Lichen sclerosus (LS) is a chronic, inflammatory skin disease of unknown cause which can affect any body part of any person but has a strong preference for the genitals (penis, vulva). LS in adult age women is normally incurable, but improvable with treatment, and often gets progressively worse if not treated properly. There is a well-documented increase of skin cancer risk in LS, potentially improvable with treatment. 

Dr. Alexandra Runnels treats Lichen Sclerosis with multiple modalities, including PRP (platelet rich plasma) and hormones.  These treatments can provide lasting relief and can be even more effective than the typical steroid creams prescribed for the condition.

Bathroom use, marital relations, activities of daily living and psychosocial stability are all significantly affected in patients with LS. The symptoms of severe itching, burning pain and tearing skin, make this chronic, relapsing, autoimmune-mediated skin disease, severely disabling. When the disease becomes severe enough, untreated or unresponsive to “Gold Standard” therapies, many patients have found relief of their symptoms with newer, regenerative therapies such as using intradermal or microneedled PRP (Platelet Rich Plasma) combined with a traditional O-Shot® procedure, phototherapy and restorative vaginal lasers. Several studies looking at regenerative procedures that help to restore the normal architecture to the tissue have shown promising benefits to LS patients when gold standard therapies no longer helped or the disease had progressed too far. 

Platelet Rich Plasma alone or in combination with an O-Shot® helps relieve LS symptoms by addressing the two major features of the disease process. Remarkably, PRP/O-Shot® is both anti-inflammatory and remodels fibrosis. Even though the PRP is unable to correct the genetic predisposition to developing LS and cannot prevent relapses, it can help restore the health of the affected tissue and provide symptom relief to patients that have been unable to find relief with first-line agents. Through the anti-inflammatory mechanisms triggered by the release of the concentrated platelet’s alpha granules in the target tissue after activation with either 10%CaCl or native collagen in the tissue, the effects of pro-inflammatory cytokines, interferons and leukocytes are blocked. Many patients report being free of the itching and burning pain characteristic of LS for the first time since onset of symptoms after being treated with PRP. The anti-fibrotic or sclerotic remodeling then adds an additional layer of relief to the patient. As the patient’s own pluripotent stem cells are recruited to the area, the process of remodeling of fibrotic scar tissue into healthy native tissue occurs. The chronic ulcers and fissures heal, the elasticity and collagen concentrations improve and this further helps ameliorate symptomatology. Many patients report being able to stop the topical steroids and avoid more damage from continued use of these agents. Many patients also report being able to have penetrative intercourse again and not cry in pain every time they have a bowel movement. 

Restorative vaginal lasers, ablative, micro-ablative & non-ablative, have been helpful to some. The non-ablative laser, neodynium: ytrium aluminium garnet has performed better than topical corticosteroids in a single RCT. Microablative lasers (radiofrequency) have shown promise in helping relieve symptoms and increase collagen type III concentrations as well as elastin concentrations for about 11 months. Ablative lasers, such as CO2 have been shown in severe, recalcitrant LS cases to provide significant improvement in signs and symptoms.