Unless you or someone close to you has it, you probably haven’t heard of lichen sclerosus. This debilitating condition often goes undiagnosed due to its sensitive nature. While gynaecologists or dermatologists can diagnose and manage this condition, many patients still suffer from ongoing symptoms. Dr Tricia Philip discusses where the healing power of platelet-rich plasma (PRP) may be beneficial.
Lichen sclerosus (LS) is a chronic inflammatory skin condition that commonly affects the anogenital region in both males and females. Less frequently, LS can also occur in other areas, such as the upper body, thighs, buttocks, and wrists.
While the cause of LS is not entirely clear, it is thought to be multifactorial and may include autoimmune disease, genetic factors, hormonal changes, as well as repeated trauma or irritation.
What does LS look like and how does it affect patients?
It presents with white patches of skin that are usually thin and may appear wrinkled. Patients may experience genital itching, burning, stiffness, bruising, bleeding, and pain in the external genital area. Sexual activity is often impaired due to discomfort or physical changes in the opening of the vagina. It may also lead to difficulty in passing urine. In mild cases, there may even be no symptoms.
Notably, patients with symptomatic LS have a slightly increased risk of developing skin cancer in the affected area. Therefore, ongoing visits to a dermatologist are essential. While the physical effects of this condition can be devastating enough, there is also a considerable emotional and psychological impact, impacting the patient’s quality of life and intimate relationships.
LS may often go undiagnosed for many years because patients are too embarrassed to talk about their symptoms. Meanwhile, catching it early and starting treatment promptly can prevent future complications. The diagnosis can usually be made by examining the skin in the affected area, together with a review of the patient’s medical history. However, it is advisable to confirm this with a biopsy.
What treatments are available?
LS is a lifelong condition. While there is no cure, there are various treatment options available that can minimise symptoms and halt the progression of the disease:
- Potent topical steroid creams or ointments
- Topical calcineurin inhibitors
- Topical and oral retinoids
- Topical oestrogen if needed
- Phototherapy
- Oral immune suppressants
- Platelet-rich plasma (PRP) therapy
- Fat grafting
What is PRP therapy?
PRP is a naturally occurring component of your blood that contains special growth factors, cells, and proteins. This milieu of biologically active molecules can lead to a well-orchestrated tissue healing response within the body. It is obtained by drawing a small amount (up to a tablespoon) of the patient’s own blood and then spinning it in a centrifuge to separate the plasma from the red blood cells.
PRP is a safe and effective treatment method that is currently being used in various medical applications, including dentistry, orthopaedics, cosmetic surgery, and acute trauma.
PRP injections into the genital region can speed up the healing process and reduce inflammation of the tissues affected. This, in turn, provides significant relief from the symptoms.
How does PRP therapy work?
These are some of the ways in which this procedure can assist in the management of LS:
- PRP downregulates the autoimmune response, which leads to delayed disease progression. It can increase or reduce the activity of specific cells and proteins involved in the immune response, resulting in less inflammation.
- PRP can remodel the scar tissue that may have formed into healthier tissue. Even if symptoms have improved with conventional therapy, thickened and injured tissues still need to be addressed.
- PRP promotes wound healing and improves blood supply to the damaged tissues. Fissures or blisters in the skin can be repaired at a quicker rate with the use of PRP.
The value of PRP therapy
Studies have shown that PRP can be considered an effective treatment option for the management of lichen sclerosus. However, not all patients respond to PRP, and those that do usually require repeated treatments every 9–18 months. Those who do not have a significant response to PRP treatments should continue topical steroids and other modalities prescribed by their treating specialist.
While this is still a condition that requires primary management from a gynaecologist or dermatologist, there may be some value from seeing an aesthetic physician who is experienced in performing PRP injections.
MBChB, DA (SA), Advanced Dip Aesth Med (cum laude)
Dr Tricia Philip qualified as a medical doctor from the University of Pretoria in 2008. After completing her internship and community service in Johannesburg, she went on to work in the fields of anaesthesiology and vaccine research before following her heart and pursuing a career in Aesthetic Medicine. She is an experienced medical practitioner with a passion for aesthetic and regenerative medicine. The evolving field of aesthetic medicine combines aspects of technical competence, theoretical knowledge and artistry, which appeals to both her scientific and creative sides. She has been trained both locally and internationally and strives to be constantly updated with the latest trends and scientific advancements in the aesthetic industry. Her field of expertise is facial aesthetics using botulinum toxin, dermal fillers, biostimulators and PRP. She has a passion for positive ageing and her goal is to help patients look and feel their best using subtle, non-surgical enhancements. She currently consults at MedAesthetiquein Johannesburg.