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Lichen Sclerosus Treatment

Lichen Sclerosus (LS) is a benign, but chronic skin condition characterized by white patches that usually causes itching, burning or pain. Both males and females can get this skin condition. It is commonly found on the genitals, and will usually occur before puberty, after menopause, or after the ovaries have been removed. The cause for LS is unknown, but there have been links proposed including genetics, environment, autoimmune and hormonal.

In woman, LS can lead to thinning and shrinkage of the genital area that can make intercourse, urination, and defecation painful. LS is a progressive and chronic disease for many patients. The discomfort and pain of lichen sclerosus cause distress and issues with self-esteem and sex. There is no definitive cure for LS.

Previous treatment options were limited to steroids. Topically applied corticosteroids to the LS-affected skin may improve or suppress symptoms for some time, which highly varies across patients, until it is required to use them again. We see patients whom previous therapies have failed.

Recent studies indicate that the injection of platelet-rich plasma (PRP) used along with fat transfer may be an effective therapy in the management of lichen sclerosus. Fox Valley Plastic Surgery, always embracing medical advances, is offers this exciting new treatment option for LS patients. This unique treatment has dramatically improved the quality of life for our LS patients. The first patient treated in this office with this therapy, was able to resume relations with her husband after seven years of abstinence.

Our recommendation for the treatment of lichen sclerosus is:

• Discontinue the use of corticosteroids. The topically applied corticosteroids alleviate the short term issues of itching and burning, but causes long term conditions such as thinned skin and atrophy. Long term use of steroid cream causes skin atrophy. Although they help especially with itching, we favor treating the cause, not the effect.
• Check hormone levels to alleviate symptoms. Balancing hormone levels may help those patients who are not contraindicated for estrogen. Previous cancer patients may not be able to take estrogen. Some patients benefit from topically applied testosterone.
• Injecting fat to the affected area may cause regeneration because fat has some stem cells. Adding the fat may improve the quality and character of the skin.
• Adding platelet rich plasma (PRP) helps the injected fat work better and faster because of the growth cells in PRP. The increased concentration of growth factors in PRP can potentially speed up the healing process. PRP is widely used the treatment of injuries.
• Profractional™ laser peels peels to the opening of the vagina may thicken the dermis and improve skin quality. Facial Profractional laser treatments have proven to be effective in stimulating collagen remodeling, and increasing skin elasticity and thickness. Studies are currently being conducted on the effectiveness of laser treatments for lichen sclerosus. There may be a role for radiofrequency skin tightening to thicken the skin.

You can feel at ease talking with us about this most private topic. For women with lichen sclerosus, it is important to choose a skilled practitioner and discrete medical facility that provides the privacy you desire. Find out more by contacting Fox Valley Plastic Surgery at (920) 233-1540 to request a consultation. The non-refundable $100 cosmetic consultation fee can be applied towards the cost of the procedure.

Pricing

LS treatment with fat transfer and PRP costs $6400 as an in office procedure. Treatment with just medical PRP and no fat grafting costs $5150 in the office. Most patients need fat grafting. To alleviate any anxiety and pain in the office, Pro-Nox is used. Patients with severe LS will need to have the procedure performed in the operating room because the pain will not be tolerable. Pricing is $6321.50 (no fat grafting) and $7571.50 (with fat grafting) at the ThedaCare Surgery Center, a hospital outpatient department. We are not affiliated with the ThedaCare Surgery Center, but TCSC has been cleared to have this treatment performed at its facility. Because the treatment can be customized for each patient, pricing for Profractional laser or ThermiVa radiofrequency procedures are determined at a personal consultation.

This is not an insurance covered procedure. Although studies have been very positive with this method of treatment for lichen sclerosus and stress urinary incontinence, the procedures are still considered experimental. Please call your insurance provider if you feel that your insurance may cover this treatment.

“I feel like I have a different life than before. I can go for a walk, and it doesn’t hurt me. It would hurt when I went the bathroom. … You can’t wipe yourself without it hurting and bleeding. … None of that anymore. So I’m very happy. It saved me. I would say 90% better. … People are going to be afraid to spend the money, but I think that it was worth it. It is better than anything I could have bought myself. It is the best present for me, because it doesn’t hurt anymore. The pain is gone.”

Post 3 months, patient 39743, age 54, suffered from LS for 7 years before this treatment.

What is PRP?

Platelet-rich plasma (PRP) is a platelet concentrate that helps to speed up tissue healing without serious side effects in a very wide range of medical conditions such as diabetic foot ulcers, muscle or tendon injury, and in a variety of cosmetic procedures.

The PRP works because of its high level of proteins that helps with wound healing. It is also apparent from the majority of published studies that PRP therapy has minimal risk of scar tissue formation or significant bad side effects.

Blood platelets clot blood, and contain hundreds of proteins called growth factors which are very important in the healing of injuries. The concentration of platelets in PRP and, thereby, the concentration of growth factors, can be 5 to 10 times richer in PRP than in blood. These growth factors are used to rejuvenate the vulva, labia, and surrounding tissue.

What is Fat Transfer?

A fat transfer procedure, also known as fat grafting or fat injection, transfers fat from areas in which there is excess and healthy fat, and injects it into the labia or vulva where the tissue has thinned or atrophied. During the procedure fat is harvested from one part of the body, washed and concentrated, and then carefully re-injected with specially designed needles into the desired location. This safe, long-lasting, well-tolerated procedure produces natural-looking results, and can improve the health of the tissue. There is evidence that the fat cells are admixed with stem cells, and the improvement in skin quality is attributed to these cells.

Procedure

The procedure takes up to 2.5 hours. The anesthesia is local, so patients can drive themselves to and from the appointment. However, if a patient desires, we can offer an oral sedative, but the patient would need a driver.

To develop a PRP preparation, blood must first be drawn from the patient. The platelets are separated from other blood cells, and their concentration is increased during a process called centrifugation. The spinning of the blood takes 20-30 minutes, so there is a wait period before it is re-injected. Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.

While the blood is spinning, the fat is harvested from the body, usually the abdomen. The fat is then combined with the PRP, and then injected into the desired location. The O Shot can also be added at this time to alleviate mild stress incontinence.

Risks

The risks associated with PRP and lipostructure are minimal because the procedure uses the patient’s own cells and tissue to treat the lichen sclerosus.

There may be increased pain at the injection site, and there will be a small incision from the liposuction site. Sometimes depending on the location of fat deposits on your body, the incisions cannot be hidden.

The use of autologous fat (from your own body), as opposed to dermal fillers, reduces the chance of allergic reactions to foreign substances.

Recovery

There is no recovery period for this procedure. Patients can go back to work immediately. There should be no heavy lifting or intercourse for two days to let the fat transfer site heal.

Make an appointment with one of our professionals to discuss your concerns, and to devise a comprehensive and personalized treatment plan. This medical advance may be just what you need to get back the life you had before lichen sclerosus. Request your consultation today.