Introduction
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.
Conclusion
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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Sources Cited
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.
Hi! Thanks for the blog post on Prp and lichen sclerosis. Your conclusion is spot on. I have had prp and use clobetasol regularly. I’m glad I invested in the prp as it helped me handle aspects of lichen sclerosis that the steroid cream doesn’t help.
Hi, Joanne. Thanks so much for your kind words and also for sharing your experience. Sounds like PRP was a great adjunct to your primary treatment plan. Can I ask about pain/discomfort during and after PRP? It’s nice to hear first hand about this rather than from a medical article.
Hi Jaclyn. The process is interesting! The area is numbed and the needles can be painful. Once numbed, you can’t really feel the prp injections. I drove myself home after each session. When the freezing wears off, you are uncomfortable but not in a debilitating way.
This article is also misleading
Thanks for your feedback. Can you let us know what’s misleading so we can do better in the future?
That prp isn’t effective I’m pretty sure there’s people who gotten a better quality of life thanks to prp I’m a guy I’m also going to try prp since I failed everything else everyone is different not everyone gets the same results you make it sound like there is no fucking hope
While I appreciate your opinion, we don’t tolerate disrespect. Refrain from cursing if you want to continue this conversation. Secondly, this article is based on scientific studies. These are not my opinions. We can dispute people “feeling” better but the key is does it manage the condition to stop to the progression of vulvar cancer. If you looked closer and read more of our content you will see that we speak about PRP as being a viable adjunct treatment, not main treatment because the science does not back that up right now. This may change in the future, but as an evidence-based organization we report what the science currently says and our content has to pass review by our medical advisory board. In your rush to judgement you may have missed this statement at the beginning of the article, “*This post is evidence-based; I draw on the medical literature to share what you need to know about platelet-rich plasma for lichen sclerosus. Importantly, what I share is my interpretation of the science and data.” Once again, thank you for your opinion but keep it civil.
There is a blatant double standard when it comes from men suffering from this condition. Some woman have been offered co2 laser treatments and radiofrequency and even surgical excision of the affected skin with skin grafting but when I advocate for a skin graft on my scrotum knowing my skin barrier is completely gone after the skin trauma I went through. There’s no clinics willing to offer me these treatments of full excision of the scrotum skin with skin grafting or even laser co2 treatments but I did get offered stem cells and prp injections for this but I’m looked at crazy for wanting a skin graft on my scrotum I can name a couple of surgeries that woman can do for this condition labiaplasty, vaginal rejuvenation while us guy’s are left in the dark without having the option to resort to a complex surgical procedure like scrotoplasty excess skin removal and in some cases skin grafting but not in my case so tell me Jaclyn is someone like me who got this condition from skin damage am I crazy for looking into prp if doctors can’t offer me what they offer you???
I agree with you, there’s a massive double standard and it’s seriously unfair to folks with penile lichen sclerosus. Penile lichen sclerosus is also vastly underresearched compared to vulvar lichen sclerosus; it’s not even comparable. You 100% deserve better, both in terms of care and treatment options. I do not think you’re crazy for considering PRP at all (never said nor implied; this article simply reports on what the science says for VLS and PRP) . In fact, I think it makes total sense; if other methods have failed, you absolutely need to try other options. You are suffering and that’s not fair. Everyone, regardless of their genitals, deserves proper care and treatment.
I sincerely hope that PRP is beneficial for you, both in terms of symptom management and quality of life.
My name is Diego and I have lichen simplex chronicus in my scrotum which from reading symptoms associated with lichen sclerosus it seems like there is really not much of a difference between the two conditions I apologize for not being civil. My journey began when I shaved my groin area including my scrotum with a rusty razor for the first time I wasn’t aware a rusty razor could cause chronic itch but for me it did. In July of 2021 I shaved for the first time and I knew after a month of still being itchy something was wrong but i didn’t put much focus into for the first couple of months I was just going to regular primary care providers to get checked out I was told I might have scabies in my scrotum that was scary I got put on the treatment twice because after the first time the itching didn’t go away unfortunately it didn’t go away after the second time either this is like 7 months later at this point of time the itching and irritation wasn’t debilitating i got told by another healthcare provider that i might have folliculitis since the itching happened after shaving this was weird to me because at that time it had already been like 8 month’s after shaving I didn’t know folliculitis could be chronic I still don’t know but nevertheless I was prescribed ointment to treat folliculitis with no symptom relief. At this point I’m desperate to try out anything to better my quality of life this is like 9 month’s later I never got recommended to see a specialist I never even knew what a dermatologist was because before I shaved my scrotum and groin I never felt not one ounce of itch in my scrotum I been pretty healthy all my life according to my doctors. 10 month’s later after shaving and still dealing with mild to moderate itching I decided to try laser hair removal on my scrotum since I believed the cause of my itching was folliculitis and even the manager at the laser hair removal clinic said that it’ll help if the cause is folliculitis since lasers permanently destroy the hair follicles after a certain number of treatments. It was the worst mistake of my life on April 6 2022 I decided to do it and not even 48 hours later my scrotum felt on fire and I felt a intense desire to scratch my scrotum. The symptoms were to much for me to handle i only lasted less than 2 weeks at my old job and I left in April 28 2022 .Ever since then I started getting serious and going to specialist to find out what’s wrong and I advocate a skin biopsy from my scrotum to find out what’s going on and 2 weeks later I got the most horrible news that the diagnosis came back that I have features in my skin of lichen simplex chronicus and to make matters worse the dermatologist at the time didn’t tell me it was a chronic condition he told this has a fix this has a cure. Ever since April 28 2022 till now I’ve done numerous research myself gone to numerous specialist’s for different opinions I’ve tried steroid creams for about a week or 2 and honestly when i had the cream i felt like my scrotum was getting stabbed nerve sensitivity. I’ve tried steroid creams steroid drug’s 2 surgical procedure’s and one spinal cord stimulator implant trail maybe I should just give up honestly I recently just about 5 months ago got offered exosomes injections in other words regenerative stem cells injections but I don’t even know if it’s worth maybe I am a crazy person most people think I’m a hypocrite or narcissist when I bring up how I believe there is a hard double standard when it comes to this condition whether it be lichen sclerosus or lichen simplex. I advocated a skin graft on my scrotum to urologist since I wholeheartedly believe that the laser hair removal caused skin damage to my scrotum and I get looked at crazy by all urologist . I got scrotoplasty about 5 month’s ago a surgical procedure that’s very hard to find a provider willing to do it but I did in Mexico unfortunately for me the urologist in Mexico didn’t think a skin graft was necessary and me being dumb and desperate I went ahead and did it. I cry mainly every day asking God why this happened to me why I damaged my skin I’m not sure if you looked into it Jaclyn but some studies indicate that lichen sclerosus and lichen simplex can possibly be caused by skin damage or trauma . It breaks my heart seeing the options men have for this condition vs the options ladies have and I hope you don’t think I’m a hypocrite for thinking this way I’m getting emotional even typing this now . There is no support group for men with this condition when I try to talk to any lady about this condition I get looked at with disgust and that breaks me down . At this point my options to live a normal healthy happy life are very limited now and a little bit pricey. I found a amazing clinic I spoke with a guy named Derek I told him everything I’ve gone through my diagnosis of lichen simplex in my scrotum and how debilitating it is and how I want to try stem cells as a alternative option to see if the itching finally calms down that’s what kills me the most is the itching and dry skin. I have a appointment this Friday but when I read articles like this sometimes it makes me think what if there is no hope and am I crazy for looking into this when everything else has failed to bring actual symptom relief. I wish I had someone to talk to but unfortunately guy’s are looked at like pig’s in my opinion for having a condition like this I feel like the biggest disgusting pig of them all I’m sorry for the long story and rant at this point I’m telling myself is it worth it trying to fight trying to repair my skin with no dryness and with the hydration I been looking for I’m so sorry all I want is to get back to work I been a prisoner inside my own home since April 28 2022 because of how bad this condition got I feel uncomfortable and embarrassed I haven’t had no other job since then I truly am the definition of pathetic and useless in my opinion if I can’t get any real relief from this then I’m better off dead I can’t live a normal life like this…..
But Derek looked at the research for this condition and seen that prp is a treatment option and it’s a lot less cheaper and just as effective as stem cells I’m praying for a change because I know if I can get a better quality of life the day God calls my mom the only person in the world who cares about me when that happens and if I’m still like this then I’m going to want to go also I cannot live a normal life with the way the condition is now and I won’t be forced to either I’d rather die I hope this comment is offensive to you or anyone else