Safety and Efficacy of Stromal Vascular Fraction Enriched Fat Grafting Therapy for Vulvar Lichen Sclerosus

Abstract

Background Lichen sclerosus is an inflammatory dermatosis of unknown etiology which currently has no cure. Most treatment guidelines recommend the use of ultrapotent topical corticosteroids. However, the relapse rate is usually high. Through a retrospective study we evaluated the efficacy and safety of stromal vascular fraction of adipose tissue as therapy for lichen sclerosus. Material and methods For this retrospective review, we obtained data on patients with vulvar lichen sclerosus treated with autologous fat grafting enriched with adipose derived stromal vascular fraction cells. Data collected through a modified vulvo-vaginal symptoms questionnaire were analyzed before treatment, six months and 24 months after treatment. The 19 items questionnaire was subdivided in four categories: symptoms, signs, social functioning and sexual functioning. Global scores and partial scores for each category were analyzed using paired t-test. For all statistical analyses, a value of p ≤ 0.05 was considered statistically significant. All data are presented as mean ± SD. Results Thirty nine patients were included in the study. Thirty seven patients (94.87%) experienced a significant decrease in global score at six months and 24 months after treatment (p < 0.05). Decrease in scores were also statistically significant between pretreatment and 24 months after treatment for each of the four questionnaire categories-symptoms, signs, social functioning and sexual functioning (p < 0.05). Conclusions This retrospective study showed that the use of autologous fat grafting enriched with adipose derived stromal vascular fraction is safe and leads to significant and long lasting improvement in patients with vulvar lichen sclerosus.

A new approach to regenerative medicine in gynecology

“…Innovative treatments such as laser, radiofrequency and carboxytherapy have been proposed 15,17 . A more recent therapeutic approach implants adipose tissue naturally rich in SVF and ADSC 12–14 …”

Adipose tissue stromal vascular fraction and adipose tissue stromal vascular fraction plus platelet‐rich plasma grafting: New regenerative perspectives in genital lichen sclerosus

“…Sporadic data in the literature reported that the application of lipofilling and autologous (PRP) are effective for the therapeutic management of LS 18‐23,43‐46 . The simultaneous use of lipofilling and PRP has been previously reported in a single case report and in a study including 15 female LS patients lacking a control group of patients treated only with lipofilling in comparison to the combinatory therapy 18,46 .…”

“…Casabona et al in 2010 first described the use of homologous fat grafting and platelet‐rich plasma (PRP) in LS treatment to reduce atrophy and scarring and improve skin tropism 18 . Then, other groups reported successful treatment of LS patients using fat grafting, stromal vascular fraction (SVF) enriched fat grafting, or purified adipose‐derived stem cells 19‐23 …”

“…18 Then, other groups reported successful treatment of LS patients using fat grafting, stromal vascular fraction (SVF) enriched fat grafting, or purified adipose-derived stem cells. [19][20][21][22][23] The great therapeutic potential of the adipose tissue is explained by the presence of highly concentration of pluripotent mesenchymal stem cells (MSC), endothelial progenitor cells, T cells, B cells, mast cells, and adipose-resident macrophages and of a vast array of bioactive secretory factors that collectively are referred as adipose-derived stromal vascular fraction (AD-SVF). [24][25][26][27][28] Several recent discoveries suggest that the adipose-derived secretome possesses similar reparative properties as their cellular counterparts.…”

Oral Lichen Planus Associated With Lichen Planus Pigmentosus and Lichen Sclerosus in Monozygotic Twins

“…44 Clinically, lichen sclerosus usually begins as erythematous papules or white patches that slowly coalesce to form larger plaques that frequently present a varied combination of intense itching, burning, or pain. 45 Characteristic histopathological findings generally include hyperkeratosis of the epidermis, epidermal atrophy with loss of rete ridges, homogenization of the collagen in the upper dermis, and a lichenoid (band-like) inflammatory infiltrate in the dermis. 46 In 1994, Marren et al 47 described the lichen sclerosus/LP overlap syndrome, which occurs when both diseases manifest in the same patient, as occurred in one of our cases.…”