The Journal of Urology is the official journal of the American Urological Association. The Journal provides the most extensive coverage of the clinically relevant issues in the field of urology. The Journal presents studies on critical areas of research and practice. The Journal reviews articles worldwide and reports on clinical observations.
The Journal of Urology is peer reviewed and published on behalf of the American Urological Association. It was established in 1917. It is the most respected, widely read and highly cited journal in the field. The Journal provides solid coverage of the most clinically relevant content in the dynamic field of urology.
Lichen Sclerosis is an autoimmune condition characterized by skin atrophy and hypopigmentation. LS is a mucocutaneous disorder. It is commonly of the genital area but can be seen in other extragenital sites. It is seen in women more than men. The total number of reported cases in approximately 200,000 per year but this figure is probably underestimated since many cases are asymptomatic and not reported.
It can occur in all age groups however, two peaks are the most prevalent in women. Between 8- and 13-year-old girls and during the fifth and sixth decade are the classic periods of incidence. Most commonly at diagnosis, the age is 52-60 years old. LS occurs in the genital skin in 85-98% of the cases.
Lichen sclerosis is caused by an infiltrate of activated T cells releasing interleukin 4 (IL-4) and transforming growth factor B. These cytokines activate fibroblasts producing altered collagen leading to fibrosis. This process also causes vascular damage by decreasing the number of capillaries.
LS has a typical appearance of thin, hypopigmented, ivory white and sclerotic plaques. The plaques can become thickened but usually they are thin in depth. The plaques can become fissured and ulcerated. The most common associated symptom is itch. The itch is worse at night. As the disease progresses the urethra can become partially blocked by the fibrotic plaque like tissue. In men, this can block or partially block the urine outflow. Extra-genital lesions can include the neck, wrists, thighs, upper back and shoulders.
Treatment
The treatment is aimed at the relief of symptoms, stopping the atrophy, prevention of scar formation and anatomical distortion. The therapy consists of general care, topical treatments, systemic treatments and surgery. Commonly recommended treatment is three months of high dose steroids, Second line treatments include topical calcineurin inhibitors and imiquimod. In men, circumcision may be needed. For extragenital lichen sclerosis, phototherapy, ultrapotent steroids, tacrolimus and systemic steroids or methotrexate. Laser use is also common. Surgery for circumcision is a final option in many cases.
Platelet Rich Plasma is an autologous blood concentrate, rich is cytokines, growth factors and bioactive proteins. PRP has been used for years in all fields of medicine to regenerate diseased or damaged tissues.
Currently , there are over 20,000 articles and studies on PubMed for platelet rich plasma and platelet rich fibrin collectively. PRP has been utilized in medicine, dentistry and veterinary protocols for over a decade. However, with all the studies and with all the articles that have been written praising platelet rich plasma and platelet rich fibrin, there has not been a body of medical professionals endorsing PRP to place it into a disease modifying protocol.
Until now.
Conservative Management of Penile and Urethral Lichen Sclerosis: A Systemic Review
Journal of Urology 2023 Dec 11: 101097JU0000000000003804 PMID: 38079459
Online ahead of print
Purpose: We evaluate the safety and efficacy profiles of currently available conservative management options for penile and urethral lichen sclerosis.
Seventeen studies describing conservative management of histologically confirmed penile lichen sclerosis in male patients were included in the final review. We present available evidence supporting the use of 4 major treatment modalities represented in the existing literature: topical corticosteroids, tacrolimus, platelet rich plasma and CO2 laser. Outcomes assessed include symptoms, clinical appearance, quality of life, sexual satisfaction, adverse effects and long-term efficacy of treatment.
Conclusion: Topical corticosteroids remain the mainstay of conservative management of penile and urethral lichen sclerosis with current literature supporting the use of other therapies such as platelet rich plasma and tacrolimus as alternatives or adjuvant treatments when escalation of treatment is necessary.
“Patients who fail corticosteroid therapy and do not wish to proceed directly to surgery, (circumcision) There is evidence for the use of other therapies such as platelet rich plasma.
This article, which was reviewed by peers in urology, will be published in the 100 year old, most prestigious, highest impact journal for urology in the US. The publication concedes that the use of platelet rich plasma is acceptable! This is a huge vindication and validation for the medical professional who have incorporated platelet rich plasma into their treatment protocols for years. Furthermore, although this article was concerning lichen sclerosis in men, one could easily extrapolate this conclusion to women as well.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits are scientifically manufactured to provide a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative process.
Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of cytokines, growth factors and bioactive proteins from the alpha granules on the platelets and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen. This mode of activation by LED light provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation guideline of the FDA.
Juventix Regenerative Medical supplies a BIO-Incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different cytokines and growth factors than the original PRP. These different cytokines provide an anti-inflammatory environment and can be used confidently in inflammatory conditions.
Juventix has many products, services and devices for the regenerative medical professional. These products include the DermaMed LLLT, the PhysioPro shockwave, the EDX shockwave for erectile dysfunction and tissue-based products such as exosomes, offered through our collaboration with Evolutionary Biologics.
With the publication discussed here, validation for regeneration and rejuvenation of damaged diseased tissues by means recognized in the past as experimental or outlying, has now come to pass. Platelet Rich Plasma is a medically accepted treatment and incorporation into many more medical protocols will be the standard of care in the near future.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
