-PDT. The 100% of patients experienced a resolution of the lesions. In the early stages the use of ASE can represent a valid alternative that is well tolerated by the patients reducing the itching, dryness and improving the mucosal texture. The use of MAL-PDT represents a valid alternative in the moderate-severe stages of LSA.