Use of Platelet-rich Plasma for Vulvovaginal Autoimmune Conditions Like Lichen Sclerosus

Abstract

Background:Lichen sclerosus (LS) is an inflammatory dermatosis with autoimmune pathogenesis. Although relatively common, its true incidence is unknown and likely underestimated. LS is usually anogenital, but in around 10% of patients, it can present as extragenital lesions. Continuous administration of topical corticosteroids is the mainstay of medical treatment. Other treatments are available but are only occasionally prescribed along with or instead of topical steroids. Injection of platelet-rich plasma (PRP) into affected areas has been reported to result in the regeneration of normal skin. In this study, we aimed to evaluate the safety, symptom resolution, and objective improvement in patients with autoimmune condition like genital LS after treatment with PRP.Methods:Over a 2-year period at FBW Gynaecology Plus, we had a total of 28 patients with confirmed LS on biopsy, unresponsive to topical steroid treatment. After acquiring informed consent, patients’ own blood was centrifuged on site and injected under local anesthesia to the external genitalia.Results:Almost all of our patients showed clinical improvement in the size of their lesions, and in 8 cases, lesions totally disappeared after treatment with PRP. Symptoms disappeared in 15 of the 28 patients after treatment, with no need for further steroid therapy in 23 patients. Thirteen women experienced partial symptom relief.Conclusions:Based on our limited findings, we hypothesize that PRP presents a potential alternative to topical steroids for treatment of vulvovaginal autoimmune conditions such as LS. A larger pilot and/or randomized controlled trial study is required to evaluate this finding further.

Platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus in a premenopausal woman: A case report

“…Recent publications concerning PRP in the treatment of LS [ 14 , 15 ] present similar results to those we obtained with our patient. However, one group [ 15 ] used a different platelet separator system (Magellan Autologous Platelet Separator System, Arteriocyte Medical Systems) and different methods for objectively rating the condition, namely a visual analogue scale (VAS) and a modified Investigator's Global Assessment (IGA) Scale.…”

“…However, one group [ 15 ] used a different platelet separator system (Magellan Autologous Platelet Separator System, Arteriocyte Medical Systems) and different methods for objectively rating the condition, namely a visual analogue scale (VAS) and a modified Investigator's Global Assessment (IGA) Scale. The other group used the Australian Pelvic Floor Questionnaire [ 14 ]. Also, a publication concerning penile LS [ 16 ] reported that PRP treatment seemed to be helpful according to ratings on the IGA (a six-point Likert scale) and the Dermatology Life Quality index (DLQI).…”

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

“…Goldstein et al describe the effectiveness of two intradermal and subdermal applications of PRP, separated six weeks apart, in 15 patients with vulvar lichen sclerosus [17]. Similarly, Behnia-Willison et al describe their positive experience with the use of multiple injections of PRP in 28 patients who were almost all postmenopausal, and affected by vulvar lichen sclerosus, using Pelvic Floor Questionnaire to validate the results [18]. Casabona et al summarize their positive experience in 12 patients using fat grafts followed by PRP, although they do not use any evaluation questionnaire to validate their results [19].…”

Autologous Platelet-Released Growth Factor and Sexual Dysfunction Amendment: A Pilot Clinical Trial of Successful Improvement Sexual Dysfunction after Pelvic Irradiation

“…The result of Behnia et al; showed that PRP presents a potential alternative to topical steroids for treatment of vulvovaginal autoimmune conditions such as lichen sclerosus. They hypothesized growth factors released by platelets, monocytes, and nutrients have an important role in phagocytosis of fibrotic tissue, inflammation reduction, angiogenesis stimulation, and collagen III synthesis (Behnia-Willison et al, 2016).…”