Lichen Sclerosus Treatment

 

If you or someone you love suffers with a condition, called Lichen Sclerosus (LS), you know the pain, frustration, loss of hope, decreased quality of life and relationship damage that is all too familiar to those with this condition. For those not familiar with LS, it is a chronic, progressive dermatological condition of the vulvovaginal and sometimes anogenital tissues with an unclear etiology and has no known cure. It is been historically hard to treat and the treatment options are inadequate and few in number. The “Gold Standard” for treating LS is topical high dose corticosteroids and supportive care. Immunmodulators like Tacrolimus are also sometimes used.

Those of you with LS may have spent countless hours in doctor’s offices, praying they may have a solution that just might work this time. You think, “Why me? What did I do to deserve this kind of torture? My friends don’t share my affliction and my lover, as much as they may try and love me, just cannot possibly understand?” You feel to blame and like it’s somehow your fault and are too embarrassed or ashamed to even seek the help of a physician and may feel like just giving up at this point. Lichen Sclerosus can be a very lonely disease for many reasons. It is a chronic, progressive condition of the genital and sometimes anal tissue that starts out itchy and becomes painful, then often does not resolve. Rather it worsens over time with cycles of acute flaring followed by chronic scarring with continued degradation of the integrity of skin of the genital region.  The skin loses elasticity and thickness. It becomes thin and tears easily, especially with chronic exposure to corticosteroids. The combination of chronic steroid use and continued disease results in severely atrophic genital tissue. The tissue becomes resistant to healing and poorly suited to defend itself against mechanical or chemical insult, leaving very fragile tissue and often unusable sex organs. The condition is also highly effected by physical and emotional stressors, hormone status, age and overall health. Covid-19 infections seem to have triggered flares in many patients as well.

Lichen Sclerosus affects both genders and all ages, with a predilection for females in the post-menopausal years. The early symptoms are aggravating, uncomfortable at best and most often, extremely painful. The condition often goes undiagnosed and the resulting long-term scarring and anatomical changes of the anogenital tissues can be disfiguring, debilitating and life-altering for those that suffer with it. Long term Lichen Sclerosus effects, as well as the deleterious effects of the current treatment modalities, result in severe scarring, labial fusion, clitoral hood phimosis, narrowing of the vagina and erosions and fissures of the anogenital tissues making using the restroom, walking and intercourse difficult and painful.

We know the mere thought of starting yet another treatment or therapy, feels like more than just a waste of time. You likely feel somewhat hopeless and that if there is  a treatment modality that really works, why aren’t all of the doctors using it?  Likely, you have spent months to years trying to find a treatment method that would help, only to be ultimately unsuccessful at alleviating the pain and suffering you endure on a daily basis. You pray very hard for something to help you to get some kind of relieve of your silent and secret pain.  Something that will help you regain some of the most important parts of your life back.

We now have an innovative new treatment that finally goes beyond topical steroids and immunosuppresive agents such as Clobetasol and Tacrolimus.  Long term use of high dose corticosteroids is associated with significant acute and long term side effects. It actually makes the tissue less healthy and less able to heal. Our treatment protocol addresses the underlying pathophysiology of the disease, the acute and chronic symptoms, and the debilitating scarring and architectural changes that plague long-term sufferers of this disease. Most of our patients enjoy either drastic improvement or complete resolution of symptoms. Many of our patients report they no longer require any topical steroid or immunosuppressive agents and have been able to resume or begin to have normal and pain-free sexual intimacy with their lovers!

We love to see our Lichen Sclerosus patients about 6-8wks after their first treatment with their custom-made treatment protocol, literally in tears because they were able to have comfortable sex with their partners for the first time in years. When the pain and itch of Lichen Sclerosus is gone, the woman suffering with this cruel disease starts to bloom. The condition that used to make her feel ashamed, unattractive and unlovable no longer has control of her anymore. Sexual relations resume, strengthening the intimate love bond between partners and mending rifts in the marriage caused by the LS symptoms. Women begin to exercise again, travel and take on new hobbies and interests. Her spirit begins to thrive again and she once again has hope.

Physicians around the world have been combining traditional Gynecology treatments with state of the art Regenerative Therapies to treat sexual dysfunction, urinary incontinence, facial and body aesthetics and cosmetic gynecologic surgical procedures, to utilize the healing and restorative  properties of PRP in conditions such as LS. After seeing patients with Lichen Sclerosus get better with an O Shot® (the original vaginal treatment using PRP), practitioners around the world have started to utilize PRP injections throughout the vulvovaginal and anogential tissues with excellent results. The use of Platelet Rich Plasma to treat conditions caused by auto-immune disorders has become increasingly common and we have found several vulvovaginal conditions caused by autoimmune disorders to respond remarkably well to PRP treatments. In addition to Lichen Sclerosus, I have treated patients with Sjogren’s Syndrome, Scleroderma, Psoriatic Arthritis and Rheumatoid Arthritis who have presented with vulvovaginal manifestations of their autoimmune conditions and have had results that have shocked me.

The treatment protocol is different for every patient and depends on many factors such as severity of the disease, age, overall health status, etc. Most patients require a second treatment 6-8wks after the first and many can then return on an annual or semi-annual basis for maintenance care and biopsy surveillance. Unfortunately, PRP treatments and O Shots® are not yet covered by insurance, but I think they will be in the future. For now, because these procedures are out of pocket expenses for the patient, we insist on giving a full refund of every penny if you don’t think we helped you. We will never keep money that didn’t make you happy to have spent.

We have always hated the disease of Lichen Sclerosus secondary to the devastating effect it has on the tissues of the anogenital region. After over 20yrs of practicing Gynecology, I have struggled, as I know many other Gynecologists have as well, to truly help our patients suffering with LS. The treatments considered to be the “Gold Standard” for Lichen Sclerosus are inadequate, do not cure the condition, contribute to worsening of the underlying tissue integrity and health and have sometimes serious side effects in other parts of the body. There has not ever been a treatment protocol that eliminates the condition adequately. It is one of the diseases that most Gynecologists hate, because it has been almost impossible to treat. As a physician, nothing is more frustrating than having a patient in pain, knowing what their pain is and what is in store for them down the road and not having anything to offer that will really help alleviate their suffering.

The ability of PRP to halt the abnormal immune response in the dermis of the genitals, repair and heal inflammation and remodel fibrotic and distorted tissue, makes it the perfect agent to treat many of the above mentioned conditions. Additionally, it has the added benefit of having relatively, no known long-term adverse side effects. In other words, it can’t hurt to try it, especially in conditions with no other good answers. PRP has never been shown to cause a condition to worsen, an infection or a cancer after several decades of using it in almost every part of the human body.

Patients and physicians alike can feel comfortable and optimistic about protocols like ours for treating Lichen Sclerosus utilizing PRP in combination with other modalities, such as a traditional O-Shot®, topical moisturizers, microdeedling with PRP, radiofrequency lasers, bioidentical hormone replacement and in-office clitoral hood phimosis repair and adhesiolysis of labia minora fusion…….all without using oral or topical steroids or immunosuppressive agents. It brings us great joy to see our patients return to the lifestyle they once enjoyed as their vulvar tissue heals, becomes more supple, healthy and comfortable once again. If you or someone you love suffers from Lichen Sclerosus and you think we can help, please reach out to us and we would love to try and help. If you would like to schedule an appointment, please click the link below.

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