International Urology and Nephrology

, Volume 49, Issue 4, pp 573–580

Autologous platelet-rich plasma (PRP) in chronic penile lichen sclerosus: the impact on tissue repair and patient quality of life

  • Francesco Casabona
  • Ilaria Gambelli
  • Federica Casabona
  • Pierluigi Santi
  • Gregorio Santori
  • Ilaria Baldelli
Urology - Original Paper

Abstract

Purpose

Lichen sclerosus (LS) is a chronic inflammatory skin condition that frequently involves the anogenital region. Ongoing research is focused on finding more effective treatments for tissue repair and reducing symptoms. The aim of this study is to evaluate the effectiveness of platelet-rich plasma (PRP) local injections in penile LS.

Methods

Forty-five male patients affected by penile LS underwent injections of autologous PRP in the affected skin areas. Age at diagnosis and at first treatment, number of treatments, clinical conditions (phimosis, splitting, inflammation, synechiae, meatus stenosis), symptoms (pain, burning, itching), and functional impairment were considered. Treatment efficacy was also evaluated through the Investigator’s Global Assessment (IGA) on a six-point Likert scale and the Dermatology Life Quality Index (DLQI).

Results

The patient age at LS diagnosis was 36.20 ± 9.19 years, while the mean age at the first PRP treatment was 42.96 ± 11.32 years (p < 0.001). The number of treatments/patient ranged from 2 to 10. The follow-up was 17.60 ± 5.63 months. After PRP injections, it was observed in all patients a significant improvement in clinical conditions, with reduction/disappearance of symptoms. Topical steroid therapy, interrupted before PRP treatment, was not restarted by any patient. Only one patient underwent a later circumcision procedure. Both IGA scale and DLQI score showed a significant difference (p < 0.001) before and after PRP treatment.

Conclusions

PRP treatment in penile LS seems to be helpful to regenerate scarring, reduce symptoms, and improve patient quality of life. Further studies are necessary to evaluate long-term results.

Keywords

PRP Platelet-rich plasma Lichen sclerosus Male genitalia Penile disease Tissue repair Quality of life 

References

  1. 1.
    Murphy R (2010) Lichen sclerosus. Dermatol Clin 28:707–715CrossRefPubMedGoogle Scholar
  2. 2.
    Clouston D, Hall A, Lawrentschuk N (2011) Penile lichen sclerosus (balanitis xerotica obliterans). BJU Int 108(Suppl 2):14–19CrossRefPubMedGoogle Scholar
  3. 3.
    Sherman V, McPherson T, Baldo M, Salim A, Gao XH, Wojnarowska F (2010) The high rate of familial lichen sclerosus suggests a genetic contribution: an observational cohort study. J Eur Acad Dermatol Venereol 24:1031–1034PubMedGoogle Scholar
  4. 4.
    Hofer MD, Meeks JJ, Mehdiratta N, Granieri MA, Cashy J, Gonzalez CM (2014) Lichen sclerosus in men is associated with elevated body mass index, diabetes mellitus, coronary artery disease and smoking. World J Urol 32:105–108CrossRefPubMedGoogle Scholar
  5. 5.
    Powell J, Robson A, Cranston D, Wojnarowska F, Turner R (2001) High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis. Br J Dermatol 145:85–89CrossRefPubMedGoogle Scholar
  6. 6.
    Pugliese JM, Morey AF, Peterson AC (2007) Lichen sclerosus: review of the literature and current recommendations for management. J Urol 178:2268–2276CrossRefPubMedGoogle Scholar
  7. 7.
    Barbagli G, De Angelis M, Romano G, Lazzeri M (2009) Clinical outcome and quality of life assessment in patients treated with perineal urethrostomy for anterior urethral stricture disease. J Urol 182:548–557CrossRefPubMedGoogle Scholar
  8. 8.
    Kirtschig G, Becker K, Günthert A, Jasaitiene D, Cooper S et al (2015) Evidence-based (S3) guideline on (anogenital) lichen sclerosus. J Eur Acad Dermatol Venereol 29:e1–e43CrossRefPubMedGoogle Scholar
  9. 9.
    Bendinelli P, MatteucciE Dogliotti G, Corsi MM, Banfi G, Maroni P, Desiderio MA (2010) Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: mechanisms of NF-κB inhibition via HGF. Cell Physiol 225:757–766CrossRefGoogle Scholar
  10. 10.
    Everts PA, Knape JT, Weibrich G, Schönberger JP, Hoffmann J, Overdevest EP, Box HA, van Zundert A (2006) Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol 38:174–187PubMedPubMedCentralGoogle Scholar
  11. 11.
    Gay LJ, Felding-Habermann B (2011) Contribution of platelets to tumor metastasis. Nat Rev Cancer 11:123–134CrossRefPubMedGoogle Scholar
  12. 12.
    Martinez-Gonzalez JM, Cano-Sanchez J, Gonzalo-Lafuente JC, Campo-Trapero J, Esparza-Gomez G, Seoane J (2002) Do ambulatory-use Platelet-Rich Plasma (PRP) concentrates present risks? Med Oral 7:375–390PubMedGoogle Scholar
  13. 13.
    Lynch MD, Bashir S (2016) Applications of platelet-rich plasma in dermatology: A critical appraisal of the literature. J Dermatolog Treat 27:285–290CrossRefPubMedGoogle Scholar
  14. 14.
    Papp KA, Langley RG, Lebwohl M, Krueger GG, Szapary P et al (2008) Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet 371:1675–1684CrossRefPubMedGoogle Scholar
  15. 15.
    Finlay AY, Khan GK (1994) Dermatology Life Quality Index (DLQI)—A simple practical measure for routine clinical use. Clin Exp Dermatol 19:210–216CrossRefPubMedGoogle Scholar
  16. 16.
    DLQI Instructions for use and scoring. Department of Dermatology of Cardiff University (2016). http://www.cardiff.ac.uk/dermatology/quality-of-life/dermatology-quality-of-life-index-dlqi/dlqi-instructions-for-use-and-scoring. Accessed May 5, 2016
  17. 17.
    Commission Directive 2005/28/EC (2005) Laying down principles and detailed guidelines for good clinical practice as regards investigational medicinal products for human use, as well as the requirements for authorisation of the manufacturing or importation of such products. OJ L 91, 9.4.2005, pp 13–19Google Scholar
  18. 18.
    World Medical Association Declaration of Helsinki (1964) Ethical Principles for Medical Research Involving Human Subjects. Adopted by the 18th WMA General Assembly, Helsinki, FinlandGoogle Scholar
  19. 19.
    Edmonds EV, Hunt S, Hawkins D, Dinneen M, Francis N, Bunker CB (2012) Clinical parameters in male genital lichen sclerosus: a case series of 329 patients. J Eur Acad Dermatol Venereol 26:730–737CrossRefPubMedGoogle Scholar
  20. 20.
    Mangera A, Osman N, Chapple C (2016) Recent advances in understanding urethral lichen sclerosus. F1000 Research, 5, F1000 Faculty Rev–96. doi:10.12688/f1000research.7120.1
  21. 21.
    Neill SM, Lewis FM, Tatnall FM, Cox NH (2010) British Association of Dermatologists’ guidelines for the management of lichen sclerosus 2010. Br J Dermatol 163:672–682CrossRefPubMedGoogle Scholar
  22. 22.
    Fistarol SK, Itin PH (2013) Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol 14:27–47CrossRefPubMedGoogle Scholar
  23. 23.
    Van de Nieuwenhof HP, Meeuwis KA, NieboerTE Vergeer MC, Massuger LF, De Hullu JA (2010) The effect of vulvar lichen sclerosus on quality of life and sexual functioning. J Psychosom Obstet Gynaecol 31:279–284CrossRefPubMedGoogle Scholar
  24. 24.
    Chi CC, Kirtschig G, Baldo M, Brackenbury F, Lewis F, Wojnarowska F (2011) Topical interventions for genital lichen sclerosus. Cochrane Database Syst Rev 7:CD008240. doi:10.1002/14651858.CD008240.pub2 Google Scholar
  25. 25.
    Cattaneo A, De Magnis A, Botti E, Sonni L, Carli P (2003) Topical mometasone furoate for vulvar lichen sclerosus. J Reprod Med 48:444–448PubMedGoogle Scholar
  26. 26.
    Raposio E, Guida C, Coradeghini R, Scanarotti C, Parodi A, Baldelli I, Fiocca R, Santi PL (2008) In vitro polydeoxyribonucleotide effects on human pre-adipocytes. Cell Prolif 41:739–754CrossRefPubMedGoogle Scholar
  27. 27.
    Laino L, Suetti S, Sperduti I (2013) Polydeoxyribonucleotide dermal infiltration in male genital lichen sclerosus: adjuvant effects during topical therapy. Dermatol Res Pract 2013:654079PubMedPubMedCentralGoogle Scholar
  28. 28.
    Marx RE (2004) Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 62:489–496CrossRefPubMedGoogle Scholar
  29. 29.
    Piertzak WS, Eppley BL (2005) Plateletrich plasma: biology and new technology. J Craniofac Surg 16:1043–1054CrossRefGoogle Scholar
  30. 30.
    Du Toit DF, Kleintjes WG, Otto MJ, Mazyala EJ, Page BJ (2007) Soft and hard-tissue augmentation with platelet-rich plasma: tissue culture dynamics, regeneration and molecular biology perspective. Int J Shoulder Surg 1:64–73CrossRefGoogle Scholar
  31. 31.
    Scala M, Gipponi M, Mereu P, Strada P, Corvò R, Muraglia A, Massa M, Bertoglio S, Santi P, Cafiero F (2010) Regeneration of mandibular osteoradionecrosis defect with plateletrich plasma gel. In Vivo 24:889–893PubMedGoogle Scholar
  32. 32.
    Piccin A, Di Pierro AM, Tagnin M, Russo C, Fustos R, Corvetta D, Primerano M, Magri E, Conci V, Gentilini I, Burchia E, Negri G, Mazzoleni G, Gastl G, Fontanella F (2016) Healing of a soft tissue wound of the neck and jaw osteoradionecrosis using platelet gel. Regen Med 11:459–463CrossRefPubMedGoogle Scholar
  33. 33.
    Iervolino V, Di Costanzo G, Azzaro R, Diodato AM, Di Macchia CA, Di Meo T, Petruzziello A, Loquercio G, Muto P, Apice G, Cacciapuoti C (2013) Platelet gel in cutaneous radiation dermatitis. Support Care Cancer 21:287–293CrossRefPubMedGoogle Scholar
  34. 34.
    Kleintjes WG (2010) Treatment of basal cell carcinoma with autogenous growth factors and adipose-derived stem cells. Plast Reconstr Surg 126:312e–313eCrossRefPubMedGoogle Scholar
  35. 35.
    Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, Rinaldi F (2013) A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol 169:690–694CrossRefPubMedGoogle Scholar
  36. 36.
    Gentile P, Garcovich S, Bielli A, Scioli MG, Orlandi A, Cervelli V (2015) The effect of platelet-rich plasma in hair regrowth: a randomized placebo-controlled trial. Stem Cells Transl Med 4:1317–1323CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    El Taieb MA, Ibrahim H, Nada EA, Seif Al-Din M (2016) Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: a trichoscopic evaluation. Dermatol Ther. doi:10.1111/dth.12437 (in press) PubMedGoogle Scholar
  38. 38.
    Lippross S, Moeller B, Haas H, Tohidnezhad M, Steubesand N, Wruck CJ, Kurz B, Seekamp A, Pufe T, Varoga D (2011) Intraarticular injection of platelet-rich plasma reduces inflammation in a pig model of rheumatoid arthritis of the knee joint. Arthritis Rheum 63:3344–3353CrossRefPubMedGoogle Scholar
  39. 39.
    El-Komy MH, Hassan AS, Abdel Raheem HM, Doss SS, EL-Kaliouby M, Saleh NA, Saleh MA (2015) Platelet-rich plasma for resistant oral erosions of pemphigus vulgaris: a pilot study. Wound Repair Regen 23:953–955CrossRefPubMedGoogle Scholar
  40. 40.
    Bolanča Ž, Goren A, Getaldić-Švarc B, Vučić M, Šitum M (2016) Platelet-rich plasma as a novel treatment for lichen planopilaris. Dermatol Ther 29:233–235CrossRefPubMedGoogle Scholar
  41. 41.
    Nofal E, Helmy A, Nofal A, Alakad R, Nasr M (2014) Platelet-rich plasma versus CROSS technique with 100% trichloroacetic acid versus combined skin needling and platelet rich plasma in the treatment of atrophic acne scars: a comparative study. Dermatol Surg 40:864–873PubMedGoogle Scholar
  42. 42.
    Díaz-Ley B, Cuevast J, Alonso-Castro L, Calvo MI, Ríos-Buceta L, Orive G, Anitua E, Jaén P (2015) Benefits of plasma rich in growth factors (PRGF) in skin photodamage: clinical response and histological assessment. Dermatol Ther 28:258–263CrossRefPubMedGoogle Scholar
  43. 43.
    Ríos DL, López C, Carmona JU (2015) Evaluation of the anti-inflammatory effects of two platelet-rich gel supernatants in an in vitro system of cartilage inflammation. Cytokine 76:505–513CrossRefPubMedGoogle Scholar
  44. 44.
    Sánchez M, Anitua E, Azofra J, Aguirre JJ, Andia I (2008) Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol 26:910–913PubMedGoogle Scholar
  45. 45.
    Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A (2013) Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med 16:356–364CrossRefGoogle Scholar
  46. 46.
    Cerza F, Carni S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M (2012) Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med 16:2822–2827CrossRefGoogle Scholar
  47. 47.
    Sánchez M, Fiz N, Azofra J, Usabiaga J, AdurizRecalde E et al (2012) A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy 28:1070–1078. doi:10.1016/j.arthro.2012.05.011 CrossRefPubMedGoogle Scholar
  48. 48.
    Vaquerizo V, Plasencia MA, Arribas I, Seijas R, Padilla S, Orive G, Anitua E (2013) Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy 29:1635–1643. doi:10.1016/j.arthro.2013.07.264 CrossRefPubMedGoogle Scholar
  49. 49.
    Celis S, Reed F, Murphy F, Adams S, Gillick J, Abdelhafeez AH, Lopez PJ (2014) Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series. J PediatrUrol 10:34–39Google Scholar
  50. 50.
    Kirtschig G (2016) Lichen sclerosus-presentation, diagnosis and management. Dtsch Arztebl Int 113:337–343PubMedPubMedCentralGoogle Scholar
  51. 51.
    World Health Organization, Department of Reproductive Health and Research and Joint United Nations Programme on HIV/AIDS (UNAIDS) (2007). Male circumcision: Global trends and determinants of prevalence, safety and acceptability. http://www.who.int/reproductivehealth/publications/rtis/9789241596169/en/. Accessed 8 Dec 2016
  52. 52.
    Masood S, Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK (2005) Penile sensitivity and sexual satisfaction after circumcision: Are we informing men correctly? Urol Int 75:62–66CrossRefPubMedGoogle Scholar
  53. 53.
    Fink KS, Carson CC, DeVellis RF (2002) Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol 167(5):2113–2116CrossRefPubMedGoogle Scholar
  54. 54.
    Boero V, Brambilla M, Sipio E, Liverani CA, Di Martino M et al (2015) Vulvar lichen sclerosus: a new regenerative approach through fat grafting. Gynecol Oncol 139:471–475CrossRefPubMedGoogle Scholar
  55. 55.
    Giuseppina Onesti M, Carella S, Ceccarelli S, Marchese C, Scuderi N (2016) The use of human adipose-derived stem cells in the treatment of physiological and pathological vulvar dystrophies. Stem Cells Int 2016:2561461. doi:10.1155/2016/2561461 CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Casabona F, Priano V, Vallerino V, Cogliandro A, Lavagnino G (2010) New surgical approach to lichen sclerosus of the vulva: the role of adipose-derived mesenchymal cells and platelet-rich plasma in tissue regeneration. Plast Reconstr Surg 126:210e–211eCrossRefPubMedGoogle Scholar
  57. 57.
    Casabona F, Priano V, Piri C, Vallerino V (2012) New regenerative approach to lichen sclerosus of the vulva with adipose derived stem cells and platelet rich plasma. 5 Years experience. Int J Gynaecol Obstet 119:S307CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Department of Regenerative Plastic SurgeryGallino HospitalGenoaItaly
  2. 2.Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
  3. 3.Plastic and Reconstructive Surgery UnitIRCCS San Martino University Hospital–IST GenovaGenoaItaly

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