Platelet-Rich Plasma (PRP) and Adipose-Derived Stem Cell (ADSC) Therapy in the Treatment of Genital Lichen Sclerosus: A Comprehensive Review

Abstract

Lichen sclerosus (LS) is a chronic inflammatory dermatosis mostly localized in the genital area, characterized by vulvar alterations that can severely impact a patient's quality of life. Current treatment modalities often provide incomplete relief, and there is a need for innovative approaches to manage this condition effectively. Platelet-rich plasma (PRP) and adipose-derived stem cells (ADSCs) have emerged as potential regenerative therapies for LS, offering promising results in clinical practice. This comprehensive review explores the utilization of PRP and ADSC therapy in the treatment of genital LS, highlighting their mechanisms of action, safety profiles, and clinical outcomes. PRP is a blood product enriched in growth factors and cytokines, which promotes tissue regeneration, angiogenesis, and immune modulation. ADSC regenerative potential relies not only in their plasticity but also in the secretion of trophic factors, and modulation of the local immune response. Numerous studies have reported the safety of PRP and ADSC therapy for genital LS. Adverse events are minimal and typically involve mild, self-limiting symptoms, such as transient pain and swelling at the injection site. Long-term safety data are encouraging, with no significant concerns identified in the literature. PRP and ADSC therapy have demonstrated significant improvements in LS-related symptoms, including itching, burning, dyspareunia, and sexual function. Additionally, these therapies enable many patients to discontinue the routine use of topical corticosteroids. Several studies have explored the efficacy of combining PRP and ADSC therapy for LS. In combination, PRP and ADSCs seem to offer a synergistic approach to address the complex pathophysiology of LS, particularly in the early stages. The use of PRP and ADSC therapy for genital lichen sclerosus represents a promising and safe treatment modality. These regenerative approaches have shown significant improvements in LS-related symptoms, tissue trophism, and histological features. Combination therapy, which harnesses the synergistic effects of PRP and ADSCs, is emerging as a preferred option, especially in early-stage LS cases. Further research, including randomized controlled trials and long-term follow-up, is warranted to elucidate the full potential and mechanisms of PRP and ADSC therapy in the management of genital LS. These regenerative approaches hold great promise in enhancing the quality of life of individuals suffering from this challenging condition.

Keywords: ADSC; PRP; lichen sclerosus; mesenchymal stromal cells; regenerative medicine; vulvar atrophy.

Figure 1

Schematic representation of the use of PRP in the setting of LS and possible mechanisms of action. PRP is obtained through centrifugation of blood and its content is particularly rich in platelets. When injected, activated platelets release a series of growth factors responsible for their therapeutic efficacy. PDGF: platelet-derived growth factor; EGF: epidermal growth factor; VEGF: vascular endothelial growth factor; IGF: insulin-like growth factor; TGF: transforming growth factor. Created with BioRender.com, accessed on 14 October 2023.

Figure 2

Possible mechanisms of action of ADSCs in the setting of LS. ADSCs exert an immunomodulatory action through the secretion of anti-inflammatory cytokines and have regenerative functions. In fact, ADSCs can both differentiate towards a fibroblast-like phenotype and activate local fibroblasts. At the same time, ADSCs contained in the adipose tissue can differentiate into adipocytes, which is fundamental for restoring volumes in the genital area. Finally, ADSCs are implied in tissue healing promoting both epithelization and vessel formation. Created with BioRender.com, accessed on 14 October 2023.