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24-03-2024 | Lichen Sclerosus Et Atrophicus | General Gynecology

Is there a role for platelet rich plasma injection in vulvar lichen sclerosus? A self-controlled pilot study

Authors: Veronica Boero, Giulia Emily Cetera, Carlotta Caia, Stefania Villa, Tiziana Montemurro, Massimiliano Brambilla, Ermelinda Monti, Maria Iorio, Edgardo Somigliana, Paolo Vercellini, Daniele Prati

Published in: Archives of Gynecology and Obstetrics

Abstract

Background

Owing to the evidence that as many as 30–40% of patients with vulvar lichen sclerosus (VLS) fail to report a remission of symptoms with first-line corticosteroid treatment (TCS), especially as what regards dyspareunia, we aimed to analyze patients’ satisfaction following vulvar injection of autologous platelet-rich plasma (PRP). This is intended as an adjunctive treatment, to be used following TCS, and appears to promote tissue repair. It may also possibly have immunomodulatory proprieties.

Materials and methods

Patients with VLS were considered eligible for this pilot study if, despite having been treated with a 3-month TCS regimen, they reported a persistence of symptoms. PRP was produced in a referral center using a manual method and a standardized protocol. Each patient received three treatments 4 to 6 weeks apart.

Results

A total of 50 patients with a median age of 53 years [IQR 38–59 years] were included in the study. 6 months after the last injection of PRP all patients were either satisfied or very satisfied with the treatment (100%; 95% CI 93–100%). Median NRS scores for itching, burning, dyspareunia and dysuria were significantly reduced (p < 0.05) and FSFI, HADS and SF-12 questionnaires revealed a significant improvement in sexual function, psychological wellbeing and quality of life (p < 0.05). The number of patients reporting the need for maintenance TCS treatment was reduced by 42% (p < 0.001) and an improvement in vulvar elasticity and color was reported in all patients.

Conclusion

Following standard medical therapy, PRP may be effective not only in improving symptoms, but also in restoring function.

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Krapf JM, Mitchell L, Holton MA, Goldstein AT (2020) Vulvar lichen sclerosus: current perspectives. Int J Womens Health 15(12):11–20. https://doi.org/10.2147/IJWH.S191200CrossRef

Sherman V, McPherson T, Baldo M, Salim A, Gao XH, Wojnarowska F (2010) The high rate of familial lichen sclerosus suggests a genetic contribution: an observational cohort study. J Eur Acad Dermatol Venereol 24(9):1031–1034. https://doi.org/10.1111/j.1468-3083.2010.03572CrossRefPubMed

Schlosser BJ, Mirowski GW (2015) Lichen sclerosus and lichen planus in women and girls. Clin Obstet Gynecol 58(1):125–142. https://doi.org/10.1097/GRF.0000000000000090CrossRefPubMed

Kirtschig G, Becker K, Günthert A et al (2015) Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol 29(10):e1–e43CrossRefPubMed

Goldstein AT, Marinoff SC, Christopher K, Srodon M (2005) Prevalence of vulvar lichen sclerosus in a general gynecology practice. J Reprod Med 50(7):477–480PubMed

Lee A, Bradford J, Fischer G (2015) Long-term management of adult vulvar lichen sclerosus. JAMA Dermatol 151:1061–1067CrossRefPubMed

Pope R, Lee MH, Myers A, Song J, AbouGhayda R, Kim JY et al (2022) Lichen sclerosus and sexual dysfunction: a systematic review and meta-analysis. J Sex Med 19(11):1616–1624. https://doi.org/10.1016/j.jsxm.2022.07.011. (Epub 2022 Sep 15)CrossRefPubMed

Ranum A, Pearson DR (2022) The impact of genital lichen sclerosus and lichen planus on quality of life: a review. Int J Womens Dermatol 8(3):e042. https://doi.org/10.1097/JW9.0000000000000042CrossRefPubMedPubMedCentral

Corazza M, Schettini N, Zedde P, Borghi A (2021) Vulvar lichen sclerosus from pathophysiology to therapeutic approaches: evidence and prospects. Biomedicines 9(8):950. https://doi.org/10.3390/biomedicines9080950CrossRefPubMedPubMedCentral

10.

Tran DA, Tan X, Macri CJ, Goldstein AT, Fu SW (2019) Lichen Sclerosus: an autoimmunopathogenic and genomic enigma with emerging genetic and immune targets. Int J Biol Sci 15(7):1429–1439. https://doi.org/10.7150/ijbs.34613CrossRefPubMedPubMedCentral

11.

Giannini A, D’Oria O, Chiofalo B, Bruno V et al (2022) The giant steps in surgical downsizing toward a personalized treatment of vulvar cancer. J Obstet Gynaecol Res 48(3):533–540. https://doi.org/10.1111/jog.15103. (Epub 2021 Dec 28)CrossRefPubMed

12.

Lewis FM, Tatnall FM, Velangi SS et al (2018) British association of dermatologists guidelines for the management of lichen sclerosus 2018. Br J Dermatol 178:823–824CrossRef

13.

Cooper SM, Gao XH, Powell JJ, Wojnarowska F (2004) Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol 140(6):702–706. https://doi.org/10.1001/archderm.140.6.702CrossRefPubMed

14.

Haunschild ED, Huddleston HP, Chahla J, Gilat R, Cole BJ, Yanke AB (2020) Platelet-rich plasma augmentation in meniscal repair surgery: a systematic review of comparative studies. Arthroscopy 36(6):1765–1774. https://doi.org/10.1016/j.arthro.2020.01.038. (Epub 2020 Feb 10)CrossRefPubMed

15.

Mazzucco L, Balbo V, Cattana E, Borzini P (2008) Platelet-rich plasma and platelet gel preparation using Plateltex. Vox Sang 94(3):202–208. https://doi.org/10.1111/j.1423-0410.2007.01027.x. (Epub 2008 Jan 7)CrossRefPubMed

16.

Everts P, Onishi K, Jayaram P, Lana JF, Mautner K (2020) Platelet-rich plasma: new performance understandings and therapeutic considerations in 2020. Int J Mol Sci 21(20):7794. https://doi.org/10.3390/ijms21207794CrossRefPubMedPubMedCentral

17.

Arora G, Arora S (2021) Platelet-rich plasma-where do we stand today? a critical narrative review and analysis. Dermatol Ther 34(1):e14343. https://doi.org/10.1111/dth.14343. (Epub 2020 Oct 8)CrossRefPubMed

18.

Huang G, Hua S, Yang T, Ma J, Yu W, Chen X (2018) Platelet-rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors. Exp Ther Med 15(3):3096–3102. https://doi.org/10.3892/etm.2018.5794. (Epub 2018 Jan 24)CrossRefPubMedPubMedCentral

19.

Fu CJ, Sun JB, Bi ZG, Wang XM, Yang CL (2017) Evaluation of platelet-rich plasma and fibrin matrix to assist in healing and repair of rotator cuff injuries: a systematic review and meta-analysis. Clin Rehabil 31(2):158–172. https://doi.org/10.1177/0269215516634815. (Epub 2016 Jul 10)CrossRefPubMed

20.

Xu Z, He Z, Shu L, Li X, Ma M, Ye C (2021) Intra-articular platelet-rich plasma combined with hyaluronic acid injection for knee osteoarthritis is superior to platelet-rich plasma or hyaluronic acid alone in inhibiting inflammation and improving pain and function. Arthroscopy 37(3):903–915. https://doi.org/10.1016/j.arthro.2020.10.013. (Epub 2020 Oct 20)CrossRefPubMed

21.

Karina K, Rosliana I, Rosadi I, Sobariah S, Christoffel LM, Novariani R et al (2021) Phase I/II clinical trial of autologous activated platelet-rich Plasma (aaPRP) in the treatment of severe coronavirus disease 2019 (COVID-19) patients. Int J Inflam 7(2021):5531873. https://doi.org/10.1155/2021/5531873CrossRef

22.

Gutierrez-Ontalvilla P, Giner F, Vidal L, Iborra M (2022) 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 46(5):2469–2479. https://doi.org/10.1007/s00266-021-02718-1. (Epub 2022 Jan 20)CrossRefPubMed

23.

Paul SM, Zelman DC, Smith M, Miaskowski C (2005) Categorizing the severity of cancer pain: further exploration of the establishment of cutpoints. Pain 113(1–2):37–44CrossRefPubMed

24.

Rosen R, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208CrossRefPubMed

25.

Costantini M, Musso M, Viterbori P et al (1999) Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale. Support Care Cancer 7(3):121–127CrossRefPubMed

26.

Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233. https://doi.org/10.1097/00005650-199603000-00003CrossRefPubMed

27.

Boero V, Liverani CA, Brambilla M, Monti E, Tozzi R, Murina F et al (2021) The “CIV Classification”, a new proposal for the architectural grading of vulvar lichen sclerosus. J Low Genit Tract Dis 25(4):291–295. https://doi.org/10.1097/LGT.0000000000000627CrossRefPubMed

28.

Tedesco M, Pranteda G, Chichierchia G, Paolino G, Latini A, Orsini D et al (2019) The use of PRP (platelet-rich plasma) in patients affected by genital lichen sclerosus: clinical analysis and results. J Eur Acad Dermatol Venereol 33(2):e58–e59. https://doi.org/10.1111/jdv.15190. (Epub 2018 Sep 19)CrossRefPubMed

29.

Franic D, Iternička Z, Franić-Ivanišević M (2018) Platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus in a premenopausal woman: a case report. Case Rep Womens Health 16(18):e00062. https://doi.org/10.1016/j.crwh.2018.e00062CrossRef

30.

Goldstein AT, Mitchell L, Govind V, Heller D (2019) A randomized double-blind placebo-controlled trial of autologous platelet-rich plasma intradermal injections for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol 80(6):1788–1789. https://doi.org/10.1016/j.jaad.2018.12.060. (Epub 2019 Jan 11)CrossRefPubMed

31.

Tedesco M, Bellei B, Garelli V, Caputo S, Latini A, Giuliani M, Cota C et al (2020) Adipose tissue stromal vascular fraction and adipose tissue stromal vascular fraction plus platelet-rich plasma grafting: new regenerative perspectives in genital lichen sclerosus. Dermatol Ther 33(6):e14277. https://doi.org/10.1111/dth.14277. (Epub 2020 Sep 22)CrossRefPubMed

32.

Tedesco M, Garelli V, Bellei B, Sperduti I, Chichierchia G, Latini A et al (2022) Platelet-rich plasma for genital lichen sclerosus: analysis and results of 94 patients. Are there gender-related differences in symptoms and therapeutic response to PRP? J Dermatolog Treat 33(3):1558–1562 (Epub 2020 Dec 6)CrossRefPubMed

33.

Medina Garrido C, Cano García A, de la Cruz Cea L, Oreja Cuesta AB (2023) Mid-term symptomatic relief after platelet-rich plasma infiltration in vulvar lichen sclerosus. Arch Dermatol Res. https://doi.org/10.1007/s00403-023-02529-1. (Epub ahead of print)CrossRefPubMedPubMedCentral

34.

Goldstein AT, King M, Runels C, Gloth M, Pfau R (2017) Intradermal injection of autologous platelet-rich plasma for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol 76(1):158–160. https://doi.org/10.1016/j.jaad.2016.07.037CrossRefPubMed

35.

Behnia-Willison F, Pour NR, Mohamadi B, Willison N, Rock M, Holten IW, O’Shea R, Miller J (2016) Use of platelet-rich plasma for vulvovaginal autoimmune conditions like lichen sclerosus. Plast Reconstr Surg Glob Open 4(11):e1124. https://doi.org/10.1097/GOX.0000000000001124CrossRefPubMedPubMedCentral

36.

Casabona F, Priano V, Vallerino V, Cogliandro A, Lavagnino G (2010) New surgical approach to lichen sclerosus of the vulva: the role of adipose-derived mesenchymal cells and platelet-rich plasma in tissue regeneration. Plast Reconstr Surg 126(4):210e–211e. https://doi.org/10.1097/PRS.0b013e3181ea9386. (PMID: 20885230)CrossRefPubMed

37.

Jiao Y, Zhang Q, Zhang J, Zha Y, Wang J, Li Y et al (2022) Platelet-rich plasma ameliorates lipopolysaccharide-induced cardiac injury by inflammation and ferroptosis regulation. Front Pharmacol 18(13):1026641. https://doi.org/10.3389/fphar.2022.1026641CrossRef

38.

Andia I, Maffulli N (2013) Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol 9(12):721–730. https://doi.org/10.1038/nrrheum.2013.141. (Epub 2013 Oct 1)CrossRefPubMed

39.

Davis VL, Abukabda AB, Radio NM, Witt-Enderby PA, Clafshenkel WP, Cairone JV et al (2014) Platelet-rich preparations to improve healing. Part I: workable options for every size practice. J Oral Implantol 40(4):500–510. https://doi.org/10.1563/AAID-JOI-D-12-00104CrossRefPubMed

40.

Iberg CA, Hawiger D (2020) Natural and induced tolerogenic dendritic cells. J Immunol 204(4):733–744. https://doi.org/10.4049/jimmunol.1901121CrossRefPubMed

Title: Is there a role for platelet rich plasma injection in vulvar lichen sclerosus? A self-controlled pilot study
Authors: Veronica Boero
Giulia Emily Cetera
Carlotta Caia
Stefania Villa
Tiziana Montemurro
Massimiliano Brambilla
Ermelinda Monti
Maria Iorio
Edgardo Somigliana
Paolo Vercellini
Daniele Prati
Publication date: 24-03-2024
Publisher: Springer Berlin Heidelberg
Keywords: Lichen Sclerosus Et Atrophicus
Dyspareunia
Published in: Archives of Gynecology and Obstetrics
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-024-07424-2

At a glance: The STEP trials

Springer Medicine

Is there a role for platelet rich plasma injection in vulvar lichen sclerosus? A self-controlled pilot study

Abstract

Background

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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