Objectives: A description of a complicated clinical case involving a patient sufferig from lichen sclerosus, whose symtoms persist despite standard treatment, accompanied by adhesions, managed using an innovative regenerative technique
Introduction: Lichen Sclerosus is a chronic inflammatory mucocutaneous disease that primarily affects the anogenital areas. In women, it may be associated with decreased estrogen levels, genetic predisposition, autoimmune diseases , and chronic trauma.
The lesions can present as flat, ivory-colored plaques with a waxy texture, thin and hyperkeratotic skin, erythema, Koebner phenomenon, ecchymosis, excoriation, and fissures. Other clinical manifestations may include genital dryness, pruritus, edema in the periclitoral area, and dysuria. It commonly involves the clitoris, labia minora, labia majora, perineum.
Materials / method: A 69-year-old female patient, she began medical consultations in 2020, reporting vulvar pruritus, with evidence of atrophy but no lesions. In 2021 with evidence of vulvar synechia. In 2022, lichenification of the posterior fourchette and perianal area, with an ulceration at the 6 o’clock position. She was treated with topical estrogens, vulvar moisturizers, prasterone, and oils.In April 2024,Marked atrophy was observed, predominantly in the anterior vulva, with no visible clitoris and an inability to explore the vagina due to severe stenosis.
Results: Treatment with PRP (Platelet-Rich Plasma) combined with hyaluronic acid was scheduled, and the patient signed informed consent. Serologies were negative, and two sessions were conducted at three-week intervals using a multi-puncture technique and debridement with a needle of the synechiae at the anterior raphe and clitoris. She was scheduled for a follow-up after 15 days, reporting significant symptom improvement and evidence of reduced atrophy, visualization of the clitoris, and significant reduction of introital stenosis, allowing for speculum insertion and Pap smear collection
Conclusion: ● Lichen Sclerosus is a multifactorial autoimmune disease.
● Lichen Sclerosus typically affects the “8” area: clitoris, inner labia, perineum.
● There is a risk of malignancy, necessitating regular follow-ups.
● Standardized treatments include topical estrogens (for atrophy), corticosteroids, moisturizers, and lubricants. Emerging therapies are considered complementary.
● PRP involves growth factors that promote tissue remodeling.
● New therapies include fat grafting, exosomes, and laser treatments.
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