PRP for Lichen Sclerosus: New hope for a difficult condition?

What is Vulvar Lichen Sclerosus (LS)?

Lichen sclerosus is a chronic inflammatory condition characterized by ivory-white patches.  It is also known as lichen sclerosus et atrophicus because the skin also tends to become very thin or atrophic.^​1​  It’s often inflammed, itchy, and fragile, bleeding easily. While this condition can occur anywhere on the body, genital lichen sclerosus often involves the vulva, labia, and less commonly the vaginal lining.  Although lichen sclerosus is much more common in females, when it affect males, it tends to occur on the glans, or head of the penis. Lichen sclerosus can cause scarring and can even lead to squamous cell carcinoma in about 4% of patients.

What causes Lichen Sclerosus (LS)?

Although LS is estimated to occur in approximately 1 in 30 women and 1 in 900 pre-pubertal girls, the cause is not fully known.  Many factors may play a role, including autoimmune, genetic, and hormonal deficiencies.  Chronic trauma and irritation may also contribute to lichen sclerosus.

Conventional treatments for lichen sclerosus

Guidelines for the managment of women with vulvar lichen sclerosus usually recommend using a topical corticosteroid.  These powerful medications are good at calming down the inflammation and itching, but unfortunately, steroids also tend to weaken the tissue and lead to thinning skin, which can make the areas involved even worse over time.  This can make the management of lichen sclerosus very challenging and frustrating for women.  Even worse, sometimes lichen sclerosus of the vulva can become unresponsive to topical steroid treatment.

PRP for lichen sclerosus: is it an effective treatment? 

Yes, several clinical studies have been published showing that autologous platelet-rich plasma can be a very effective treatment option for vulval lichen sclerosus.  Please refer to the next question and the list of academic references below.

What does the research say about PRP as a treatment option for women with lichen sclerosus?

One small study out of Australia, (Behnia-Willison et al, 2016),  published in the Journal of Plastic and Reconstructive Surgery, treated 28 women with biopsy proven lichen sclerosus, who were unresponsive to steroid cream, with PRP.  After 3 initial PRP treatments and one booster a year later, almost 90% showed clinical improvement in the size of their lesions and more than 50% had complete relief of all their symptoms.^​2​ 

Another small study, (Tedesco et al, 2019), from Italy , treated 31 patients, including 13 males, in a similar manner with 3-4 treatments every 2 weeks.  After 1 year, there was a 62% rate of improvement, 35% remained stable, and 3% worsened.^​3​ 

A note about type of PRP: The above studies used low concentration PRP, but at our clinic, we have seen much better results with the type of high concentration PRP we are using, as it has a much higher concentration of platelets and active growth factors.

Another small study from George Washington University School of Medicine, by Goldstein et al in 2017, treated 15 patients with biopsy proven LS with 2 sessions of PRP, 6 weeks apart. Each treatment consisted of 5 mL of PRP prepared from a Magellan system.  A biopsy was performed before and 6 weeks after the treatment, and showed improvement in about 60% of the 12 patients who  had the 2nd biopsy done. ^​4​  

Overall, research is still in the early stages regarding the use of autologous PRP and lichen sclerosus. A recent review article from the Mayo Clinic looked at 8 studies which had been published between 2016 and 2021.  The authors found a high variability in the design of the studies and often the type of PRP being used was not reported. ^​5​ 

How does platelet rich plasma compare to other treatments for lichen sclerosus?

PRP is completely autologous, dervied from the patient themselves.  No medications are involved, so there is no risk of allergic reaction and side effects are minimal (mild discomfort during the treatment).  PRP does not cause thinning of the skin, instead it promotes healing and regeneration.   PRP tends to help with inflammation, itching and burning.  PRP can also be used to treat other inflammatory skin conditions, such as eczema and psoriasis. PRP has been also been reported effective in other types of inflammatory skin disorders, even in a rare condition known as Zoon vulvitis.^​6​

What’s involved in a PRP procedure for vulvo-vaginal lichen sclerosus?

A small amount of blood is taken from the patient using standard venipuncture equipment.  This blood is then separated carefully using a centrifuge to isolate and concentrate the platelets while removing most of the red blood cells and white blood cells (leukocytes).   After the area has been numbed with anesthetic cream, the concentrated solution of platelets is then injected into the affected areas.  This is known as autologous platelet-rich plasma intradermal injections.  

Using PRP for lichen sclerosus is very similar to having the O-Shot™ (Orchid Shot™). Please click here to learn more about the O-Shot™

Do platelet-rich plasma therapy injections for lichen sclerosis hurt?

Injection of platelet-rich plasma for the treatment of LS can hurt, but most patients tolerate the procedure quite well with the use of numbing cream applied beforehand.

Case report: Real Patient Experiences with Platelet-rich plasma therapy to treat vulvar and vaginal lichen sclerosus

At PRP Medical Aesthetics, we specialize in all types of PRP therapy, and have treated several patients with platelet-rich plasma for vulvovaginal autoimmune, and other inflammatory skin conditions.  Often these patients come to us after having tried many other treatments, including some very expensive treatments such as vulvar ls laser treatments.  Following is a testimonial from a real patient who we recently treated with the use of platelet-rich plasma injections for vulvovaginal lichen sclerosus.  Three weeks after a single treatment, many of the symptoms which had been present for years had already started to show dramatic improvement:

I was diagnosed with the rare condition Lichen Sclerosus nearly 5 years ago, and despite numerous attempts, nothing seemed to provide the relief I desperately needed.

After spending thousands on ineffective laser treatments, I was feeling defeated and hopeless. It was a turning point when I decided to visit PRP Medical Aesthetics, and it has been nothing short of a transformative experience.

From the moment I contacted the clinic, the team’s warmth and kindness were evident. Dr. Yam and Siara took the time to thoroughly understand my condition, patiently addressing my concerns and anxieties. Their level of expertise is unmatched, and they guided me through every step of the PRP procedure, ensuring I felt comfortable and informed.

I’m thrilled to report that, just three weeks after my PRP treatment, I’m already experiencing significant improvements. It’s a feeling of relief and progress that I had almost given up hope of ever experiencing. The affordability of the treatment is also a tremendous relief, especially considering the financial strain of previous ineffective treatments.

Practical Considerations and Patient Insights on PRP Treatment for Vulvar Lichen Sclerosus

As with any treatment involving the use of PRP, there are several practical aspects to take into consideration before making a decision.  Have conventional treatments been tried, and with what level of success?  What is the quality of the PRP being used, and how experienced is the doctor who is preparing and injecting it?  

For best results, see a PRP expert

The most important thing to know about PRP is that not all PRP is the same.  For the best results, it’s essential that the right dose and concentration of PRP is used in each situation.  Studies have shown more than 2000% differences in concentration and quality of PRP depending on the type of preparation system used.  Therapeutic response to PRP depends on the concentration of growth factors in the PRP.   Please see this page for more information on the best type of PRP system.

How many PRP treatments are needed to treat lichen sclerosus?

The number of treatments needed will depend on the severity and individual response, as well as the quality of the PRP and the injection technique.  In general, the patients we’ve treated have seen good results, lasting several months or longer, after only one or two PRP treatments.  

How long does it take for PRP to work for lichen sclerosus?

While PRP for other skin conditions such as eczema or acne may work within a few days, it usually takes 2-3 weeks for PRP to start working for lichen sclerosus.

Summary: Using PRP for the treatment of lichen sclerosus

Lichen sclerosus in women and men can have a tremendous negative effect on patient quality of life.  No single treatment (including injection of PRP), will work for every person’s situation.   Although topical steroids are considered the first line of treatment for ls, they carry significant risk, including worsening skin atrophy (thinning).   For resistant cases of ls, second and third line prescription medication may be tried including topical calcineurin inhibitors, topical and system retinoids.  

While every case is different, platelet-rich plasma intradermal injections for the treatment of lichen sclerosus has been shown in several clinical studies to improve signs and symptoms.  If you suffer from lichen, and conventional treatments like steroid creams are not working, a trial of autologous platelet-rich plasma may be worth considering.

Please feel free to contact our office for more information.