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TREATMENTS

Lichen Sclerosus

Video Transcription

Hello, everybody. Dr. Coyle coming to you today from the Coyle Institute for Female Pelvic Medicine and Reconstructive Surgery here in Pensacola, Florida. And today, I wanted to send out a video kind of going over a disorder that is debilitating for many women, and it's called lichen sclerosus. I did an earlier video with this where I briefly touched on that, the lichen sclerosus as well, some of the treatments specifically like using the O-Shot and things like that. And so, I wanted to give a little bit more in-depth, detailed view of lichen sclerosus, of what we've been doing here at Coyle Institute to help women out with this disorder.

What is lichen sclerosus? Well, lichen sclerosus is a horrible skin disorder that affects the vulva, the labia, the clitoris, the perineal area, the perirectal area. And what it does is the skin is very white and it's flat, it can tear very easily to where it's...will have some bleeding from it. These women oftentimes...I mean, I've had women that it's been so bad that they were having difficulty voiding or urinating because it causes the labia to fuse together. And by fusing together, what it does is it will fuse over top of the urethra to where they're not able to even see their urethra anymore. These women really struggle with this and it really places a large burden on themselves physically and emotionally. But it also can put a large burden on their family life as well. And so, I wanted to send out a little bit more in-detail video about this horrible disorder.

Well, what have we done in the past with this in treating lichen sclerosus? And what are some of the things that are coming down the pipeline? So, what we've pretty much done for the longest time with lichen sclerosus is treat it with steroids. Patients would come in, we'd biopsy them and the biopsy would come back showing that they have lichen sclerosus. And so, the treatment option of choice is to put them on a steroid cream, and it usually is a high potency steroid cream that you stay on for an extended period of time and then you kind of come off of it because we don't want you to be on that steroid cream forever. And then you start to have symptoms again, and then you kind of go right back on the steroid cream again.

That's pretty much what we've done. We've tried other things like hormone cream, we've tried estrogen cream, we've tried testosterone cream, we've tried moisturizers. Really, all of that has not been very effective at all. The mainstay or what we would call the gold-standard procedure or gold-standard treatment option would be the steroids.

Well, there's been some really good research out there on using the O-Shot, which is using platelet-rich plasma to inject into the areas of lichen sclerosus. And we've been seeing some good results with that as well. I think there's more research to be done, and trust me, we're going to do it for sure. But that is definitely something that is gaining ground and showing some really good research.

Let me tell you some things that we've been doing here at Coyle Institute that is completely different. There's been some studies done using CO2 laser on lichen sclerosus as well. And so, everybody is out there trying to come up with a way to help these women because it really is a horrible disorder that is affecting their life. And so, we've tried CO2 laser, we've tried the hormones, we've tried the steroids, we're trying PRP. And so, let me tell you a little bit about what we're doing here at Coyle Institute.

Well, over a year ago, a year, probably a year and a half ago, what we started doing is actually using a pro-fractional handpiece that will shoot the laser in a grid format. And so, it's actually using not a CO2 laser, but it's using an erbium laser from Sciton. And this profractional laser will create this grid where the erbium laser has a much higher affinity for water, it has a 10 times higher affinity for water. And so, the laser will actually go in and treat the tissue with that affinity to water. One of the really neat things about this profractional laser from Sciton is it's the only laser that we have that we can dial in how deep we want the laser to go.

And that got me thinking, we've never asked the question how deep does lichen sclerosus go? It's always been either you have it or you don't. So, we biopsy it and you either are yes, you have lichen sclerosus or no, it's something else. Since I had a laser here that I could tell it how deep I wanted it to go, that got me thinking saying, "Wait a second, what if we asked the question how deep does lichen sclerosus go?" And so, I got in touch with a dermatologic pathologist friend of mine, and I asked him, I said, "Hey, if I gave you a biopsy of what I think is lichen sclerosus, can you tell me how deep the disease goes?" And he's like, "Sure, of course, I can." And so, that's how we started our study.

And so, I took my own patients that we enrolled into a study and we took 15 women that had previously biopsy lichen sclerosus or people that came to me thinking that they had lichen sclerosus. We biopsied them, and we asked the question, how deep does your disease go? And then based upon that, I created a protocol to treat these women using the profractional handpiece on the Sciton laser. And what we have found has just been absolutely phenomenal.

These women, it is a series of three treatments, one month apart, and the protocol that I have developed, we base it on the patient's disease process themselves, how deep their disease goes. They do very, very well and I've actually had the wonderful opportunity to present some of this data at some talks that I've been doing around the country. And we're in the process of now getting several other institutions, urogynecologists across the country. We're going to be doing a multi-center international review board study to where we can, you know, really try to finetune this and kind of come up with ways to treat lichen sclerosus.

The results from treating these women have been unbelievable to the point to where these women came in with a horrible disease and we took them off their steroids, we treated them in a series of three treatments and they have come back doing fantastic, even to the point to where many of the women, not all of them, but many of the women have had a complete resolution of their disease at three months out after treatment. So, I would biopsy them before treatment, do their series of three treatments and then had then come back at one month. And then at three months, we re-biopsy them. Those women that we re-biopsied at those months, the worse that I've had so far has been 50% improved where we've had several that have had complete resolution of the disease, where they saw lichen sclerosus beforehand, and then afterwards, no evidence of lichen sclerosus.

Obviously, there's still research to be done. I don't know if these women are ever gonna need to have another treatment or not. There's a possibility that they may have to have maybe one or two touch-up treatments per year, but that's still better than taking a steroid cream every day, right? And so, without a doubt, we are breaking some ground with lichen sclerosus. Very, very exciting, it is an exciting time to be in this field of Female Pelvic Medicine and Reconstructive Surgery. And it's a very exciting time to be able to treat these women that have lichen sclerosus.

And so, if you yourself or somebody that you love or somebody that you know has lichen sclerosus, they've been diagnosed with it before or they think they may have it and they want to be...find out if they've been…that they need it to be diagnosed with it, then don't hesitate. Instead of just dealing with steroid cream, it does seem now that we actually have something very, very exciting to be able to offer.

And so, give us a call at Coyle Institute or get us on the web, www.coyleinstitute.com, and you can send in request from the website. And also send us an email, okay? At any rate, I hope this helps. And don't hesitate to give us a call. We really want to help you. And this research is going to get out and I'm not going to be the only person on the planet doing this in the future. And so, ultimately, I do think that this is going to revolutionize the way that we treat lichen sclerosus.