Vulvar lichen sclerosus: A new regenerative approach through fat grafting

• Published in: Gynecologic oncology Vol. 139; no. 3; pp. 471 - 475
• Main Authors: Boero, Veronica, Brambilla, Massimiliano, Sipio, Elisa, Liverani, Carlo A, Di Martino, Mirella, Agnoli, Benedetta, Libutti, Giada, Cribiù, F.M, Del Gobbo, Alessandro, Ragni, Enrico, Bolis, Giorgio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2015
• Subjects: Adipose Tissue - transplantation; Adult; Aged; Aged, 80 and over; Clitoris - physiology; Elasticity - physiology; Fat grafting; Female; Hematology, Oncology and Palliative Medicine; Humans; Lichen sclerosus; Middle Aged; Mucous Membrane - pathology; Mucous Membrane - physiology; Obstetrics and Gynecology; Quality of Life; Regeneration; Sexuality; Skin - pathology; Skin Physiological Phenomena; Stem cells; Vulva; Vulva - physiology; Vulvar Lichen Sclerosus - pathology; Vulvar Lichen Sclerosus - physiopathology; Vulvar Lichen Sclerosus - surgery; Lichen sclerosus; Vulva; Fat grafting; Stem cells
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2015.10.014

Abstract Objective The aim of this study was to evaluate the efficacy of fat grafting in the treatment of severe vulvar lichen sclerosus (LS). Our primary outcome was to assess the improvement of mucocutaneous trophism, the resolution/reduction of symptoms, and the histological features of the vulvar skin after treatment. The secondary outcome was to evaluate the improvement in life quality, and in resumption and quality of sexual life. Methods Between 2011 and 2014, 36 patients were offered fat grafting to treat LS. Inclusion criteria were age between 25 and 80 years, histopathologic diagnosis of LS, good health, failure of previous first line treatments. Results 34 out of 36 patients (94%) showed a better vulvar trophism of the skin and mucosae; 27 (75%) had an improvement in caliber and elasticity of the vaginal introitus; clitoris burying degree was reduced in 18 patients (50%), 30 (83%) reported an increased volume of labia majora and minora, 34 (94%) had a complete disappearance of scratching lesions, and 28 (78%) showed a remission of white lesions. Eventually 34 patients (95%) stopped using topical corticosteroids routinely. The improvement in life quality was significant for both DLQI (p < 0001) and FSFI (p < 0001). Conclusions Fat grafting may have a role as a support and completion treatment in selected cases of women with vulvar LS who do not respond to first line therapy or in severe cases where the anatomical impairment does not allow a regular sexual function and a good quality of life.