Experimental treatments show promise in managing a condition but have yet to be thoroughly evaluated for efficacy, safety, and acceptability. Think of it like a non-approved treatment option; it may or may not work. In the context of lichen sclerosus, when discussing experimental treatment options, I mean interventions, medications, or procedures that have not yet shown to be fully effective as a treatment but show promise in helping with symptom management. Some of these experimental treatments include platelet-rich plasma for vulvar lichen sclerosus, laser, and phototherapy.
I often get asked about platelet-rich plasma for lichen sclerosus. For example, folks ask, “Someone on a forum mentioned platelet-rich plasma; what is this?” or “Is platelet-rich plasma an effective treatment for lichen sclerosus?”. In today’s post, I will take a deep dive into platelet-rich plasma by addressing what it is, what the procedure involves, and what the science says for vulvar lichen sclerosus.
*This post is evidence-based; I draw on the medical literature to share what you need to know about platelet-rich plasma for vulvar lichen sclerosus. Importantly, what I share is my interpretation of the science and data.
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What is Platelet-Rich Plasma (aka PRP)?
To answer this, let’s go back to basics.
Platelet-rich plasma for lichen sclerosus all starts with your blood.
Yes, you read that right, your blood.
Blood is composed of two parts – a liquid and a solid part. The liquid portion is plasma, which is basically water, salt, and proteins. The solid part is made up of red and white blood cells along with platelets.
Platelets contain growth factors that are known to tell cells in your body to do their job and stimulate tissue regeneration and healing.
Put simply, PRP is blood with a higher concentration of platelets.
What Does it Look Like to Have PRP for Vulvar Lichen Sclerosus?
To prepare PRP, your clinician will draw some of your blood. They will then take that blood, put it into a tube, seal it off, and put it into a centrifuge machine. A centrifuge machine is a device that uses centrifugal force to separate the liquid components from the solid parts of your blood.
Further, the concentration of platelets is increased in addition to separating out the liquid from solid components. For example – and this example is completely arbitrary and simplistic to illustrate the point – let’s say your blood sample initially contains 30 platelets. The centrifugation process will increase the number of platelets from 30 to 150.
Once the centrifugation process is complete, your blood and the increased number of platelets will be placed inside a syringe. Your clinician will then numb the vulva and inject your blood/platelet sample into various parts of your vulva.
PRP promotes healing by stimulating and releasing growth factors and cytokines (proteins that, when released, tell the body to do its job). For example, if you tore a ligament, the body’s job, so to speak, is to heal that ligament and restore function to the area. Thus, in this example, the growth factors and cytokines will tell the body, “Hey, see that torn ligament? Yeah. That one. We will need you to work hard to heal that area”.
Why Did Researchers Start to Investigate Platelet-Rich Plasma for Vulvar Lichen Sclerosus?
PRP is helpful for several conditions, including but not limited to venous ulcers, Achilles tendonitis, muscles, and ligament strains.
Because platelet-rich plasma has been found effective in treating many conditions, many started to wonder if it could be an effective treatment for lichen sclerosus. Specifically, if PRP can help with tissue regeneration and healing, it may help regenerate and restore the vulvar tissues for folks with vulvar lichen sclerosus. Thus, studies looking at the efficacy of platelet-rich plasma for lichen sclerosus started to emerge.
What Does the Science Say about Platelet-Rich Plasma for Vulvar Lichen Sclerosus?
Let’s run through a few studies to see if PRP is an effective treatment for lichen sclerosus.
A Case Study on PRP for Vulvar Lichen Sclerosus
Franic D. et al. (2018) published a study on the effectiveness of PRP for Lichen Sclerosus. While its positive results showed promise, this study contained only one patient and was not controlled or blinded. Therefore, we must take a study like this with a grain of salt.
The Tedesco et al. 2020 Paper
Another study by Tedesco et al. (2020) showed more promise. This study included more patients, with 43 male and 51 female patients with Lichen Sclerosus participating. All patients received PRP. The results showed that most patients reported a significant decrease in symptoms at six months.
For example, both male and female patients stated they saw a decrease in their experience of pain and burning. However, painful sex continued to be a problem for the female patients in the study.
But that sounds good, right? Maybe not perfect, but it suggests it would be a good potential treatment.
Unfortunately, it is not that simple. The quality of the study could have been more reliable. For example, the study was not a placebo/sham-controlled study. Placebo or sham-controlled studies involve two or more groups of people where one group gets the active treatment or procedure, and the other receives the inactive treatment. This is important because, without these measures, it’s hard to determine if the results are from the PRP itself or are a coincidence.
Further, this study also did not include pre and post-biopsy assessments. What does this mean, and why is it important? It’s important because we want to see a significant decrease in inflammation from before PRP and after PRP to determine if it is an effective treatment. The best way to measure inflammation in the vulvar tissues is via biopsy. In steroid studies, pre and post-biopsy assessments have repeatedly shown that steroids significantly reduce inflammation, and this is what most specialists look for when they endorse a medication or intervention as the primary treatment.
Therefore, it’s difficult to say from this study whether PRP was effective as a treatment over and above helping to improve some but not all symptoms.
The Goldstein et al. 2019 Paper
Goldstein et al. (2019) conducted a randomized, double-blinded control study to evaluate whether PRP effectively treats Lichen Sclerosus. The study included 30 people with vulvar lichen sclerosus. Of that cohort, 20 received the PRP treatment, and 10 received a sham treatment. The syringes were blacked out, so neither the patient nor the clinician knew if they were injecting PRP or an inactive substance.
The results were assessed via two measures. First, they evaluated whether there was a statistically significant improvement in inflammation levels by comparing pre and post-treatment biopsies. Importantly, the expert dermatopathologist who assessed the biopsies was also blinded, meaning they did not know if the biopsy was from a patient who received PRP or the sham treatment. Secondly, results were considered from a questionnaire based on symptoms for vulvar Lichen Sclerosus. Both showed PRP was ineffective as a monotherapy (i.e., the only or primary therapy used to treat Lichen Sclerosus) in reducing the inflammation caused by Lichen Sclerosus.
Overall Trends in PRP Research for Vulvar Lichen Sclerosus
A systematic review – a paper that reviews, discusses and synthesizes information from different studies on a specific topic like lichen sclerosus – by Villalpando et al., 2021, stated at this point, we more and better research. The authors mention that most studies on platelet-rich plasma are of poor quality, so we cannot take much away from them. Finally, the authors note that more research and standardization of preparation and treatment are required for lichen sclerosus.
So, what’s the verdict? Is PRP an effective treatment for vulvar lichen sclerosus?
Unfortunately, our current studies are limited and have yet to demonstrate the significant reduction in inflammation many doctors look for when they counsel patients on primary treatments. For this reason, most LS specialists do not recommend this as a monotherapy or primary treatment.
Nonetheless, it’s important to note that some patients report an improvement in their symptoms after receiving PRP. And let’s be honest, LS symptoms are awful, and symptom management and reduction are fundamental to our quality of life. Therefore, you may consider PRP as an add-on/adjunct therapy that you use in conjunction with steroids or calcineurin inhibitors. I have, anecdotally, heard a couple of folks tell me steroids helped them feel 80% better, and then PRP treatments helped get them all the way to 100%. Thus, there may be a place for PRP for folks who cannot tolerate steroids to help manage symptoms or as an add-on/adjunct therapy.
In sum, platelet-rich plasma is considered a regenerative therapy/treatment that *may* help with symptoms and quality of life. However, more quality research is required to show that PRP is effective as a primary treatment. So far, the research shows it is not effective as a primary treatment but may have its place as an add-on therapy in conjunction with steroids or calcineurin inhibitors.
Let us know in the comment section if you have done PRP and if you found it helpful.
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Franic D, Iternička Z, Franić-Ivanišević M. Platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus in a premenopausal woman: A case report. Case Rep Womens Health. 2018;18:e00062. Published 2018 Apr 16. doi:10.1016/j.crwh.2018.e00062
Goldstein AT, Mitchell L, Govind V, Heller D. 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. 2019 Jun;80(6):1788-1789. doi: 10.1016/j.jaad.2018.12.060. Epub 2019 Jan 11. PMID: 30639885.
Tedesco M, Garelli V, Bellei B, Sperduti I, Chichierchia G, Latini A, Foddai ML, Bertozzi E, Bonadies A, Pallara T, Romani C, Morrone A, Migliano E. 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. 2022 May;33(3):1558-1562. doi: 10.1080/09546634.2020.1854650. Epub 2020 Dec 6. PMID: 33226278.
Villalpando BK, Wyles SP, Schaefer LA, Bodiford KJ, Bruce AJ. Platelet-rich plasma for the treatment of lichen sclerosus. Plast Aesthet Res. 2021;8:63. doi: 10.20517/2347-9264.2021.86. Epub 2021 Dec 5. PMID: 34950752; PMCID: PMC8694569.