Photodynamic therapy of vulvar lichen sclerosus with 5-aminolevulinic acid

Objective: To evaluate the therapeutic effect of photodynamic therapy on vu lvar lichen sclerosus. Methods: Twelve women with lichen sclerosus were enrolled in a prospective, single-arm pilot study. Four to 5 hours before photodynamic therapy, 10 mt , of a 20% solution of 5-aminolevulinic acid was applied topically to the v ulva. Photodynamic therapy was administered with an irradiation of 80 J/cm( 2) at an irradiance of 40-70 mW/cm(2). Light with a wavelength of 635 nm wa s delivered by an argon ion-pumped dye laser. The degree of pruritus was ev aluated using a horizontal visual analog scale before and after 6-8 weeks, and patients were followed tri-monthly after photodynamic therapy. Results: Two women underwent two cycles of photodynamic therapy, one underw ent three cycles, and the remaining nine women underwent one cycle each. Tr eatment was tolerated moderately well, with eight patients not requiring an y analgesia; three treated with opioids intravenously during the procedure, due to burning sensations; and one undergoing separation of adhesions unde r general anesthesia. Minimal local toxicity included vulvar erythema but n o necrosis, sloughing, or scarring. No generalized cutaneous photosensitivi ty was present. Six to 8 weeks after photodynamic therapy, pruritus signifi cantly improved in ten of the 12 women. A prolonged effect of photodynamic therapy was reported, with a mean of 6.1 months. Conclusion: Photodynamic therapy after topical application of 5-aminolevuli nic acid produced statistically significant relief of symptoms of vulvar li chen sclerosus for an average of 6.1 months with minimal side effects. (C) 1999 by The American College of Obstetricians and Gynecologists.