EFFICACY AND SAFETY OF TOPICAL TREATMENTS FOR LICHEN SCLEROSUS
Vulvar Lichen Sclerosus, Quality of Life, Corticosteroids, Immunomodulator, Women's health.
Objectives: To evaluate the efficacy and safety of topical treatments and therapeutic techniques used to reduce the symptoms of Lichen Sclerosus (LS) and to improve the quality of life of women diagnosed with the condition. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A comprehensive search was conducted in the PubMed, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Clinical Trial Databases on June 18, 2025. Randomized clinical trials comparing topical interventions and therapeutic techniques for LS were included. Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB 2.0). Results: A total of 2,240 articles were retrieved. Of these, 28 studies met the eligibility criteria and were included in the systematic review, comprising 1,054 participants. The mean age of patients ranged from 34 to 67 years. The most frequently used interventions were: laser therapy (Nd:YAG and CO₂), followed by clobetasol, hormonal treatments (testosterone and progesterone), tacrolimus, pimecrolimus, and phototherapy. Compared to other interventions (tacrolimus, phototherapy, progesterone, and testosterone), clobetasol proved to be superior or equally effective. Regarding laser therapy, the studies showed greater improvements in clinical scores, higher patient satisfaction, and better quality of life compared to clobetasol. However, in some studies, no statistically significant difference was observed when compared to placebo. Most of the included studies presented a low risk of bias. Conclusions: Clobetasol remains the most effective and safest treatment for LS. However, laser therapy and phototherapy have shown promising results, with good efficacy and patient acceptance, especially in refractory cases or in those intolerant to corticosteroids.