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Vulvar leukoplakia is not a histological diagnosis and involves several diseases. Most commonly, these are vulvar lichen sclerosus and squamous cell hyperplasia of the vulva. These two conditions have similar aetiology, clinical presentation and treatment but different histopathological changes. They both lead to significant impairment of quality of life, risk of malignancy, as well as recurrence after treatment. Treatment of these conditions includes topical corticosteroids as a first-line therapy, but they have their side effects and not all patients are receptive to this therapy. This requires the use of alternative therapeutic options such as topical calcineurin inhibitors, topical and systemic retinoids, other steroid creams, various destructive techniques and, as a last resort, surgical removal of affected tissues. Surgical treatment should be avoided, despite the malignant potential, because of recurrence risk in both diseases New therapeutic approaches are coming into effect in gynaecological practice due to potential risks of the above-mentioned methods. Platelet-rich plasma therapy, ablative and non-ablative laser treatment, and new topical medicines, are some of the new options applied to improve the efficacy of treatment avoiding the side effects of conventional medications. A number of them are still in their initial phase of application and time will tell their effectiveness.

The aim of study is to evaluate the tolerability and effectiveness of photodynamic therapy as an organ‑preserving treatment in patients with vulvar leukoplakia. 50 patients with a verifed diagnosis of «vulvar leukoplakia» were included in the study. The age varied from 27 to 74 years. The method of treatment assumed the use of the photosensitizer рhotolon (RUE «Belmedpreparaty», Belarus) administered intravenously in doses of 1.8–2.5 mg/kg. Photoirradiation of pathological foci was carried out 2.5–3 hours after intravenous injection of photolon® using a semiconductor laser «UPL PDT» (LEMT, Belarus, λ=661 nm) at exposure doses from 30 to 100 J/cm2 with a power density of 100–170 mW/cm2. The treatment was performed under medical anesthesia. The results of treatment were evaluated using clinical data. Adverse reactions and complications after the introduction of the photosensitizer and photoirradiation have not been observed. Complete clinical regression of the treated pathological foci was noted in 100% of cases with a follow‑up observation 1 month after the treatment. At follow‑up after 3 months, local recurrences of the disease were detected in 4 cases, which were successfully treated with repeated photo‑dynamic therapy sessions. The percentage of complete regressions was 92%, partial – 8%. The obtained results allow judging on the possibility of using photodynamic therapy in the treatment of patients with vulvar leukoplakia, which allows to preserve the organ and obtain a satisfactory functional and cosmetic result.

Introduction: The term vulvar leukoplakia encompasses a variety of non-inflammatory diseases that lead to skin discoloration of the external genitalia and white colouration. Most commonly, these are vulvar lichen sclerosus (VLS) and squamous cell hyperplasia of the vulva (SCHV). They have similar aetiology, clinical presentation, and treatment but different anatomical pathology. Aim of the study: The study aims to determine the effect of Theresienöl herbal oil treatment in patients with clinically proven diagnosis of VLS and SCHV. Material and methods: This prospective study includes 17 patients with a diagnosis of VLS and SCHV, who underwent a 3-month treatment course with Theresienöl herbal oil. All patients were followed up for 1 year after therapy initiation, and the effect of treatment was reported using a visual analogue scale (VAS) for genital itching. Results: The median age of patients enrolled was 60.6 years (range 42-74); 2 patients dropped out due to failure to attend follow-up visits. The mean score of the VAS taken at the beginning of treatment was 1.65 (0-5); at the 3rd month the mean score was 9 (8-10) and it remained similar at the 12th month - 8.67 (7-10). Conclusions: Theresienöl herbal oil treatment of vulvar leukoplakia is effective and safe, but studies should be continued. [ABSTRACT FROM AUTHOR]

Vulvar leukoplakia is not a histological diagnosis and involves several diseases. Most commonly, these are vulvar lichen sclerosus and squamous cell hyperplasia of the vulva. These two conditions have similar aetiology, clinical presentation and treatment but different histopathological changes. They both lead to significant impairment of quality of life, risk of malignancy, as well as recurrence after treatment. Treatment of these conditions includes topical corticosteroids as a first-line therapy, but they have their side effects and not all patients are receptive to this therapy. This requires the use of alternative therapeutic options such as topical calcineurin inhibitors, topical and systemic retinoids, other steroid creams, various destructive techniques and, as a last resort, surgical removal of affected tissues. Surgical treatment should be avoided, despite the malignant potential, because of recurrence risk in both diseases New therapeutic approaches are coming into effect in gynaecological practice due to potential risks of the above-mentioned methods. Platelet-rich plasma therapy, ablative and non-ablative laser treatment, and new topical medicines, are some of the new options applied to improve the efficacy of treatment avoiding the side effects of conventional medications. A number of them are still in their initial phase of application and time will tell their effectiveness. [ABSTRACT FROM AUTHOR]

• Application of combined continuous-pulse irradiation mode for vulvar leukoplakia PDT was investigated for the first time in this study. • Clinical research results indicate strong potential in utilizing such technology towards treatment of pathological vulvar diseases. • The developed treatment protocol is profitable in terms of price and healing effect and allows carrying out theranostics daily in 20 patients. • Selectivity of PDT' impact, absence of adverse reactions, and excellent cosmetic effect are the strengths of the applied approach. Using continuous-pulse irradiation mode application for performing photodynamic therapy sessions to introduce a new method, and conclude results of clinical research focused on vulvar leukoplakia photodynamic therapy efficiency in combination with topical aqueous «Alasens®» solution administration. Seventy patients (average age of 61 years) diagnosed with vulvar leukoplakia disease (2018 ICD-10-CM Diagnosis Code N90.4) were examined. The following values represent doses of combined mode photodynamic therapy session: 12 J/cm2 pulse radiation dose; 3.5 J/cm2 continuous radiation dose. Non-invasive spectroscopic and visual control of drug accumulation in real time was carried out by fluorescence diagnostic method before and after each therapy session. Single-therapy session efficiency was estimated by a fluorescent signal reduction in the pathological region after irradiation, and the direct correlation between photosensitizer photobleaching and disease regression was registered. Photodynamic therapy course included three procedures, with each session applied in 24 -h intervals, and when necessary, an additional course of therapy was applied 60 days afterward. Significant post-treatment results took effect after 2–3 courses with symptom presence reduced or fully regressed depending on the initial severity of the disease. Additionally, side effects and sequelae remained absent in all cases. The result of methods applied during the clinical research period indicate strong potential in utilizing such promising technology to contribute to the possible prevention of malignant transformation and the treatment of vulvar leukoplakia. [ABSTRACT FROM AUTHOR]