Platelet-rich plasma in the management of genital lichen sclerosus: A review of mechanisms, evidence, and future directions

Abstract

Lichen sclerosus (LS) is a chronic, relapsing, inflammatory skin condition that primarily affects the anogenital region. Treatment with potent topical corticosteroids (TCS) can help control symptoms for many patients, but complications such as atrophy and scarring often persist. Platelet-rich plasma (PRP) has emerged as a regenerative therapy with potential application in LS. We review the clinical evidence and highlight gaps and future research needs. We searched PubMed and Web of Science databases for studies of PRP in LS. The outcomes evaluated included symptom relief, quality of life (QoL), tissue repair, and safety. The evidence regarding PRP monotherapy includes one randomized controlled trial, 11 single-arm studies, one case series, and one case report. Four studies included PRP combined with other regenerative therapies such as adipose-derived stem cells. Most studies reported benefits in symptomatic relief, sexual function, vaginal health, tissue quality, and QoL after PRP therapy. PRP appeared to work effectively alongside other regenerative treatments. The evidence is limited due to small sample sizes, lack of control groups, short follow-up periods, inconsistent objective measures of treatment efficacy, variability in PRP preparation and injection protocols, limited use of objective endpoints, and a lack of standardized outcome measures. The safety profile of PRP appears favorable. In conclusion, PRP can serve as an adjuvant therapy for genital LS in patients who do not respond to TCS treatment or when such treatment is discontinued. More rigorous studies are needed nonetheless. The potential of combining PRP with other regenerative therapies warrants further investigation.