Platelet‐rich plasma for male genital lichen sclerosus resistant to conventional therapy: First prospective study

Abstract

Ultrapotent topical corticosteroids and circumcision are usually effective for male genital lichen sclerosus (MGLSc); however, refractory cases are often referred to our Male Genital Dermatology Unit. Treatment with autologous platelet-rich plasma (TPRP) has recently been advocated as a safe and effective treatment option, but there have been no prospective studies in men to date. The objective of this study is to assess the safety and efficacy of TPRP for MGLSc resistant to conventional therapy. A prospective, open-label, single-arm, therapeutic study was carried out in this study. Inclusion criteria: resistant to conventional therapy for at least 6 months. Procedure: infiltration of 0.1 mL/cm 2 PRP every 8 weeks. Monthly data recording: visual appearance with photographs and external scoring by an expert using Investigator's Global Assessment Scale (IGA scale 0-5), symptoms (scale 0-5), quality of life (QoL; Dermatology Life Quality Index [DLQI]), and complications. No. of patients included was n = 5. No. of patients excluded during treatment was n = 1. Mean initial IGA: 3.6. Mean initial DLQI: 6. TPRP n = 34 (range: 2-9; average: 6.8 per patient). Mean IGA at 18 months: 3.25. Mean DLQI at 18 months: 1.25. All patients reported being completely asymptomatic at 10 months. No. of patients with complications is n = 1 (balanitis). TPRP seems to be safe and effective, regarding symptom control and improvement in QoL; however, visual changes were minimal. K E Y W O R D S balanitis xerotica obliterans, lichen sclerosus et atrophicus, platelet-rich plasma 1 | INTRODUCTION Male genital lichen sclerosus (MGLSc) is an acquired, chronic, inflammatory dermatosis. It affects the glans and the inner prepuce, with hypopigmented plaques, erythema, infiltration, lichenification, and deformity (phimosis, balanoprepucial adhesions, meatal stenosis, and naviculomeatal valve insufficiency). The main symptom is male dyspareunia, with a significant impact on quality of life (QoL). 1,2 There have been no randomized controlled trials in MGLSc. Ultrapotent corticosteroids are the first line of treatment, achieving about 50% healing; however, their efficacy in reversing scarring sequelae is limited. 1-4 Retrospective studies suggest that circumcision can be curative in 90%-100% of cases, and should be offered before intralesional or systemic therapy is considered. 1-5 The Investigator's Global Assessment (IGA) scale has been used to assess physical signs in LSc studies, and to assess response to treatment with platelet-rich plasma (TPRP). 6,7 TPRP for MGLSc has been advocated to be a safe and effective option; however, no prospective studies have yet been done in men. 7,8 The putative mechanism is promoting healthy tissue formation by releasing growth factors; an analgesic role has also been postulated. 9-12

Conservative Management of Penile and Urethral Lichen Sclerosus: A Systematic Review

“…Autologous PRP injection for treatment of penile LS was assessed in 2 cohort studies 28,29 and 1 prospective open-arm study (Supplementary Appendix 5, https://www.jurology.com). 30 All patients were males with histologically proven LS and proven failure of previous treatment, most commonly ultrapotent steroids. Outcomes were assessed using the DLQI and the IGA scale.…”

“…Navarrete et al conducted a similar prospective single-arm cohort study assessing PRP treatments in 4 patients with penile LS who failed to achieve complete response with at least 6 months of ultrapotent corticosteroids or circumcision. 30 Patients received autologous PRP treatment with follow-up every 6 months until a mean of 18 months. DLQI scores were found to be decreased between baseline and at time of final follow-up (6.25AE4.48 to 1.25AE2.45), although statistical significance was not reported.…”