{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T19:36:27Z","timestamp":1780428987615,"version":"3.54.1"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,4,16]],"date-time":"2023-04-16T00:00:00Z","timestamp":1681603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Lasers Surg Med"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the histologic characteristics of vulvar tissues before and after completion of fractionated carbon dioxide (CO<jats:sub>2<\/jats:sub>) laser therapy (FxCO2) for vulvar lichen sclerosus (LS). The secondary objective was to assess subjective improvement in symptoms via the Skindex\u201016 questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective single\u2010arm study was conducted from April 2021 to August 2022 at one academic medical center. Ten postmenopausal women with biopsy\u2010proven LS planning FxCO2 laser treatment were enrolled. Exclusion criteria included prior transvaginal mesh for prolapse, topical corticosteroid use within 8 weeks, prior pelvic radiation, malignancy, active genital infection, or pregnancy. The vulvovaginal SmartXide2\u2010V2\u2010LR laser system fractionated CO<jats:sub>2<\/jats:sub> laser (DEKA) was utilized to treat visually affected areas of vulvar and perianal LS with a single pass. Subjects underwent three treatments 4\u20136 weeks apart. Subjects completed the Skindex\u201016 questionnaire and had vulvar biopsy at baseline and at 4 weeks after completion of fractionated CO<jats:sub>2<\/jats:sub> laser therapy. Blinded histologic slides were scored by one dermatopathologist (Michael A. Cardis) rating from 1 to 5 the degree of dermal sclerosis, inflammation, and epidermal atrophy. Change scores were calculated as the difference between pre\u2010 and post\u2010treatment scores for each subject.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 10 subjects enrolled had a mean age of 61 and most were white, privately insured, and had a college\/graduate\u2010level education. Post\u2010fractionated CO<jats:sub>2<\/jats:sub> laser treatment vulvar biopsies showed significant improvement in sclerosis and epidermal atrophy compared with pretreatment baseline biopsy specimens (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) with no statistically significant change found in inflammation score. Skindex\u201016 and FSFI scores showed a trend towards improvement (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05 for both). A statistically significant correlation was found between change in sclerosis and Skindex\u201016 symptoms scores with an average change of 21.4 units in Skindex\u201016 symptoms score for every one\u2010point change in histologic sclerosis score (<jats:italic>p<\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In postmenopausal women with vulvar LS undergoing fractionated CO<jats:sub>2<\/jats:sub> laser, symptomatic improvements correlated with histologic change in degree of sclerosis on vulvar biopsy. These results demonstrate FxCO2 laser therapy as a promising option for the treatment of LS and suggest that further studies should assess degree of sclerosis on histopathology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lsm.23669","type":"journal-article","created":{"date-parts":[[2023,4,16]],"date-time":"2023-04-16T10:24:04Z","timestamp":1681640644000},"page":"521-527","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO<sub>2<\/sub> laser therapy"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0850-3289","authenticated-orcid":false,"given":"Alexis A.","family":"Dieter","sequence":"first","affiliation":[{"name":"MedStar Washington Hospital Center Washington District of Columbia USA"},{"name":"Georgetown University School of Medicine 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew I.","family":"Sokol","sequence":"additional","affiliation":[{"name":"MedStar Washington Hospital Center Washington District of Columbia USA"},{"name":"Georgetown University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu","family":"Tefera","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute Hyattsville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Cardis","sequence":"additional","affiliation":[{"name":"MedStar Washington Hospital Center Washington District of Columbia USA"},{"name":"Georgetown University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-16-0019"},{"issue":"7","key":"e_1_2_8_3_1","first-page":"477","article-title":"Prevalence of vulvar lichen sclerosus in a general gynecology practice","volume":"50","author":"Goldstein AT","year":"2005","journal-title":"J Reprod 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