To investigate the efficacy of modified Shechuangzi Powder fumigation and washing combined with high-intensity focused ultrasound (HIFU) in the treatment of vulvar leukoplakia (WLV) and its effects on traditional Chinese medicine (TCM) syndrome scores and nerve growth factor (NGF) levels in patients.

A total of 196 WLV patients with liver-kidney yin deficiency pattern treated at Hengshui Maternal and Child Health Hospital from January 2023 to June 2024 were selected and randomly divided into a combination group and a control group using a random number table method, with 98 cases in each group. Due to loss to follow-up, 1 case in the combination group and 2 cases in the control group were excluded, resulting in 97 and 96 cases being included in the final statistical analysis, respectively. The control group received HIFU treatment, while the combination group received additional modified Shechuangzi Powder fumigation and washing on the basis of HIFU. The therapeutic efficacy, TCM syndrome scores, and Dermatology Life Quality Index (DLQI) scores were evaluated before and after treatment. Serum and vulvar tissue-related indicators were measured before and after treatment. Adverse reactions and recurrence within 6 months of follow-up were recorded in both groups.

The total effective rate in the combination group was 100.00%, which was higher than that in the control group (90.63%) (P<0.01). After treatment, TCM syndrome scores and DLQI scores in the combination group were significantly lower than those in the control group (P<0.05). Regarding serum indicators, the levels of NGF, substance P (SP), C-reactive protein (CRP), and interleukin-6 (IL-6) in the combination group after treatment were significantly lower than those in the control group (P<0.05). Regarding vulvar tissue indicators, the optical density (OD) value of NGF positive expression in the combination group after treatment was significantly lower than that in the control group (P<0.05), while the OD value of vascular endothelial growth factor (VEGF) positive expression was significantly higher than that in the control group (P<0.05). There was no significant difference in adverse reactions between the two groups (P>0.05). The 6-month recurrence rate in the combination group was 3.09%, which was lower than that in the control group (10.42%) (P<0.05).

Modified Shechuangzi Powder fumigation and washing combined with HIFU is safe and effective in the treatment of WLV. It can significantly reduce TCM syndrome scores, down-regulate NGF and pro-inflammatory factor levels, upregulate VEGF expression, reduce the recurrence rate, and improve patients' quality of life.