What is Lichen Sclerosus?

It’s an inflammatory condition affecting, most often, women’s privates, but can occur in the genital and anal area of both men, women, and kids. It’s often precipitated by hormone changes such as perimenopause and menopause. Many women don’t realize they have it and many doctors don’t recognize it.

Often women present with itching, and they think they have a yeast infection. If left untreated, it can lead to scarring, loss of the normal anatomy, pain with intercourse and risk of cancer. Most doctors treat Lichen Sclerosis with Clobetasol, a very strong steroid that generally needs to be used for life. Even with treatment some women have persistent symptoms.

The O-Shot can help. The O-Shot is PRP injected into the private area.

At VitalityMD, we have perfected a technique which is a variation of the O-Shot to address Lichen Sclerosus.

Why does PRP help with Lichen Sclerosus?
– Downregulates the immune system
– remodels scar tissue
– promotes wound healing

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Lichen Sclerosus can cause (especially in severe cases):

  • Phimosis (scarring) of the clitoral hood to the clitoris with decreased sensation and anorgasmia (inability to orgasm)
  • decreased blood flow to the area
  • fissures (cuts in the skin)
  • itching to the point of torment
  • bleeding & pain with walking, or even wearing tight jeans or clothes
  • pain, bleeding, & tearing with sex (called dyspareunia)
  • because of the above, often women can’t tolerate any penetration even when aroused, (so sad)
  • secondary loss of libido when sex becomes associated with pain,
  • loss of the labia, narrowing of the vaginal opening and vaginal atrophy
  • pain with urination, recurrent bladder infections
  • secondarily cause depression and low self esteem
  • 10% chance of squamous cell carcinoma

Don’t be SCARED! Be PROACTIVE! Go to an expert and get checked out. Clobetasol is the standard of care but there is a better way to heal the tissues instead of just controlling symptoms. Consider the Modified O-Shot.

Why the O-shot/PRP may work:

PRP Down-Regulates the Autoimmune Response

In thinking about the use of PRP for use in Lichen Sclerosus, consider other autoimmune conditions in which PRP has been shown to down-regulate the disease process.

Vitiligo treatment usually involves steroids or melanocyte transplantation, both of which can lead to unsatisfactory results.  Studies showed a dramatic improvement with PRP.

Alopecia Areata (usually treated with steroids) responded better to PRP than to steroids in more than one study. More, and darker hair follicles appeared when using PRP compared with steroids.

In Rheumatoid Arthritis (also an autoimmune process), studies demonstrated that PRP did all the following:  alleviated arthritis and reduced humoral and cellular immune responses, leading to beneficial effects on histological parameters as observed using joint tissue histological staining. CIA mice treated with PRP exhibited beneficial effects, including decreased joint inflammation, cartilage destruction and bone damage, and increased repair (Tong2017).

Even experimental autoimmune encephalitis and Bell’s Palsy (both autoimmune in etiology) have shown benefits from PRP.

PRP Remodels Scar Tissue into Healthier Tissue and May Prevent Cancer

With the recurrent cracking, bleeding, and sclerotic changes that plague women with Lichen Sclerosus (LS), even if the LS is magically turned off, there is still a need to remodel the scarring from the previous activity of the disease.

PRP has been used to treat acne scars, postpartum striae, cleft-palate-repair scars, and even the scars left from breast cancer surgeries without increase in recurrence.

Even in women who use clobetasol religiously, women still face a 10% risk of squamous cell carcinoma. Little is known about the effects of chronic use of clobetasol on the recurrence or occurrence of other problems like HPV (since chronic steroids could affect the local immune system). The fear that PRP itself may propagate neoplasia should be addressed and has been as of yet, thousands of studies have indicated that neoplasia is not a risk when PRP is used. A growing number of studies indicate (but do not conclusively prove) that PRP may decrease the risk of neoplasia.

PRP Promotes Wound Healing

Does the woman immediately feel well if you instantly turn off the disease activity?

No. Turning off the immune and disease process is a must, but we also must heal fissures, replace sclerotic tissue with healthy tissue, and regrow blood vessels into the damaged tissue for resolution of symptoms.

Unfortunately, cortisone (used by most women to treat Lichen Sclerosus) delays wound healing. In comparison, PRP, when used, shuts off the overactive autoimmune process and therefore shuts off Lichen Sclerosus and promotes, rather than delays wound healing, thereby providing a remarkable synergistic effect.

With Lichen Sclerosus, we not only face an active autoimmune process that creates sclerosis and blood vessel destruction, but we also face the secondary wounds of fissures and excoriations. So, using PRP to help heal these wounds could be of great benefit.

PRP Helps Some Women with Lichen Sclerosus (both with and without phimosis)

When Dr. Runels first met Dr. Andrew Goldstein, he was lecturing to the International Society for Women’s Sexual Health. They decided to do a study together on PRP for LS.  At that time, Dr. Casabona had published an article demonstrating that stem cells would improve Lichen Sclerosus, but no one had published anything regarding PRP for LS.

Some months later, they published a study where women suffering from LS were biopsied, treated with PRP, and then surveyed for changes in symptoms and re-biopsied. Two dermatopathologists with much experience with LS were blinded to which was the before and which was the after biopsy. Both the surveys of the women, and the biopsies, demonstrated a statistical improvement in Lichen Sclerosus after treatment with PRP. They then extended the numbers of women in the study and published a second paper—also showing a statistical benefit to PRP for LS. These were the first two studies to show the benefit of LS after treatment with PRP using a variation of our O-Shot® procedure.

I think the research at least demonstrates the idea which has been shown by others that—saline, when used for hydro-dissection, is not a placebo.  Saline can even be used to treat scars and even to decrease pain, especially when saline is injected in such a way that it causes hydro-dissection, there can be measurable changes in the tissue resulting from the resultant micro trauma.  Adding PRP can augment results seen with hydro-dissection. With our O-Shot®, there is not simply a biological effect from the growth factors; there is also a mechanical effect—essentially a surgical effect—from the mechanical hydro-dissection of injecting the PRP.

Other studies have since been published showing that PRP can improve Lichen Sclerosus.

FemiLift has also been used to treat Lichen Sclerosus in many of our patients. Read more about the FemiLift HERE: https://vitalitymd.com/femilift-toronto/ )

Summary

  • PRP, when injected in some women suffering from lichen sclerosus, provides a dramatic down-regulation of their disease.

  • There is, of yet, no sure-fire “cure” for lichen sclerosus. Not everyone responds to PRP and those who do usually require repeated treatments every nine to eighteen months. Also, not everyone finds complete relief from clobetasol. It does appear that some who do not find relief from clobetasol do find relief from PRP and vice versa.

  • Those who do not respond to PRP should be put back on clobetasol. Those who find complete relief from clobetasol may not need PRP.