Overview
This is a prospective, randomized study in women of reproductive age with vulvar lichen sclerosus. Participants will be randomly assigned by investigators using a computer-generated sequence to receive either combined dynamic quadripolar radiofrequency (DQRF) plus topical corticosteroid therapy or topical high-potency corticosteroid therapy alone. Clinical outcomes, patient-reported outcomes and tissue-level changes evaluated by histology, elastin histochemistry, and immunohistochemistry for estrogen, androgen receptors and superoxide dismutase 2 (SOD2) will be assessed before and after treatment, and during follow-up at 3, 6, and 12 months. Safety will be monitored throughout the study. Histochemical and immunohistochemical analyses will be performed in a subset of 10 patients per group before the treatment and at 3 months after the completion of treatment.
Description
This is a prospective, randomized study conducted in women reproductive age with vulvar lichen sclerosus. Computer-generated randomization using an electronic spreadsheet will be used by investigators to assign participants to study groups.
Study groups Group 1: topical high-potency corticosteroid therapy according to the standardized regimen, followed by combined Dynamic Quadripolar Radiofrequency (DQRF) therapy initiated 2 weeks after the start of corticosteroid treatment. DQRF therapy will be administered using a small vulvar applicator in a total of four sessions, performed at two-week intervals.
Group 2: topical high-potency corticosteroid therapy according to a standardized regimen.
Study assessments Clinical assessment At baseline and each follow-up visit, participants will undergo standardized vulvar examination with documentation of objective signs (skin color changes, sclerosis, fissures, erosions, scarring and architectural changes) and symptom severity. Clinical severity will be assessed using a structured clinician-rated vulvar lichen sclerosus severity score. Standardized photo documentation will be performed.
Patient-reported outcome measures
Patient-reported outcomes will be assessed using validated questionnaires:
- Numeric Rating Scale (NRS) for pruritus, vulvar pain, burning, dryness and dyspareunia;
- Vulvar Quality of Life Index (VQLI);
- Short Form-12 Health Survey (SF-12);
- Female Sexual Function Index (FSFI). Histological and tissue-level assessment
Histochemical and immunohistochemical analyses will be performed in a subset of 10 patients per group. Vulvar punch biopsy specimens will be obtained before initiation of therapy and after completion of treatment for:
- immunohistochemical analysis of estrogen receptors, androgen receptors and superoxide dismutase 2 (SOD2) expression;
- histochemical assessment of elastin fiber staining intensity and distribution using a standardized elastin stain, with semi-quantitative grading and/or digital image analysis.
Safety assessment Adverse events related to topical therapy, radiofrequency treatment will be recorded throughout the study.
Follow-up period Participants will be followed longitudinally before the treatment, at the end of treatment, and at 3, 6, and 12 months after completion of therapy to evaluate short-term response, durability of clinical improvement, and disease recurrence.
Eligibility
Inclusion Criteria:
- Women aged 18 to 49 years (women of reproductive age);
- Histologically confirmed diagnosis of vulvar lichen sclerosus;
- Written informed consent to participate in the study.
Exclusion Criteria:
- Pregnancy or lactation;
- Malignancy at the time of treatment or during any period of follow-up;
- Postmenopausal status;
- Severe decompensated somatic disease;
- Sexually transmitted infections, including hepatitis B, hepatitis C, and syphilis;
- Presence of a cardiac pacemaker or metal-containing intrauterine device (IUD);
- History of treatment with other high-energy-based modalities within the last 6 months;
- Use of topical corticosteroids within the last 3 months;
- Immunosuppression, including immunodeficiency disorders (such as HIV/AIDS) or use of immunosuppressive medications;
- Psychiatric disorders or communication difficulties that may interfere with study participation or compliance.