Lichen Sclerosus
 

     Lichen Sclerosus is a skin condition that occurs in women, men and even children but most frequently seen in post-menopausal women. The skin around the genitals and anus can turn shiny and smooth and spots grow into patches. Skin over the spots turns thin and crinkled and can tear easily and become scarred. Itching, changes in skin color, pain, bleeding and blisters can also occur. Causes of LS may be auto-immune or hormonal but overall the exact cause is poorly understood. Other areas of the body can be affected but those usually resolve without treatment. LS is not contagious. Diagnosis can be confirmed on skin biopsy. Without treatment, patches on the genitals can lead to scarring and pain or become cancerous. LS can cause scars that narrow the vagina interfering with sexual intercourse.
 
     Treatment has traditionally involved surgical excision (not always possible especially in women) and powerful topical steroids which can help mitigate itching and scarring. Optimization of estrogen levels is also helpful. More advanced treatment includes retinoids (vitamin A like compounds), UV light therapy, or Tacrolimus (immune suppressant). At California Stem Cell Treatment Center, Dr. Lander can perform a mini liposuction to obtain stromal vascular fraction (SVF) which is rich in adult stem cells and growth factors. SVF has immuno-modulatory and anti-inflammatory effects and therefore may be effective in healing the abnormal patches of skin associated with LS. Our protocol also addresses the systemic component of LS by administration of intra-venous SVF in addition to local injections.

 
CANDIDATE APPLICATION

The Use of Human Adipose-Derived Stem Cells in the Treatment of Physiological and Pathological Vulvar Dystrophies.
 
Stem Cells Int. 2016;2016:2561461. doi: 10.1155/2016/2561461. Epub 2016 Jan 10. Giuseppina Onesti M, Carella S, Ceccarelli S, Marchese C2, Scuderi N.

Abstract
 

"Vulvar dystrophy" is characterized by chronic alterations of vulvar trophism, occurring in both physiological (menopause) and pathological (lichen sclerosus, vulvar graft-versus-host disease) conditions. Associated symptoms are itching, burning, dyspareunia and vaginal dryness. Current treatments often do not imply a complete remission of symptoms. Adipose-Derived Stem Cells (ADSCs) injection represents a valid alternative therapy to enhance trophism and tone of dystrophic tissues. We evaluated efficacy of ADSCs-based therapy in the dystrophic areas. From February to April 2013 we enrolled 8 patients with vulvar dystrophy. A biopsy specimen was performed before and after treatment. Digital photographs were taken at baseline and during the follow-up. Pain was detected with Visual Analogue Scale and sexual function was evaluated with Female Sexual Function Index. All patients received 2 treatments in 3 months. Follow-up was at 1 week , 1 and 3 months, and 1 and 2 years. We obtained a significant vulvar trophism enhancement in all patients, who reported pain reduction and sexual function improvement. Objective exam with speculum was easy to perform after treatment. We believe ADSCs-based therapy finds its application in the treatment of vulvar dystrophies, since ADSCs could induce increased vascularization due to their angiogenic properties and tissue trophism improvement thanks to their eutrophic effect.

 

Vulvar lichen sclerosus: A new regenerative approach through fat grafting.
 
Gynecol Oncol. 2015 Dec;139(3):471-5. doi: 10.1016/j.ygyno.2015.10.014. Epub 2015 Oct 21.

Boero V, Brambilla M, Sipio E, Liverani CA, Di Martino M, Agnoli B, Libutti G, Cribiù FM, Del Gobbo A, Ragni E, Bolis

Abstract
 

OBJECTIVE. The aim of this study was to evaluate the efficacy of fat grafting in the treatment of severe vulvar lichen sclerosus (LS). Our primary outcome was to assess the improvement of mucocutaneous trophism, the resolution/reduction of symptoms, and the histological features of the vulvar skin after treatment. The secondary outcome was to evaluate the improvement in life quality, and in resumption and quality of sexual life.

  METHODS. Between 2011 and 2014, 36 patients were offered fat grafting to treat LS. Inclusion criteria were age between 25 and 80 years, histopathologic diagnosis of LS, good health, failure of previous first line treatments.

RESULTS. 34 out of 36 patients (94%) showed a better vulvar trophismof the skin and mucosae; 27 (75%) had an improvement in caliber and elasticity of the vaginal introitus; clitoris burying degree was reduced in 18 patients (50%), 30 (83%) reported an increased volume of labia major a and minor a, 34 (94%) had a complete disappearance of scratching lesions, and 28 (78%) showed a remission of white lesions. Eventually 34 patients (95%) stopped using topical corticosteroids routinely. The improvement in life quality was significant for both DLQI (p b 0001) and FSFI (p b 0001).

  CONCLUSIONS. Fat grafting may have a role as a support and completion treatment in selected cases of women with vulvar LS who do not respond to first line therapy or in severe cases where the anatomical impairment does not allow a regular sexual function and a good quality of life.


New surgical approach to lichen sclerosus of the vulva: the role of adipose-derived mesenchymal cells and platelet-rich plasma in tissue regeneration.
 

Plast Reconstr Surg. 2010 Oct;126(4):210e-211e. doi: 10.1097/PRS.0b013e3181ea9386.

Casabona F1, Priano V, Vallerino V, Cogliandro A, Lavagnino G.

 

Adipose-derived mesenchimal cell transplantation can be considered as a promising strategy for treating LC

 

 
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