Lichen Sclerosus is a chronic inflammatory skin disorder of unknown etiology that commonly affects women before puberty or after menopause.Although LS commonly affects women, it can occur in all ages and both sexes. The male to female ration varies between 1:3 cases to 1:10. The estimation for children is 0.1% and 3% of women over 80 years of age/50% of all cases of LS occur in women over 50.
Many cases of Lichen Sclerosus go unreported or misdiagnosed therefore the incidence is unknown world -wide. Lichen Sclerosus usually affects the external genitalia. The most common distribution is in the area of the vulva, perianal area, and head of the penis. However, LS can and does affect other areas of the body such as the breast, wrists, shoulder, back, neck, thigh and the mouth. Reported other area involvement is 6-20% of all cases. In the mouth, the lips, tongue and gums may be involved with lesions.
In males, LS is more likely to affect the uncircumcised than circumcised. In men, perianal involvement is rare. The foreskin may become narrow, fissured discolored and very painful. Symptoms in the male are commonly pain, itching, discoloration and sometimes erectile dysfunction.
In children, LS commonly affects the perianal areas and the first symptom may be constipation.
Symptoms of Lichen Sclerosus
- Intense itching
- Pain and soreness
- Bleeding, tearing and blistering (although rare)
- Painful sex
- Painful urination
- Constipation especially in children
Characteristic Appearance
- Pale, ivory- colored lesions, the skin becomes thin and cellophane paper like appearance
- Ulceration, erosions and fissures
- The earliest areas are white and china like with surrounding erythema
- Later lesions are ecchymotic with bleeding and cracking of the skin
- Distribution around the vulva and anus in the figure of eight
- Very late disease, with the presence of non-healing ulcers raises the suspicion of squamous cell cancer which is a complication of LS
Causes
The primary cause of Lichen Sclerosus is unknown. Current research supports that it is caused by dysfunction of the immunological system and there appears to be a genetic factor.
Overall, this disease is underdiagnosed because of the similar appearance of other diseases such as:
- Candida Infection
- Psoriasis
- Eczema
- Vitiligo
- Blistering Autoimmune Dermatosis
Associated Diseases
Males
- Atopic Dermatitis in young boys
- Diabetes in older males
Females
- Psoriasis
- Scleroderma
- Rheumatoid Arthritis
- Inflammatory Bowel Diseases such as Crohn’s and Ulcerative Colitis
- Vitiligo
- Alopecia
- Thyroid Diseases- about 12-16% of cases
Other Associated Risk Factors
- Infections- There has been reports of Hepatitis C or local infections such as Urethritis or Vulvitis but no compelling evidence of an infectious etiology.
- Trauma- Severe scratching or friction can serve as a trigger, this is called the Kobner phenomenon and describes lesions that appear at the site of trauma.
- Hormones- Since this disease is seen more in post-menopausal women, it is felt hormones are of clinical significance. It has been demonstrated there is a loss of androgen receptors in the lesions of lichen sclerosus.
Treatment
Males
Circumcision in uncomplicated cases is very effective for men and boys. In those males who have already been circumcised, potent topical steroid ointments are the current recommendation. The incidence of squamous cell cancer is a very low risk of development in males.
Females
Vulvar Lichen Sclerosus requires life long treatment and monitoring to avert scarring and the development of squamous cell cancer in women.
Ultrapotent topical corticosteroid ointment (not creams) is the current standard treatment.
- Steroids usually applied for 12 weeks before reducing the dose to maintenance dosages
- Topical Calcineurin Inhibitors- These drugs work by altering the immune system
- Systemic Steroids
- Methotrexate- This is an immunosuppressive drug also used in chemotherapy for certain cancers, rheumatoid arthritis and psoriasis
- Topical Retinoids
In extragenital lesions of lichen sclerosus, UVA phototherapy has been used alone and in combination with other therapies mentioned above.
Platelet-Rich Plasma
Platelet-Rich-Plasma is an autologous blood derived product that provides super-physiologic concentrates of growth factors, cytokines and proteins utilized in the repair and regeneration of damaged tissues in the body. Platelet Rich Plasma has been utilized for various tissue engineering applications in the body. As an autologous product, there are few if any reported side effects.
Studies of PRP and Lichen Sclerosus
- Platelet-Rich-Plasma for Genital Lichen Sclerosus: Analysis and Results of 94 Patients J Dermatolog Treat 2020 Dec 6;1-5 PMID 33226278
Purpose: 43 male and 51 female patients affected by LS were evaluated. Each patient was subjected to PRP treatment every 15 days times three treatments
Results: Significant decrease in symptoms was reported 6 months after PRP treatment. Reduction in pain and burning sensation was significant in both groups but more accentuated in women. The study concluded that PRP based therapy may exert a relevant role in LS management due to its effect on quality of life and sexual function in both genders
- Platelet-Rich-Plasma for the Treatment of Lichen Sclerosus (Plast Aesthet Res 2021 Dec 5 (8) 63 PMID 34950752)
Purpose: A systematic review of the literature published between 1946 and 2021 on the use of PRP for LS
Results: PRP is an emerging regenerative medicine therapy currently being explored as treatment for chronic inflammatory dermatoses including LS. Patients demonstrated quality of life improvement following PRP administration. While PRP may have a therapeutic role in the treatment of LS , high level evidence is needed with standardized PRP processing and application is needed
- Use of Platelet-Rich-Plasma for Vulvovaginal Autoimmune Conditions Like Lichen Sclerosusn Plast Reconstr Surg 2016 Nov 23;4(11) :e1124. PMID 27975027
Purpose: In this study, we aimed to evaluate the safety, Symptom resolution and objective improvement in patients with an autoimmune condition like genital LS.
28 patients with biopsy proven LS were evaluated over a 2 year period
Results: Almost all of the patients showed clinical improvement. 8 patients the lesions disappeared and symptoms improved in 15 of the 28 patients after treatment with no further need for steroid therapy in 23 of the 28 patients.
Based on our limited findings, we hypothesize that PRP presents a potential alternative to topical steroids for the treatment of vulvovaginal autoimmune conditions such as LS
- The Effect of Lipofilling and Platelet- Rich-Plasma on Patients with Moderate-Severe Vulvar Lichen Sclerosus who were non- responders to Topical Clobetasol Propionate: A Randomized Pilot Study Aesthetic Plast Surg 2022 Jan 20 dol: 10.1007/s00266-021-02718-1 PMID 35048150
Background: The first line treatment for vulvar Lichen Sclerosus is 3 months of topical corticosteroid therapy. However, limited evidence is available concerning the use of fat grafting and platelet rich plasma as a second line treatment for patients who are non -responders
Conclusion: Compared with topical steroids, two infiltrations delivered 3 months apart decreased the inflammation of the vulva and improved most of the clinical signs and symptoms associated with lichen sclerosus
Juventix Regenerative Medical provides a FDA approved Platelet Rich Plasma Kit that is cost effective, easy to use and provides reproducible concentrates when taken from the same sample.
Juventix Regenerative Medical has a patent pending LED activator that activates the platelets for higher concentrations of growth factors and cytokines without the addition of other chemicals such as Calcium Chloride or Thrombin.
Juventix Regenerative Medical has a Bio-Incubator that transforms the Platelet Rich Plasma into an injectable Platelet Rich Fibrin, the so called “Second Generation” of platelet rich products. PRF is used in a variety of clinical applications including rejuvenation of damaged tissues.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
