ArticlePDF Available

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

Authors:

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.
www.PRSGlobalOpen.com 1
Lichen sclerosus (LS) is a chronic autoimmune in-
flammatory dermatosis characterized by a lympho-
cytic response that has a predilection for the genital
skin in both sexes and an association with several other
autoimmune diseases.1 Women are 6 to 10 times more of-
ten affected than men.2 LS may involve complications of
erosions, atrophy, and scarring as a result of inflammation
and altered fibroblast function, leading to fibrosis of the
upper dermis. There can also be purpura, hyperpigmenta-
tion, fissures, and edema.3 LS mainly affects the anogenital
area of the skin, in more than a 5:1 ratio when compared
with extragenital skin.4
LS is relatively common although the true incidence
is unknown and possibly underestimated, in part, due to
the distribution of patients among different clinical spe-
cialities and to the fact that it can be asymptomatic.1 The
etiology of LS is uncertain although there is evidence
for linkages between autoimmune mechanisms and the
pathogenesis of LS.5
LS is a scarring process and may cause loss of the labia
minora, sealing of the clitoral hood, and burying of the
clitoris. In women, vulvar LS can present with progressive
pruritus, dyspareunia, dysuria, or genital bleeding.4 These
symptoms may also occur in postmenopausal women due
to the lack of estrogen in the vaginal area. LS has a consid-
erable impact on affected patients physically, emotionally,
Received for publication August 4, 2016; accepted September 16,
2016.
Copyright © 2016 The Authors. Published by Wolters Kluwer
Health, Inc. on behalf of The American Society of Plastic Surgeons.
All rights reserved. This is an open-access article distributed under
the terms of the Creative Commons Attribution-Non Commercial-
No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible
to download and share the work provided it is properly cited. The
work cannot be changed in any way or used commercially without
permission from the journal.
DOI: 10.1097/GOX.0000000000001124
From the *FBW Gynaecology Plus, Adelaide, South Australia,
Australia; †Urogynaecology Clinic, Flinders Medical Centre,
Adelaide, South Australia; ‡Department of Obstetrics, Gynaecology
and Reproductive Medicine, Flinders University, Adelaide, South
Australia, Australia; §Northern Sydney Local Health District,
Sydney, New South Wales, Australia; ¶Faculty of Medicine, Nursing
and Health Sciences, Flinders University, Adelaide, South Australia,
Australia; Faculty of Health Sciences, University of Adelaide,
Adelaide, South Australia, Australia; ** Australian Skin Face
Body, Geelong, Victoria, Australia; and †† Urogynaecology Clinic,
Flinders Medical Centre, Adelaide, South Australia, Australia.
Background: Lichen sclerosus (LS) is an inflammatory dermatosis with autoim-
mune 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 cortico-
steroids 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, symp-
tom resolution, and objective improvement in patients with autoimmune condi-
tion 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. Symp-
toms 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. (Plast Reconstr Surg Glob Open 2016;4:e1124;
doi: 10.1097/GOX.0000000000001124; Published online 23 November 2016.)
Fariba Behnia-Willison, MBBS,
MIS, FRANZCOG*†‡
Nina Reza Pour, MD,
DRANZCOG, FRANZCOG
Trainee§
Behrang Mohamadi*
Nadia Willison¶
Madeleine Rock
Ian W. Holten, MBBS, MD,
FRACS, FRCS (Plas) Lon**
Robert O’Shea, MBBS,
FRANZCOG, FRCOGࠠ
Joseph Miller, BS*
Use of Platelet-rich Plasma for Vulvovaginal
Autoimmune Conditions Like Lichen Sclerosus
Disclosure: The authors have no financial interest to de-
clare in relation to the content of this article. The Article Pro-
cessing Charge was paid for by the authors.
Reconstructive
ORIGINAL ARTICLE
PRS Global Open 2016
2
and psychologically, affecting their quality of life through
pain and embarrassment and having a significant impact
on their sexual lives, which can affect their intimate rela-
tionships.
Severe introital stenosis (ie, narrowing of the vaginal
opening) occurs rarely.1 LS can also be associated with squa-
mous cell carcinoma (SCC); there is a 4% lifetime risk of
developing SCC among LS sufferers.6 Histopathological
examination of vulval SCC cases shows that over 60% have
a background of LS.7 In the presence of typical clinical fea-
tures, confirmation with colposcopy and exclusion of con-
ditions such as vulvar intraepithelial neoplasia, a biopsy is
not always necessary for the diagnosis of LS.8 However, his-
tological examination is recommended given the presenta-
tion of atypical features and mandatory if the disease fails to
respond to treatment and second-line therapy is to be used.1
There is no current cure for LS nor is there a com-
prehensive treatment to cover all patients. Much of the
management of LS is aimed at controlling symptoms,
such as pruritus in extragenital LS. Current guidelines
aim at treating patients with ultrapotent topical cortico-
steroids, which are symptomatically effective in 90% of
women and show variable objective improvement.9 Cor-
ticosteroids require continuous administration and pres-
ent complications.10 Furthermore, for the 40% to 57% of
postmenopausal women experiencing symptoms resulting
from atrophic vaginitis11 due to menopausal estrogen de-
ficiency and natural aging of the vagina, corticosteroids
can worsen the atrophy.12 As most patients with LS are of
postmenopausal age,13 corticosteroids are a problematic
treatment option.
In Australia, the guidelines for treatment of LS are
for betamethasone dipropionate ointment (0.05%) to
be used twice daily for 1 month, then daily for 2 months,
and gradually reduced as needed (ideally 1–2 times per
week14). This high-maintenance treatment regime can
lead to relapse by patients who are not compliant or who
find it to be a difficult regime to uphold. A study by Ren-
aud-Vilmer et al15 investigated remission and recurrence
rates of 85 patients with 0.05% clobetasol proprionate
ointment and found that 72% of women under age 50
showed complete remission, 23% of women between 50
and 70 years old had complete remission, and no women
over 70 years old had complete remission. These results
highlight the impact of age on the success of topical corti-
costeroids as treatment for LS.15
A variety of other treatment options are available, in-
cluding calcipotriol, retinoids, systemic steroids, tacroli-
mus, and pimecrolimus. Photodynamic therapy has also
been reported to be beneficial.16 Surgical treatments in-
volve vulvectomy, cryosurgery, and laser ablation.1 These
procedures pose the risk of scarring to damaged tissues
and present high recurrence rates.17 Less invasive tech-
niques are therefore of interest.
In recent years, many scientists have shown the exis-
tence of cells in the adult body that are capable of repair-
ing and regenerating damaged tissue. By extracting and
processing blood through a sophisticated extraction sys-
tem, it is possible to produce platelet-rich plasma (PRP), a
type of plasma that contains several major growth factors,
nutrients, minerals, and monocytes with the potential to
assist in wound healing.
PRP has been used clinically for tissue regeneration, re-
constructive and plastic operations, and surgery, including
wound hemostasis, wound sealing, augmentation of bone
grafts periodontics, and treatment of tendonitis.18–20 In ad-
dition, PRP has promoted tendon healing in acute tendon
injury and repair models. Increased epithelialization has
been demonstrated in both acute traumatic wounds and
chronic diabetic wounds through the use of PRP.20 PRP
injection with or without needling has been described as a
new and promising modality for the treatment of atrophic
acne scars.21 Activated platelets release growth factors that
contribute to cell migration, proliferation, differentiation,
angiogenesis, removal of tissue debris, and regeneration
of appropriate type of tissue.22 PRP has a high safety level
and can be obtained relatively noninvasively through a
venous blood draw where the blood is then mechanically
centrifuged to extract a concentrate of PRP, which allows
repeated administration.17,23
One study investigated a new regenerative approach
based on grafting of adipose-derived stem cells and injec-
tion of PRP that removed symptoms and reduced atrophy
and sclerosus in 15 female patients with a histologic di-
agnosis of LS who were unresponsive to topical steroid
therapy.17 However, the need for all patients to undergo
liposuction to isolate the adipose-derived stem cells means
that the process still requires day surgery, thereby having a
significant impact on the health system and patients’ life-
styles. The aim of this study was to investigate the efficacy
of injecting PRP alone as a treatment for LS, so that the
need for surgery may be eliminated or rendered as mini-
mally invasive as possible for patients who do not respond
to topical steroid treatment.17
The potential adoption of PRP for autoimmune skin
conditions such as LS has been discussed in the litera-
ture.5,17 However, it still remains unclear whether PRP is a
sufficiently effective treatment to replace topical steroids.
The aim of this article is to present a new regenerative ap-
proach that removes symptoms and reduces atrophy and
sclerosus in patients diagnosed with LS. This method is
based on injection of PRP.17
PATIENTS AND METHODS
Patients were 28 women aged 22 to 88 years (M = 60)
who attended FBW Gynaecology Plus from 2013 to 2016
(Table 1). Twenty-six of the 28 patients had confirmed LS
on biopsy, with histopathological data indicating possible
LS for 1 patient and no LS for one other patient. However,
colposcopic examination suggested the presence of LS in
all patients. Symptoms were unresponsive to topical ste-
roid treatment in all cases. Those patients who had been
using steroids for management of LS symptoms discontin-
ued their use throughout the duration of the study.
After providing written informed consent, patients’ own
blood (10 mL) was centrifuged (Regens Lab, New York,
N.Y.) on site and injected under local anesthesia (ligno-
caine, 23%; tetracaine, 7%) to any affected areas of the ex-
ternal genitalia, including the labia majora, labia minora,
Behnia-Willison et al. PRP for Treatment of Lichen Sclerosus
3
clitoris, and clitoral hood. The injection was carried out
using a 27-gauge needle in a fanning motion to break the
scar and fibrotic tissue and retrograde injection of PRP in
the tissue. Patients received 3 PRP treatments 4 to 6 weeks
apart and again at 12 months. Patients were verbally inter-
viewed about their symptoms (eg, soreness, discomfort, and
dyspareunia) after each treatment session, and lesions were
evaluated at each session by colposcopy. Patients with vulval
intraepithelial neoplasia (n = 2) were excluded from the
study. Posttreatment pain scores were measured after each
treatment using a verbal scale from 0 to 10. Patients were
asked to complete the Australian Pelvic Floor Question-
naire 24 at baseline and at 2 to 3 months after the final PRP
treatment, with higher scores indicating greater frequency
of symptoms on each variable. The questionnaire was used
to assess symptoms of urinary incontinence, general blad-
der function, prolapse, and sexual function.
Statistical Analyses
Changes in lesion size, symptoms, and need for topical
steroid use were compared from pre- to posttreatment using
the Wilcoxon signed-rank test. Statistical analyses were per-
formed using SPSS Statistics version 21.0 (IBM, Chicago, Ill.),
and values of P less than 0.05 were considered to be statisti-
cally significant.
RESULTS
Nearly all patients exhibited clinical improvement in
the size of their lesions (Table 2), and in 8 of the 28 patients
(28.6%), lesions disappeared completely after treatment with
PRP. A Wilcoxon signed-rank test indicated that there was
a statistically significant decrease in the number of patients
with lesions after PRP treatment (Z = −4.562; P < 0.001).
Pretreatment symptoms included severe itch (requir-
ing steroid treatment), soreness, discomfort, and/or dys-
pareunia. As shown in Table 2, more than half the sample
had become free of symptoms after the final PRP treat-
ment at 12 months or more. A Wilcoxon signed-rank test
showed a statistically significant decrease in the presence
of symptoms after treatment (Z = −4.768; P < 0.001).
After the final treatment (at 12 months or more),
82.1% of patients (n = 23) no longer needed to use ste-
roids; the remaining 17.9% (n = 5) continued to use them
intermittently. A Wilcoxon signed-rank test showed a sta-
tistically significant decrease in steroid use after treatment
with PRP (Z = −4.963; P <.001).
Although there was a generally declining trend for
responses to items on the Australian Pelvic Floor Ques-
tionnaire from pre- to posttreatment, none of the changes
were statistically significant, likely due to the very small
sample size for pelvic floor disorders.
Patients reported minimal to moderate pain. During
the 24 hours after the procedure, 26 patients (92.9%)
reported pain scores of 2 to 3; the remaining patients re-
ported scores of 5 and 7, respectively. There were 0 cases of
infection, bleeding, hematoma, or other adverse outcomes.
DISCUSSION
In this study, we found that the majority of patients with
LS reported significant improvement in their symptoms,
with no need for further steroid therapy after PRP treatment.
Furthermore, the majority of patients’ lesions disappeared
or became smaller after treatment. Based on these limited
findings, we hypothesize that PRP can be used as a possible
alternative to topical corticosteroids for the treatment of LS
or at least in cases where steroids have ceased to work. The
PRP procedure is minimally invasive and safe and can be
performed in an office setting under local anesthesia. Our
findings lend support to those of Casabona et al17 by demon-
strating that PRP injection may be an effective treatment for
LS, without the need for further surgery and associated risks.
The study possessed several limitations. First, our sam-
ple size was limited, and a subsequent pilot study or ran-
domized controlled trial (RCT) with a larger sample size
is required to further evaluate the efficacy of PRP. Second,
the vast majority of patients were postmenopausal, making
it difficult to generalize the current findings to women of
reproductive age. However, it should be considered that
LS occurs most frequently in postmenopausal women.25 Fi-
nally, it is conceivable that the observed improvements in
LS symptoms after PRP treatment were partially or wholly
due to the tissue needling involved in the PRP injection
process rather than to a simple effect of the PRP in and of
itself. Subjecting tissues to microtrauma can instigate the
tissue repair cascade, and in the present circumstances,
this cannot be ruled out as a therapeutic mechanism. For
this reason, we intend to conduct a double-blind RCT in
which one group is randomized to a saline injection, with
a second group randomized to PRP treatment.
CONCLUSIONS
Growth factors released by platelets, monocytes, and
nutrients have an important role in phagocytosis of fibrot-
ic tissue, inflammation reduction, angiogenesis stimula-
Table 1. Baseline Patient Characteristics
Value (%)
Age range, y
< 4 5 2 (7.1)
46–55 6 (21.4)
56–65 14 (50)
66–75 3 (10.7)
> 7 6 3 (10.7)
Histopathology of LS
Y e s 26 (92.9)
N o 1 (3.6)
Unclear 1 (3.6)
LS, lichen sclerosus.
Table 2. Presence of Lesions and Symptoms after
Platelet-rich Plasma Treatment
n (%)
Presence of lesions
Lesion not seen 8 (28.6)
Lesion became smaller 17 (60.7)
Lesion the same 3 (10.7)
Presence of symptoms
No symptoms 15 (53.6)
Intermittent symptoms 13 (46.4)
PRS Global Open 2016
4
tion, and collagen III synthesis. The injection of PRP can
therefore be considered effective therapy for LS.
It remains unclear whether needling with saline can re-
sult in the same outcome as PRP due to the breakdown of
sclerotic tissue, allowing the local stem cells and monocytes
to improve tissue healing. There is a need for further RCTs
to compare outcomes between these 2 treatment methods
and to elucidate the precise mechanism whereby PRP treat-
ment seems to benefit patients with skin conditions like LS.
Fariba Behnia-Willison, MBBS, MIS, FRANZCOG
19 Alexander Ave
Ashford, South Australia 5035, Australia
E-mail: fariba.willison@gmail.com
ACKNOWLEDGMENTS
We thank Katherine Bell for her assistance in proofreading
the article.
REFERENCES
1. Neill SM, Lewis FM, Tatnall FM, et al; British Association of
Dermatologists. British Association of Dermatologists’ guide-
lines for the management of lichen sclerosus 2010. Br J Dermatol.
2010;163:672–682.
2. Newman N, Dolphin NN, Newman GR. Signs and symptoms of
genital lichen sclerosus in women seeking autologous adipose
derived stem cell treatment. Med J Obstet Gynecol. 2015;3:1067–
1072.
3. Ball SB, Wojnarowska F. Vulvar dermatoses: lichen sclerosus, li-
chen planus, and vulval dermatitis/lichen simplex chronicus.
Semin Cutan Med Surg. 1998;17:182–188.
4. Meffert J. Lichen sclerosus et atrophicus [Internet]. Medscape.
Accessed May 21, 2016. Available at: http://emedicine.med-
scape.com/article/1123316-overview.
5. Boero V, Brambilla M, Sipio E, et al. Vulvar lichen sclerosus: a
new regenerative approach through fat grafting. Gynecol Oncol.
2015;139:471–475.
6. Wallace HJ. Lichen sclerosus et atrophicus. Trans St Johns Hosp
Dermatol Soc. 1971;57:9–30.
7. Neill SM, Tatnall FM, Cox NH; British Association of
Dermatologists. Guidelines for the management of lichen scle-
rosus. Br J Dermatol. 2002;147:640–649.
8. Royal College of Obstetricians and Gynaecologists. The
Management of Vulval Skin Disorders. Royal College of Obstetricians
and Gynaecologists: London. 2011.
9. Sinha P, Sorinola O, Luesley DM. Lichen sclerosus of the
vulva. Long-term steroid maintenance therapy. J Reprod Med.
1999;44:621–624.
10. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitor-
ing and management of the complications of systemic corticoste-
roid therapy. Allergy Asthma Clin Immunol. 2013;9:30.
11. Palacios S. Managing urogenital atrophy. Maturitas
2009;63:315–318.
12. Fischer G. Treatment of vaginitis and vulvitis. Aust Prescr.
2001;24:59–61.
13. Moyal-Barracco M, Wendling J. Vulvar dermatosis. Best Pract Res
Clin Obstet Gynaecol. 2014;28:946–958.
14. Welsh BM, Berzins KN, Cook KA, et al. Management of common
vulval conditions. Med J Aust. 2003;178:391–395.
15. Renaud-Vilmer C, Cavelier-Balloy B, Porcher R, et al. Vulvar
lichen sclerosus: effect of long-term topical application of
a potent steroid on the course of the disease. Arch Dermatol.
2004;140:709–712.
16. Olejek A, Kozak-Darmas I, Kellas-Sleczka S, et al. Effectiveness
of photodynamic therapy in the treatment of lichen sclerosus:
cell changes in immunohistochemistry. Neuro Endocrinol Lett.
2009;30:547–551.
17. Casabona F, Priano V, Vallerino V, et al. New surgical approach to
lichen sclerosus of the vulva: the role of adipose-derived mesen-
chymal cells and platelet-rich plasma in tissue regeneration. Plast
Reconstr Surg. 2010;126:210e–211e.
18. Jeon YR, Kang EH, Yang CE, et al. The effect of platelet-
rich plasma on composite graft survival. Plast Reconstr Surg.
2014;134:239–246.
19. Salcido RS. Autologous platelet-rich plasma in chronic wounds.
Adv Skin Wound Care 2013;26:248.
20. Harris NL, Huffer WE, von Stade E, et al. The effect of platelet-
rich plasma on normal soft tissues in the rabbit. J Bone Joint Surg
Am. 2012;94:786–793.
21. Nofal E, Helmy A, Nofal A, et al. Platelet-rich plasma versus
CROSS technique with 100% trichloroacetic acid versus com-
bined skin needling and platelet rich plasma in the treatment
of atrophic acne scars: a comparative study. Dermatol Surg.
2014;40:864–873.
22. Dionyssiou D, Demiri E, Foroglou P, et al. The effectiveness of
intralesional injection of platelet-rich plasma in accelerating the
healing of chronic ulcers: an experimental and clinical study. Int
Wound J. 2013;10:397–406.
23. Jeong KH, Shin MK, Kim NI. Refractory lipodermatosclero-
sis treated with intralesional platelet-rich plasma. J Am Acad
Dermatol. 2011;65:e157–e158.
24. Baessler K, O’Neill SM, Maher CF, Battistutta D. Australian pel-
vic floor questionnaire: a validated interviewer-administered
pelvic floor questionnaire for routine clinic and research. Int
Urogynecol J Pelvic Floor Dysfunct. 2009;20:149–158.
25. O’Connell TX, Nathan LS, Satmary WA, et al. Non-
neoplastic epithelial disorders of the vulva. Am Fam Physician
2008;77:321–326.
... Six studies on PRP for LS met our criteria, including one RCT 82 and ve case series. [83][84][85][86][87] Four studies focused on vulvar lesions, 82,83,86,87 one focused on penile lesions, 85 and one considered both female and male patients. 84 Patients received 1 to 6 mL of intralesional (ID, subdermal, or unspeci ed) PRP for two to 10 sessions with 2-to 12-week intervals (average of 3.2 sessions with 5.5week intervals), with one study including an additional treatment performed at one year. ...
... Six studies on PRP for LS met our criteria, including one RCT 82 and ve case series. [83][84][85][86][87] Four studies focused on vulvar lesions, 82,83,86,87 one focused on penile lesions, 85 and one considered both female and male patients. 84 Patients received 1 to 6 mL of intralesional (ID, subdermal, or unspeci ed) PRP for two to 10 sessions with 2-to 12-week intervals (average of 3.2 sessions with 5.5week intervals), with one study including an additional treatment performed at one year. ...
... 84 Patients received 1 to 6 mL of intralesional (ID, subdermal, or unspeci ed) PRP for two to 10 sessions with 2-to 12-week intervals (average of 3.2 sessions with 5.5week intervals), with one study including an additional treatment performed at one year. 87 For vulvar LS, Goldstein et al initially documented clinical improvement in a case series, 86 but their subsequent RCT found no improvement compared to a saline control group. 82 84 For penile LS, one study showed improvement in quality of life scores among all patients, and clinically mitigated resumption of steroids. ...
Article
Platelet-rich plasma (PRP) has been integrated into numerous treatment regimens for medical and aesthetic dermatology. While some of these approaches are well-established, many uses are underreported in the literature. We sought to identify and summarize the emerging dermatologic applications for PRP by conducting a comprehensive PubMed search of studies published between 2000 and 2020. These studies were reviewed to synthesize collection methods, treatment schedule, adverse effects, and the impact of therapy for new and emerging uses for PRP. In general, we identified positive treatment outcomes for skin rejuvenation, scar revision, alopecia, pigmentary disorders, lichen sclerosus, leprosy-induced peripheral neuropathy, plaque psoriasis, and nail disorders. Widely, therapy was well-tolerated and suitable for all reported phototypes. The variations in collection and application sequences make concrete recommendations difficult to discern, underscoring the need for a standardized approach to preparation and treatment methods. We hope this review serves as an outline for new and interesting uses for PRP and will help readers familiarize themselves with this exciting technology for comfortable integration into their practices.
... In the 1980s, PRP first emerged from a strictly thrombocytopenic treatment to a peri-operative treatment for maxillofacial surgery [12] . However, PRP has been most extensively studied as a therapy for musculoskeletal injuries, including chronic tendinopathies, acute ligamentous injuries, muscle injuries, osteoarthritis, and bone healing for various types of fractures [12,13] . Since PRP's therapeutic inception, it has been utilized in many medical fields, such as dermatology, cardiovascular surgery, orthopedic surgery, pain management, and plastic surgery [13] . ...
... However, PRP has been most extensively studied as a therapy for musculoskeletal injuries, including chronic tendinopathies, acute ligamentous injuries, muscle injuries, osteoarthritis, and bone healing for various types of fractures [12,13] . Since PRP's therapeutic inception, it has been utilized in many medical fields, such as dermatology, cardiovascular surgery, orthopedic surgery, pain management, and plastic surgery [13] . Specific to dermatological practice, PRP is being explored as a regenerative therapy for a variety of conditions, including wound healing, scar revision, alopecia, and LS [12] . ...
Article
Full-text available
Aim: Evaluate the clinical effectiveness of platelet-rich plasma as a treatment for lichen sclerosus. Methods: A systematic review was performed. The electronic databases PubMed, Ovid MEDLINE®, Web of Science, Cochrane, clinicaltrials.gov were used to identify case studies, case series, prospective uncontrolled, and randomized controlled studies published between 1946 and April 21, 2021. Six prospective uncontrolled studies, one randomized double-blind prospective study, and one case report were included. Results: Platelet-rich plasma treatment was subjectively reported to improve quality of life, but objective measures demonstrating treatment efficacy were not observed. In addition, platelet-rich plasma preparation and administration between studies lacked standardization. Conclusion: Platelet-rich plasma may be used for symptomatic adjuvant treatment of lichen sclerosus, though additional double-blind controlled studies with standardized platelet-rich plasma protocols are needed to better characterize the efficacy of platelet-rich plasma.
... The only difference consists in different platelet separator systems used by investigators and the different protocols for PRP procedures 13 . Our protocol includes three procedures with PRP every two weeks apart, while others apply PRP in a different manner 11,12 . ...
... Therefore, topical progesterone might be an option if topical steroids or calcineurin inhibitors are contraindicated or fail. They are a potential reserve, like UV-A1 treatment or platelet-rich plasma injections [24,25]. ...
Article
Background Lichen sclerosus (LS) is a chronic inflammatory skin disease that mostly affects the anogenital region of women and lowers patients’ quality of life. Current standard treatment of LS is topical steroids. Objective To evaluate the efficacy of topical progesterone 8% ointment and compare to standard therapy with topical clobetasol propionate 0.05% in premenopausal women presenting with previously untreated early onset LS. Study Design Randomized, double-blind, 2-arm, single center superiority trial in premenopausal women with histologically confirmed vulvar LS who were randomized in a 1:1 ratio to receive clobetasol propionate 0.05% ointment or progesterone 8% ointment. The primary outcome was the clinical severity LS score after 12 weeks, which consists of six clinical features assessed by the physician. Secondary outcomes were the symptom severity LS score, which consists of three symptoms rated by the patient, the Short Form SF-12 physical and mental health scores, and adverse events. Response to medication was assessed by biopsy at the end of the treatment to evaluate inflammatory parameters. Results Overall, 105 women were screened, 102 underwent vulvar biopsy and 37 received a histologically confirmed diagnosis of LS and were randomized: 17 to progesterone and 20 to clobetasol propionate. At 12 weeks, the mean clinical LS scores improved from 4.6 (SD 2.0) to 4.5 (SD 1.7) in the progesterone arm, and from 4.6 (SD 2.8) to 2.9 (SD 2.2) in the clobetasol propionate arm (difference in favor of clobetasol 1.61; 95% CI 0.44 to 2.77, p = 0.009), and the mean symptom severity LS scores improved from 4.5 (SD 3.8) to 3.1 (SD 3.0) in the progesterone arm, and from 4.7 (SD 2.8) to 1.9 (SD 1.8) in the clobetasol propionate arm (difference in favor of clobetasol 1.32; 95% CI -0.25 to 2.89, p = 0.095). LS was in complete remission in 6 out of 10 patients (60%) with available biopsy in the progesterone arm, and in 13 out of 16 patients (81.3%) in the clobetasol propionate arm (odds ratio in favor of clobetasol 0.35; 95% CI 0.06 to 2.06, p=0.234). No drug-related serious adverse event occurred during the trial. Conclusions Topical progesterone 8% ointment is inferior to standard therapy with topical clobetasol propionate 0.05% in previously untreated premenopausal women with vulvar LS after 12 weeks treatment.
... Hua et al., observed a shorter tissue healing time, milder adverse effects and complete cure (93.7%) in PRP treated patients than laser treatment patients (92.4%). They reported PRP as a promising treatment in these patients [14]. [19]. ...
... Hua et al., observed a shorter tissue healing time, milder adverse effects and complete cure (93.7%) in PRP treated patients than laser treatment patients (92.4%). They reported PRP as a promising treatment in these patients [14]. [19]. ...
Article
Platelet rich plasma (PRP) is a biological product defined as a portion of the plasma fraction of autologous blood with a platelet concentration above the baseline. The plasma occupies 55% of blood, which is rich in immunoglobulins and proteins that have a wide range of applications in various medical fields. Plasma therapy is applied to tackle various disorders or diseases as it induces the body to develop new healthy cells. It contains important components like antibodies, coagulation factor, enzymes, fibrinogen, proteins and albumin. PRP is a unique and advanced treatment which helps to increases the body’s natural healing process. Platelet lysate which is obtained from platelet rich plasma consist of various growth factors such as chemokines, cytokines, and antibacterial molecules and also has anti-inflammatory, immunomodulatory, anti-fibrotic and repairing effects. As PRP is rich in the proteins and several antibodies, it is used for various chronic therapies such as hemophilia and autoimmune disorders as well as in various severe health problems. Lyophilized Platelet-rich plasma (LPRP) therapy is currently used in various fields such as in tissue regeneration, wound healing, scar revision, skin rejuvenating effects, alopecia and for the coronavirus disease (COVID-19). It is also used to heal wounds and illnesses. LPRP therapy is gaining attraction by many health professionals as it is a safe, effective, efficient, and easy approach in procuring, preserving, and therapy. In this review we described the advantages and applications of using lyophilized PRP in various diseases which might found to be effective in different treatment. Keywords: Plasma, Platelet, Growth Factors, Lyophilized platelet rich plasma.
Article
Vulvar inflammatory disorders (VID) are a miscellaneous group of non-infectious conditions of the vulvar area, which can be broadly classified based on etiology and pathology. Here, we discuss a few pertinent VID including vulvar dermatitis, psoriasis, lichen planus, and lichen sclerosus. This review will focus only on common VID, and a few rare conditions with characteristic features such as Crohn’s disease, plasma cell vulvitis, acantholytic disorder of genitocrural area, desquamative vulvitis, and atrophic vulvovaginitis. A thorough history taking and relevant investigations including dermoscopy and biopsy are relevant to proper diagnosis and management of VID. Early management of VID is essential since these conditions are prone to interfere with psychosexual functioning of the patient. Potent topical steroids are the first line management in most cases, followed by topical calcineurin inhibitors, emollients, and antihistamines. Vulvar area is resistant to steroid induced atrophy; hence, use of potent topical steroids does not pose a problem. Oral steroids or steroid sparing agents are used in resistant cases.
Article
Background: There is lack of published data investigating injection of autologous platelet rich plasma (A-PRP) alone in treatment of postmenopausal VVA. Objectives: In this pilot study, we aimed to investigate the safety and efficacy of injection of A-PRP alone in postmenopausal VVA in women without history of cancer breast to explore its utility as a hormone free therapy for postmenopausal VVA and for vulvovaginal rejuvenation. Methods: In this pilot study, 47 women with postmenopausal VVA were included. Vulvovaginal condition was evaluated at the baseline by vaginal health index (VHI). Impact of VVA on quality of life and sexual life was evaluated at the baseline by vulvovaginal symptom questionnaire (VSQ). Treatment protocol was 2 sessions of A-PRP injection with one month interval. Response was evaluated one month after the last session by VHI and VSQ. Side effects were also evaluated. Results: Post menopausal VVA was significantly improved by A-PRP injection as indicated by significant improvement of total VHI score and its items at 1 month post treatment ( p vlue < 0.001). Also, there was significant improvement of burning, hurting, being irritated, being dry, discharge, desire to be intimate, sexual relationships, pain during sexual activity, and dryness during sexual activity at 1 month post treatment as indicated by VSQ ( p value = 0.045 for being dry and < 0.001 for other items). Conclusions: A-PRP injection is safe and effective as minimally invasive monotherapy for postmenopausal VVA without history of cancer breast and hence for vulvovaginal rejuvenation.
Chapter
The beautification of the female form is no longer restricted to the exposed areas like face, neck, arms and legs, but has gone beyond these to encompass the covered areas like the genitalia.Over the last decade or so, the demand for aesthetic and medical enhancement of the female genitalia has grown substantially, aided by the perceptions created by social media.This has given rise to a sub-speciality of medicine—Cosmetic Gynaecology.Due to various causes ranging from childbirth and ageing to genetics or even trauma, the female genital region becomes loose and lax over time, resulting in stress urinary incontinence, atrophic vaginitis, decreased sensation during coitus and generalized dissatisfaction with the appearance of the area.Various surgical procedures like labioplasty, vaginoplasty, vaginal introital repairs, G spot amplification and others, as well as newer non-surgical, minimally invasive techniques to rejuvenate the labial and vaginal regions have been gaining momentum.These include the use of lasers and radiofrequency energy-based devices and other non-energy-based modalities like fillers, botulinum toxin, platelet-rich plasma therapy, fat and nanofat transfer, stem cells and many more.We shall be covering the use of non-energy-based modalities in vulvovaginal rejuvenation in this chapter.
Article
Since introduced in 1961, intralesional (IL) agent has become an essential part of the dermatological practice. The term IL referred to the direct delivery of agent percutaneously into skin lesions. This therapeutic approach is relatively safe, easy to perform and applicable for a broad range of dermatological conditions. On the other hand, immediate side effects, including pain during administration, bleeding, high risk of infection and allergic reaction, and subsequent side effects involving skin changes such as atrophy, telangiectasia, pigmentary changes, and striae are usually associated with this modality. This review paper highlights the pros and cons of IL agents in modern dermatology practice.
Article
Full-text available
Background: Platelet-rich plasma (PRP) is an autologous preparation of platelets in concentrated plasma that may be beneficial in the treatment of atrophic acne scars by promoting collagen deposition. Skin needling is a technique that uses a sterile dermaroller to puncture the skin and release growth factors. The combination of skin needling and PRP could enhance the efficacy of both modalities. Chemical reconstruction of skin scars technique consists of focal application of high concentration of trichloroacetic acid (TCA) on the acne scars to stimulate collagen production. Objective: To evaluate the efficacy and safety of intradermal injection of PRP, 100% focal TCA, and combined skin needling plus topical PRP in the treatment of atrophic acne scars. Patients and methods: Forty-five patients with atrophic acne scars were randomly assigned to 3 equal groups; Group A received intradermal injection of PRP, Group B received chemical reconstruction of skin scars technique with TCA 100%, and Group C was treated by combined skin needling and PRP. Each patient underwent 3 sessions at 2-week interval. Results: All the patients completed the study. The 3 groups showed statistically highly significant improvement in the degree of acne scars after treatment (p < .001). No major adverse effects were observed in the studied groups. Conclusion: This is the first study to use intradermal injection of PRP alone for the treatment of atrophic acne scars. The 3 modalities showed a promising efficacy and safety in the treatment of atrophic acne scars.
Article
Full-text available
Systemic corticosteroids play an integral role in the management of many inflammatory and immunologic conditions, but these agents are also associated with serious risks. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing's syndrome, psychiatric disturbances and immunosuppression are among the more serious side effects noted with systemic corticosteroid therapy, particularly when used at high doses for prolonged periods. This comprehensive article reviews these adverse events and provides practical recommendations for their prevention and management based on both current literature and the clinical experience of the authors.
Article
Full-text available
SYNOPSIS The range of conditions that can cause vulvovaginitis is large and includes infective and non-infective causes. Although Candida albicans is a common infective cause, it is essential to consider other diagnoses. A diagnosis should be made from the clinical presentation, history, bacteriology and in some cases histopathology, before starting treatment. The treatment can then be based on the precise aetiology. Index words: vulva, vagina, lichen sclerosus, candidiasis. (Aust Prescr 2001;24:59–61) Patient presentation Women with vulvovaginitis may present with itch, discharge, dyspareunia, burning, soreness, dysuria and swelling. Symptoms may vary with the menstrual cycle. Symptoms are often not a reliable clue to diagnosis, and patients with a variety of different conditions may experience similar symptoms. Which conditions cause vulvovaginal symptoms? Although fungal infections are common they are not the only cause of vulvovaginitis (see Table page 63). Infections C. albicans can cause acute, recurrent and chronic symptoms that always involve the vagina and may also spread to the vulva. Trichomonas can cause itching and an offensive discharge. Bacterial vaginosis causes a non-irritating discharge. Group B and sometimes D streptococcus may occasionally cause a vaginitis with a persistent non-offensive discharge, which may cause maceration and irritation of the vulval skin. This infection may co-exist with C. albicans. Herpes simplex does not cause a vulvovaginitis in the true sense. The patient presents with pain and discrete ulcers and blisters on the vulva. Human papilloma virus causes genital warts. It does not cause itch or discharge. Tinea is an uncommon cause of vulvitis, but does not cause vaginitis. A scaly rash with a well-defined edge that may extend onto the thighs is characteristic. Non-infective conditions When dealing with women with vulval symptoms remember that disabling pain and burning may occur in the presence of a completely normal vulva and normal bacteriology. These patients do not have vulvovaginitis and may prove to have neuropathic or referred pain. 1 Rarely is the complaint 'psychogenic'. Despite their lack of apparent abnormality the patient's symptoms should be taken seriously. Dermatitis This is the commonest cause of vulvitis (see picture). It is most often found in atopic individuals, but they may not have a history of dermatitis on other parts of the body. Atopic dermatitis invariably has itch as part of the symptom complex. There is an observable erythematous scaly rash, with fissuring and desquamation involving the labia majora and minora. Atopic dermatitis does not involve the vagina. Allergic or irritant vulvovaginitis is a dermatitis involving parts of the genital tract that have been exposed to irritating or allergenic substances. This includes imidazole antifungals, neomycin, latex condoms, perfumed oils, overuse of soap and bubble baths, and in rare cases seminal fluid. The dermatitis may be very severe and ulcerative, so that pain and burning are the main symptoms. Urinary and faecal incontinence may also cause a chronic irritant dermatitis.
Article
Objective. The aim of this study was to evaluate the efficacy of fat grafting in the treatment of severe vulvar lichen sclerosus (LS). Our primary outcome was to assess the improvement of mucocutaneous trophism, the resolution/reduction of symptoms, and the histological features of the vulvar skin after treatment. The secondary outcome was to evaluate the improvement in life quality, and in resumption and quality of sexual life. Methods. Between 2011 and 2014, 36 patientswere offered fat grafting to treat LS. Inclusion criteria were age between 25 and 80 years, histopathologic diagnosis of LS, good health, failure of previous first line treatments. Results. 34 out of 36 patients (94%) showed a better vulvar trophismof the skin andmucosae; 27 (75%) had an improvement in caliber and elasticity of the vaginal introitus; clitoris burying degree was reduced in 18 patients (50%), 30 (83%) reported an increased volume of labia majora and minora, 34 (94%) had a complete disappearance of scratching lesions, and 28 (78%) showed a remission of white lesions. Eventually 34 patients (95%) stopped using topical corticosteroids routinely. The improvement in life quality was significant for both DLQI (p b 0001) and FSFI (p b 0001). Conclusions. Fat grafting may have a role as a support and completion treatment in selected cases of women with vulvar LS who do not respond to first line therapy or in severe caseswhere the anatomical impairment does not allow a regular sexual function and a good quality of life.
Article
Vulvar dermatoses are inflammatory conditions responsible for chronic or recurrent itching and soreness. The lesions are either circumscribed to the vulva or associated with extragenital localizations which may help to assess the diagnosis. They should be differentiated from infectious or neoplastic diseases which may have clinical similarities. As opposed to the majority of all dermatoses that have a benign and regular course, lichen sclerosus or lichen planus could exceptionally foster the occurrence of an epithelial cancer precursor which may evolve to squamous cell carcinoma. Topical corticosteroids are the mainstay treatment of vulvar dermatosis. We do not know if the treatment of vulvar lichen sclerosus and vulvar lichen planus prevents squamous cell carcinoma.
Article
Composite grafts are suitable for facial reconstruction because of good color matching, low donor site morbidity, acceptable texture, and easy surgical techniques. However, their use is limited to small-sized defects and by unpredictable survival rates. As platelet-rich plasma (PRP) contains large numbers of growth factors and has been widely used for tissue regeneration, this study aimed to study PRP as an adjuvant to enhance composite graft survival. Twenty New Zealand White rabbits were used, and chondrocutaneous composite grafts were applied to their ears. The grafts were then returned to their original positions after rotation to block the original circulation from the base of the graft. Each of the individual ears was randomly divided into two groups: Experimental (20; PRP group) or Control (20; control group). The surrounding skin of the composite graft was injected with either 1.0 ml PRP derived from autologous whole blood in the PRP group or normal saline in the control group. Graft survival, cutaneous blood flow, CD31-stained vessels, and VEGF protein levels were examined. Twelve days after surgery, graft viability in the PRP group was higher than in the control group. Blood perfusion was also higher in the PRP group. Compared to the control group, the number of CD31-positive blood vessels and VEGF expression levels were significantly increased in the PRP group. Our results suggest that PRP restores the perfusion of composite grafts by enhancing revascularization and may exert therapeutic effects on the survival of composite grafts.
Article
The purpose of this prospective experimental and clinical study is to evaluate the effectiveness of the intralesional injection of platelet-rich plasma (PRP), in the management of non healing chronic wounds. Skin defects were created at the ears of 20 white New Zealand rabbits. In the study group, autologous PRP was injected intralesionally. The control group was treated conservatively. Nineteen out of 20 cases of the study group healed within a mean time of 24·9 days. At the control group, seven defects healed within a mean period of 26·7 days, seven ulcers did not heal at the day 28 and in six cases a full thickness ear defect was recorded. For a 3-year period, 26 patients with chronic ulcers underwent surgical debridement and intralesional injection of PRP. A histological study was performed before and 7 days after PRP injection. Ten patients healed within a mean period of 7 weeks. In 16 cases, PRP prepared the wound bed for the final and simpler reconstructive procedure. Intralesional injection is a newly described method for application of PRP and represents an effective therapeutic option when dealing with non healing wounds.
Article
Platelet-rich plasma is reported to contain multiple growth factors, and has been utilized in orthopaedic surgery to aid healing in multiple tissues. To date, the use of autologous platelet-rich plasma has not been studied for its effects on normal soft tissue. Eighteen adult New Zealand White rabbits were injected with 0.5 mL of autologous platelet-rich plasma in the right or left quadriceps muscle, Achilles tendon, medial collateral ligament, subcutaneous tissue, tibial periosteum, and ankle joint. Saline solution was injected on the contralateral side as a control. The soft tissues were examined histologically at two weeks (six rabbits) and six weeks (six rabbits), and soft tissues from six rabbits that had been reinjected at six weeks were examined at twelve weeks. Inflammatory skin lesions were visible at forty-eight hours at superficial platelet-rich plasma sites. All lesions resolved by six days. Compared with findings in control specimens, histological analysis of platelet-rich plasma injection sites at two weeks showed a marked inflammatory infiltrate with lymphocytic and monocytic predominance. Intra-articular injection showed villous synovial hyperplasia and chronic synovitis. Tendon and ligament sites showed new collagen deposition. Intramuscular injection sites showed thrombosis, necrosis, and calcium deposition. Subcutaneous sites also showed calcium deposition without necrosis as well as collagen nodules representing early scar tissue. Histological examination of platelet-rich plasma injection sites at six and twelve weeks demonstrated a persistent but diminished inflammatory infiltrate. Focal areas of scar tissue were seen with fibroblasts, collagen formation, and neovascularity. All saline solution sites at all times were nonreactive. Platelet-rich plasma can initiate an inflammatory response in the absence of an inciting injury in normal soft tissue in rabbits.