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Lichen sclerosus (LS) is an autoimmune disorder that primarily affects the vulva and anus, but can occur in other areas. Though it can occur in men and women, it is overwhelmingly more common in women (approximately 10:1). Affected areas often exhibit a white patch that may be itchy or painful and can progress to scarring and fusing of tissues. As tissue loses elasticity, there is often significant pain with sexual intercourse, urination and defecation and the vaginal opening can be visibly narrowed.
Conventional treatments for LS typically consist of topical steroids to control inflammation, however steroids can further compromise tissue integrity. Other treatments include hormone replacement and general immune modulation, as the condition is generally thought of as autoimmune, and is most prevalent in prepubertal girls and postmenopausal women, indicating that there may be a strong hormonal component.
Platelet rich plasma (PRP) is a blood product that uses concentrated growth factors to stimulate healing and regeneration of tissue. Though most frequently used (and studied) in orthopedic medicine, there are broad applications for PRP including it’s use to halt the progression of lichen sclerosus and often restore tissue integrity. Formal studies in this area are still scant, although there are more and more practitioners and patients who are turning to this therapy, as conventional approaches are often ineffective.
The procedure itself begins with a simple blood draw, and the patient’s blood is then processed to extract and activate growth factors that are associated with the platelets (a key component to any healing cascade). The vulva is treated with a topical anesthetic while the plasma is processed, and then the PRP (along with a small amount of lidocaine) is injected into the affected tissue. The total office visit takes approximately 90 minutes, although the injections typically take only 10-15 minutes. With the use of the topical anesthetic and very small needles, the procedure is remarkably comfortable for most patients.
Full benefit may take 3 months, although improvement is often noted after 3-4 weeks. Generally the injections are recommended in a series, as additional treatments build on each other and continue to push the tissue to regenerate. We suggest a series of 3 treatments spaced 6-8 weeks apart. For maximal benefit, we require an initial office visit, and often suggest a number of naturopathic therapies to treat the immune system and underlying inflammatory process.