Proposition of standardized protocol for photodynamic therapy for vulvar lichen sclerosus.

Background: Photodynamic therapy (PDT) is an alternative treatment modality for vulvar lichen sclerosus (VLS) which is a chronic inflammatory mucosal condition. In literature, no consensus of optimal parameters of PDT for VLS is reached so far.

Objectives: The aim of this narrative review is to develop a standardized treatment protocol for PDT in VLS.

Methods: A systematic literature search was conducted to identify studies reporting on PDT in VLS and used treatment parameters, side-effects, and clinical outcomes were summarized.

Results: Thirteen studies used 5-aminolevulinic acid (5-ALA) with concentrations of 20%, 10%, 5% and three studies used methyl aminolevulinate (MAL). Generally, the light source was red light (median 630 nm). Light dose varied between 9 and 180 J/cm and light intensity between 40 and 700 mW/cm. Incubation period with the photosensitizer ranged from 2 to 6 h. All studies showed a substantial improvement in VLS-related pruritus, burning and pain.

Conclusions: Based on a literature review, we suggest the following protocol for PDT in VLS: 5% 5-ALA as a photosensitizer applied for 3 h under occlusion before irradiation at the dose of 120 J/cm with red light (590-760 nm) and intensity of 204 mW/cm.