Experience in the combined use of autologous platelet-rich plasma and CO2 laser in the treatment of vulvar lichen sclerosus atrophicus

Background. Lichen sclerosus atrophicus (LSA) is a chronic recurrent inflammatory dermatosis of unknown etiology, mainly occurring in women before menarche and after menopause. Today, much in the pathogenesis and treatment of drugs remains uncertain, which necessitates the search for new effective ways to treat this pathology. Objective. Evaluation of the effectiveness of the combined treatment of vulvar lichen sclerosus atrophicus (VLSA) by administering autologous platelet-rich plasma with and CO2 fractional laser radiation in a small group of patients diagnosed with VLS as an alternative to long-term use of topical glucocorticosteroids (GCS). Methods. The observed group consisted of 12 women aged 25 to 66 years with a histologically verified diagnosis of VLSA. Using the assessment of the lesion area by the LSS index, the patients were distributed as follows: 1 woman with an area estimated at 9 points, 3 women had 8 points, 6 patients -7 points, and 2 women had 5 points. The activity of skin manifestations was assesed using the LSA index before treatment and 3 months after the end of treatment. Assessment of quality of life was carried out using the Dermatological Life Quality Index (DLQI) and in 9 women it corresponded to an interval of 11-20 points, and in 3 women - 21-30 points. The treatment consisted of injection of autologous platelet-rich plasma into the VLSA foci for the course of 4 procedures, alternating with CO2 laser fractional exposure - for the course of 3 procedures. Results. The treatment showed a positive trend reflected in the DLQI, as well as in the assessment using lichen sclerosus atrophicus indices, which demonstrated a decrease in the lesion area and the severity of clinical manifestations: in 1 woman who had an LS-A score of 19 points before the treatment, the dynamics was up to 7 points after treatment; 3 women - before treatment 20, after treatment - 6 points, 6 patients - 18 before treatment and 8 points after treatment, and 2 women - 17 before treatment and 7points after treatment. Conclusion. The combined use of autologous platelet-rich plasma with and CO2 fractional laser exposure has demonstrated good efficiency, allowed patients to refuse the use of topical corticosteroids, and also improved indicators of quality of life. Further research in order to assess the long-term effect of the therapy is reasonable.

lichen sclerosus atrophicus, lichen sclerosus atrophicus index, autologous plasma, fractional CO2 laser