Laser Vs Steroid Cream for Lichen Sclerosus
What a New Study Just Told Us About Lichen Sclerosus
If you’re living with VLS you already know the drill. You eventually get diagnosed. Your doctor hands you a tube of clobetasol - a very strong steroid ointment - and says "use this." And for a lot of women that steroid is genuinely life-changing. It calms the itching, it calms the burning, and most importantly, it helps protect against the small but real risk of skin cancer that comes with untreated LS.
But here's the thing nobody talks about enough: for a good chunk of women, that cream just... doesn't cut it. Maybe it stops working. Maybe the side effects become their own problem. Maybe you're doing everything right and you're still miserable.
So when I saw this brand-new study - the biggest one ever done comparing laser treatment to steroid cream for LS - I knew I had to share it with other women. And I want to walk you through it in plain English, because this is exactly the kind of research that deserves to leave the medical journals and land in real conversations with real women.
So What Did They Actually Study?
A team of researchers in Germany ran what's called a randomized controlled trial - basically the gold standard of medical research, where you flip a coin (figuratively) to decide who gets which treatment, so you can compare apples to apples.
They took 245 women with symptomatic LS and split them into two groups:
One group got three sessions of a gentle, non-ablative CO2 laser spaced three weeks apart (Controlled CO2 laser treatment has been shown to help repair the thinning, hardened skin caused by vulvar lichen sclerosus. It does this by helping new blood vessels grow, boosting a natural sugar-storage molecule (glycogen) in the tissue, and helping the skin produce more collagen - the protein that keeps skin strong, flexible, and healthy.
The other group used the standard clobetasol steroid cream on a tapering schedule for three months - daily, then every other day, then a few times a week.
Then they measured symptoms using something called a BIP score, which just stands for Burn, Itch, and Pain - three of the most miserable parts of living with LS, all rolled into one number.
The Headline Result
Here's what made me sit up: the laser group had noticeably better symptom improvement than the steroid cream group. We're talking real, statistically meaningful improvement, not just a coin-flip difference.
And it wasn't just symptoms. The laser group also came out ahead on:
How much their symptoms visibly improved, as judged by a doctor who didn't know which treatment they'd gotten (that's important).
Overall improvement, as rated by their treating physician.
Quality of life - meaning things like comfort, confidence, and just feeling like themselves again.
So across the board, laser won. That's a big deal, especially because for years, laser therapy for LS has been sitting in this frustrating "promising but unproven" category. This study is the strongest evidence yet that it's a legitimate option worth taking seriously.
Quick Detour: What Even Is a CO2 Laser?
You've probably heard the term "CO2 laser" before - maybe from a friend who got a skin resurfacing treatment at a med spa or dermatologist's office to smooth out wrinkles, acne scars, or sun damage. That's the same underlying laser technology used in this study, just applied to a very different area for a very different reason.
Here's the thing you should know: not all CO2 lasers are set up the same way. The stronger, more aggressive versions used for cosmetic facial resurfacing are typically "ablative," meaning they actually remove the top layer of skin to trigger deep collagen remodeling. That's why facial CO2 resurfacing usually comes with real downtime, redness, swelling, oozing, and peeling for a week or two while the skin regrows.
The version used in this LS study was a non-ablative CO2 laser, which is a gentler setting on the same category of device. It doesn't remove skin layers; instead, it delivers energy underneath the surface to stimulate healing without the same open-wound recovery. That's part of why the LS study's side effects were milder than what you'd expect from a full facial resurfacing treatment - though as we'll get to, "milder" didn't mean zero discomfort either.
So when I say "CO2 laser," I want you to picture the same family of technology you may have seen used cosmetically at a med spa, just dialed down and redirected to treat inflamed, thinned vulvar skin instead of smoothing facial wrinkles.
Now Let's Talk About the Fine Print
Now, if you've followed me for any amount of time, you know I'm never going to hand you a headline without flipping it over to check the label. So let's do that together, because this study - as exciting as it is - has some real limitations you deserve to know about.
1. Nobody was "blinded" (mostly)
This was an open-label study, which is a fancy way of saying both the patients and most of the doctors knew who was getting which treatment. That matters because when you know you're getting the shiny new laser treatment, there's a natural tendency to feel a bit more hopeful, a bit more attentive to improvement. That's not anyone being dishonest — it's just human psychology, and it's one reason "blinded" studies (where nobody knows who got what) are considered more airtight. The one exception here: a separate doctor who didn't know which group each patient was in rated visible improvement, and laser still came out ahead - which is a nice bit of reassurance.
2. This was one type of laser, at one clinic
The laser used here was a specific non-ablative CO2 device at a single specialty clinic in Germany. That means we can't automatically assume every laser, at every med spa or clinic, using every setting, would get the same results. Laser therapy is not one-size-fits-all - the device, the settings, and the provider's skill all matter enormously. So "laser worked in this study" does not mean "any laser treatment will work for you."
3. They couldn't look under the hood
Because of ethics rules at the study site, researchers weren't allowed to take repeat tissue samples (biopsies) throughout the study. That means we still don't fully know why the laser group improved more. Is it actually changing the skin at a cellular level? Calming nerve signals? We don't have the biological receipts yet - just the symptom improvement, which, to be fair, is still really meaningful to the women living with this.
4. The symptom scale itself isn't fully "validated"
The BIP score (burn, itch, pain) is intuitive and easy to use, but it hasn't gone through the rigorous validation process that some other medical questionnaires have.
5. The "switch to laser" data is a little misleading
Here's a detail I found fascinating: after the initial three months, patients could choose to switch treatments. And get this, way more steroid-cream patients chose to switch to laser (74 women) than laser patients chose to switch to steroid cream (23 women). At first glance, that feels like a vote of confidence for laser.
But here's the catch: the women who switched to laser were, on average, doing worse than the ones who stuck with their original treatment. So this isn't a clean, randomized comparison anymore, it's essentially "the women who weren't getting better tried something else." That's useful real-world information, but it's not the same quality of evidence as the main randomized part of the study. The researchers themselves were careful to say this data "suggests" a benefit, it doesn't "prove" one.
6. Laser had its own side effects, too
This one's important, and it didn't get nearly as much attention in the headline results. When researchers specifically checked for procedural side effects from the laser sessions, over a quarter of laser patients experienced minor bleeding or pain during the procedure that needed a pain reliever. That's not nothing. It doesn't mean CO2 laser is unsafe (no serious complications happened in either group), but it's a reminder that "no big scary side effects" doesn't mean "zero discomfort." If you're weighing this kind of laser treatment, you deserve the full picture.
7. This does NOT mean skip the steroid cream
I want to be really clear here, because this is the part that worries me most when studies like this get turned into clickbait headlines. The researchers were explicit: this study does not support ditching clobetasol as your go-to first treatment. Steroid cream still has one job that laser hasn't proven it can do yet, helping protect against the long-term risk of vulvar cancer that comes with LS. Laser looks like a promising additional tool, especially for women who aren't getting full relief from steroids alone. It is not yet positioned to replace them.
Wait - Isn't Solasta Also a Laser? Let's Clear This Up
If you've been following my content, you might be wondering: does any of this apply to the Solasta laser I recommend in my protocols? Great question, and the honest answer is: not really, because it's a completely different kind of technology.
The laser in this big study is a CO2 laser. These devices work by creating tiny, controlled areas of heat-based injury in the skin's surface to trigger a healing response, kind of like a very precise, very small burn that prompts the body to rebuild. That's part of why some women in the study reported bleeding or pain needing medication during treatment.
Solasta works completely differently. It's what's called a cold laser, using red and near-infrared light to gently communicate with your cells and support healing and circulation, without heat, without cutting, and without damaging tissue at all. Most women describe it as a gentle, warm feeling, if they feel anything at all. Think of the CO2 laser as sending a wake-up call through controlled injury, and Solasta as sending a gentle nudge through light energy alone.
A Gentle Option Worth Knowing About: Photobiomodulation
Here's something I don't want to get lost in all this CO2 laser talk: there's a whole separate, growing body of research on gentle, light-based treatment for LS that looks nothing like the procedure described above. It's called photobiomodulation (PBM), also known as low-level laser therapy or "cold laser," and it's the category Solasta belongs to.
And unlike the single CO2 laser study, this isn't just one small trial. Here's what the research actually shows:
The big one: A Danish study followed 94 women with LS who weren't getting enough relief from their steroid cream alone. They received 10 sessions of gentle red/near-infrared light therapy (808 nanometers, essentially the same wavelength range used in Solasta) over 8 weeks. The results were genuinely encouraging, significant improvement in pain, sleep, mood, and overall quality of life, across the majority of measures researchers tracked. And here's the detail that matters most for anyone nervous about discomfort: zero adverse events were reported, during the study or afterward. The researchers' own conclusion was refreshingly honest, they called it a promising supplemental therapy alongside steroid treatment, not a replacement, and said larger studies are still needed to confirm the findings.
A smaller but consistent study: Twelve women with confirmed LS were treated with a similar light-based laser three times a week for two weeks. They saw meaningful drops in itching and pain, along with visible improvement in redness and skin fissures, and - again - no side effects reported at all.
An even more direct comparison: A smaller study put red light therapy head-to-head against steroid cream in women with confirmed LS over four weeks, and found the light therapy held its own. It's a small study, so I wouldn't call it definitive, but it's an interesting early signal.
So while this research is still smaller in scale than the big CO2 laser trial we just spent this whole post talking about, it's real, it's growing, and it consistently points in the same encouraging direction: gentle, non-invasive light therapy might genuinely help, especially as a supplement for women who need more than their cream is giving them, without the discomfort that came with the CO2 laser sessions in the big study above.
If you're someone who wants to explore every gentle, evidence-informed option available to you, it's worth bringing this up with your provider - not as a replacement for your prescribed treatment, but as a potential at-home adjunct alongside it.
Learn more in my guide to Lichen Sclerosus and Red Light Therapy
So What Should You Actually Take Away From This?
If you're navigating LS yourself, or you're a provider trying to counsel patients well, here's my honest, no-fluff summary:
This is genuinely exciting, high-quality evidence that laser therapy can meaningfully improve LS symptoms, possibly more than steroid cream alone, at least in the short term.
It's the largest study of its kind, which gives it real weight compared to the smaller, shakier studies we've had until now.
It is not a green light to abandon your steroid regimen, especially given the cancer-risk piece.
The open-label design, single-device, single-clinic setup, and the "who switched treatments" wrinkle all mean we need bigger, more diverse follow-up studies before this becomes a universal recommendation.
If you're curious about laser as an add-on option, this is a great, evidence-backed conversation to bring to your provider - just go in with realistic expectations about the side effects and the fact that we're still in early innings on the "why does this work" question.
Research like this is how the standard of care actually evolves - slowly, one well-designed study at a time. This one moves the needle. It just doesn't rewrite the whole playbook yet.
Tracy
Additional Resources
Hecken JM, Shoham I, Tempfer CB, Rezniczek GA. "Carbon Dioxide Nonablative Laser Compared with Topical Clobetasol for Lichen Sclerosus: A Randomized Controlled Trial." Obstetrics & Gynecology, October 2026.
Liang A, Welch K. "Laser Therapy: Balancing Innovation With Evidence-Based Practice" (Editorial). Obstetrics & Gynecology, October 2026.
ClinicalTrials.gov. "Laser Vs Clobetasol for Lichen Sclerosus" (NCT05010421).
Tasker F, et al. Systematic review of laser therapy for genital lichen sclerosus, 2021.
"Low-Level Laser Therapy: An Efficient Supplement to Treatments of Vulvar Lichen Sclerosus to Improve Quality of Life." Journal of Obstetrics and Gynaecology, 2024.
ClinicalTrials.gov. "Low-Level Laser Therapy: An Efficient Supplement to Treatments of Vulvar Lichen Sclerosus" (NCT05060224).
Bergamo S, et al. "Blue Diode Laser as Supportive Therapy for the Management of Vulvar Lichen Sclerosus." Dermatology Reports, 2025.
Mayo Clinic. "Laser Resurfacing" — patient education overview of ablative vs. non-ablative laser technology.
American Society of Plastic Surgeons. "Laser Skin Resurfacing Recovery."
