Autologous lipoaspirate as a new treatment of vulvar lichen sclerosus: A review on literature

Abstract

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that mostly affects the genital and anal skin areas. LS can be asymptomatic or accompanied by symptoms, for example progressive pruritis, pain, sexual dysfunction and thus, a reduced quality of life (QoL). 1,2 LS occurs at all ages and in both sexes, whereby the male-to-female ratio ranges between 1:3 and 1:10. The exact prevalence is unclear; however, vulvar LS has been found to affect one in 70 women presenting to a general gynaecology practice. 1 The incidence of histologically proven LS in women was 14.6 per 100.000 woman-years in 2011 in the Netherlands. Noticeably, approximately 5% of all women affected by LS will develop vulvar squamous cell carcinoma, for which both LS and differentiated vulvar intraepithelial neoplasia (dVIN) are additional risk factors. 3,4 Although the aetiology of LS is still unknown, it is hypothesized to be an autoimmune disorder with a genetic component. 3 Currently, treatment of LS is mainly initiated to relieve symptoms of pruritis and pain, to reduce the progression of the skin alterations and eventually decrease the risk of cancer. Conventional treatment of LS consists of local application of corticosteroids, for example clobetasol propionate. 5 In severe cases of therapy-resistant LS, immunosuppressive agents (e.g. calcineurin inhibitors) can be administered, which inhibit T-cell activation. [6][7][8] However, clinical evidence

A retrospective comparative cohort study of ultra-pulse CO2 lattice laser and glucocorticoids in the treatment of vulvar epithelial nonneoplastic lesions

“…The findings revealed a remarkable improvement in the itching of the vulva and pain during intercourse without adverse effects ( 8 , 9 ). This may be related to the thermal response of the laser inducing tissue edema and the release of HSP70 and transforming growth factor beta (TGF) ( 10 ), which in turn improves skin circulation and nutrition in the localized nonneoplastic lesions of the vulvar epithelium and repairs damaged tissue from local scratching ( 1 ). In our study, the efficacy of CO 2 lattice laser and glucocorticoids was more than 50% at 1, 3, and 6 months of treatment.…”

Fat Grafting in Vulvar Lichen Sclerosus: Long Term Follow-Up

“…27 The benefit of autologous regenerative treatments in VLS has been reported in an increasing number of recent studies, although the evidence is still limited due to exiguous study populations, heterogeneous treatment types, and short follow-up periods. 8,[13][14][15][16][17][18][19][20][21][22]28,29 In 2015, Boero et al treated 36 women with VLS with fat grafting. Among these, 75% reported improved caliber and elasticity of the vaginal introitus, 83% reported an increased volume of labia majora and minora, and 94% no longer presented scratching lesions.…”

“…6 Up until recent years, surgical treatment for VLS has been limited to cases of severe vaginal introitus stenosis, urinary retention, and preneoplastic and neoplastic lesions. 7,8 However, surgery could gain a new role as a regenerative treatment.…”

“…11 The rationale of fat grafting in VLS consists of four main mechanisms: reduction of inflammation, regeneration of tissues through an angiogenetic and antifibrotic action, volume increase by the means of a "cushion effect," which improves both vulvar morphology and dyspareunia, and pain fiber control. 8,12 However, few studies, which are mainly based on a shortterm follow-up, have reported the use of fat grafting for the treatment of VLS-alone [13][14][15][16][17][18] or in combination with platelet-rich plasma (PRP). [19][20][21] On the basis of this background, the aim of our study was to evaluate the long-term efficacy of fat grafting in VLS on a large cohort of patients.…”

“…The rationale of fat grafting in VLS consists of four main mechanisms: reduction of inflammation, regeneration of tissues through an angiogenetic and antifibrotic action, volume increase by the means of a “cushion effect,” which improves both vulvar morphology and dyspareunia, and pain fiber control 8,12 …”