Behnia-Willison Fariba, Pour Nina Reza, Mohamadi Behrang, Willison Nadia, Rock Madeleine, Holten Ian W, O'Shea Robert, Miller Joseph
FBW Gynaecology Plus, Adelaide, South Australia, Australia; Urogynaecology Clinic, Flinders Medical Centre, Adelaide, South Australia; Department of Obstetrics, Gynaecology and Reproductive Medicine, Flinders University, Adelaide, South Australia, Australia; Northern Sydney Local Health District, Sydney, New South Wales, Australia; Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia; Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia; Australian Skin Face Body, Geelong, Victoria, Australia; and Urogynaecology Clinic, Flinders Medical Centre, Adelaide, South Australia, Australia.
Plast Reconstr Surg Glob Open. 2016 Nov 23;4(11):e1124. doi: 10.1097/GOX.0000000000001124. eCollection 2016 Nov.
Lichen sclerosus (LS) is an inflammatory dermatosis with autoimmune pathogenesis. Although relatively common, its true incidence is unknown and likely underestimated. LS is usually anogenital, but in around 10% of patients, it can present as extragenital lesions. Continuous administration of topical corticosteroids is the mainstay of medical treatment. Other treatments are available but are only occasionally prescribed along with or instead of topical steroids. Injection of platelet-rich plasma (PRP) into affected areas has been reported to result in the regeneration of normal skin. In this study, we aimed to evaluate the safety, symptom resolution, and objective improvement in patients with autoimmune condition like genital LS after treatment with PRP.
Over a 2-year period at FBW Gynaecology Plus, we had a total of 28 patients with confirmed LS on biopsy, unresponsive to topical steroid treatment. After acquiring informed consent, patients' own blood was centrifuged on site and injected under local anesthesia to the external genitalia.
Almost all of our patients showed clinical improvement in the size of their lesions, and in 8 cases, lesions totally disappeared after treatment with PRP. Symptoms disappeared in 15 of the 28 patients after treatment, with no need for further steroid therapy in 23 patients. Thirteen women experienced partial symptom relief.
Based on our limited findings, we hypothesize that PRP presents a potential alternative to topical steroids for treatment of vulvovaginal autoimmune conditions such as LS. A larger pilot and/or randomized controlled trial study is required to evaluate this finding further.
硬化性苔藓(LS)是一种具有自身免疫发病机制的炎症性皮肤病。尽管相对常见,但其真实发病率未知且可能被低估。LS通常发生于肛门生殖器部位,但约10%的患者可表现为生殖器外病变。持续外用糖皮质激素是主要的药物治疗方法。其他治疗方法也有,但仅偶尔与外用类固醇联合使用或替代外用类固醇使用。据报道,向受影响区域注射富血小板血浆(PRP)可使正常皮肤再生。在本研究中,我们旨在评估PRP治疗后,患有生殖器LS等自身免疫性疾病患者的安全性、症状缓解情况和客观改善情况。
在FBW妇科中心的两年时间里,我们共有28例经活检确诊为LS且对外用类固醇治疗无反应的患者。在获得知情同意后,将患者自身的血液在现场离心,并在局部麻醉下注射到外生殖器。
几乎所有患者的病变大小均有临床改善,8例患者经PRP治疗后病变完全消失。28例患者中有15例治疗后症状消失,23例患者无需进一步使用类固醇治疗。13名女性症状部分缓解。
基于我们有限的研究结果,我们推测PRP可能是治疗外阴阴道自身免疫性疾病如LS的外用类固醇的潜在替代方法。需要进行更大规模的试点研究和/或随机对照试验来进一步评估这一发现。