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Methods: This interventional clinical study included 14 patients diagnosed with VLS. The participants underwent three CO\u2082 laser sessions with a monthly interval. Clinical assessments and biopsies were performed at baseline and six weeks after the final session. Primary outcomes were improvement in symptoms (Visual Analog Scale \u2013 VAS) and clinical signs (Global Aesthetic Improvement Scale \u2013 GAIS), associated with histological regression. Secondary outcomes included quality of life (Skindex-29) and specific histological parameters, such as hyperkeratosis, dermal elastic fibers, and type I\/III collagen ratio. Results: All patients reported vulvar pruritus at baseline. After treatment, 50% became asymptomatic (p\u2009=\u20090.016), with a reduction in mean VAS score from 8 to 1 (p\u2009=\u20090.016). Burning sensation, present in 71.4% at baseline, decreased to 28.5% at follow-up (p\u2009=\u20090.031), with VAS scores declining from 6 to 0 (p\u2009=\u20090.008). Clinical improvement assessed by GAIS was observed in up to 64.3% of patients, with high inter-rater agreement (ICC\u2009=\u20090.855). Histological regression occurred in 42.9% of cases (p\u2009=\u20090.031). Quality of life significantly improved across all Skindex-29 domains (p\u2009&lt;\u20090.05). There was a reduction in hyperkeratosis (p\u2009=\u20090.032) and in type I\/III collagen ratio (p\u2009=\u20090.022), along with reappearance of dermal elastic fibers (p\u2009=\u20090.024). Conclusion: CO\u2082 laser therapy reduced symptoms and improved clinical, histological, and quality-of-life outcomes, suggesting therapeutic potential for VLS. Larger controlled studies are warranted.<\/jats:p>","DOI":"10.1007\/s10103-026-04923-3","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T02:13:25Z","timestamp":1782440005000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Use of fractional and microablative CO2 laser in cases of vulvar lichen sclerosus: a clinical-histological analysis"],"prefix":"10.1007","volume":"41","author":[{"given":"Dayane","family":"de Assis Pereira Hansen Cavalheiro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Carolina","family":"Silva Chuery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milvia Maria","family":"Sim\u00f5es e Silva Enokihara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helio","family":"Amante Miot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Fillippini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neila Maria","family":"de G\u00f3is Speck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"4923_CR1","doi-asserted-by":"publisher","unstructured":"Krapf JM, Mitchell L, Holton MA, Goldstein AT (2020) Vulvar lichen sclerosus: Current perspectives. 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Regarding commercial interests in the healthcare sector, Maurizio reports that, over the past two years, he has maintained relationships, including financing, with entities that have commercial interests in the healthcare sector (DEKA). The other authors declare no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of the Federal University of S\u00e3o Paulo Medical School (CEP\/UNIFESP) under protocol number 1471\/2020 on April 13, 2021.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Institucional review board statement"}}],"article-number":"133"}}