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.
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).
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Murphy R (2010) Lichen sclerosus. Dermatol Clin 28:707–715
Clouston D, Hall A, Lawrentschuk N (2011) Penile lichen sclerosus (balanitis xerotica obliterans). BJU Int 108(Suppl 2):14–19
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 24:1031–1034
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 32:105–108
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 145:85–89
Pugliese JM, Morey AF, Peterson AC (2007) Lichen sclerosus: review of the literature and current recommendations for management. J Urol 178:2268–2276
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 182:548–557
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–e43
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 225:757–766
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 38:174–187
Gay LJ, Felding-Habermann B (2011) Contribution of platelets to tumor metastasis. Nat Rev Cancer 11:123–134
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 7:375–390
Lynch MD, Bashir S (2016) Applications of platelet-rich plasma in dermatology: A critical appraisal of the literature. J Dermatolog Treat 27:285–290
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 371:1675–1684
Finlay AY, Khan GK (1994) Dermatology Life Quality Index (DLQI)—A simple practical measure for routine clinical use. Clin Exp Dermatol 19:210–216
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
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 13–19
World Medical Association Declaration of Helsinki (1964) Ethical Principles for Medical Research Involving Human Subjects. Adopted by the 18th WMA General Assembly, Helsinki, Finland
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 26:730–737
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
Neill SM, Lewis FM, Tatnall FM, Cox NH (2010) British Association of Dermatologists’ guidelines for the management of lichen sclerosus 2010. Br J Dermatol 163:672–682
Fistarol SK, Itin PH (2013) Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol 14:27–47
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 31:279–284
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
Cattaneo A, De Magnis A, Botti E, Sonni L, Carli P (2003) Topical mometasone furoate for vulvar lichen sclerosus. J Reprod Med 48:444–448
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 41:739–754
Laino L, Suetti S, Sperduti I (2013) Polydeoxyribonucleotide dermal infiltration in male genital lichen sclerosus: adjuvant effects during topical therapy. Dermatol Res Pract 2013:654079
Marx RE (2004) Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 62:489–496
Piertzak WS, Eppley BL (2005) Plateletrich plasma: biology and new technology. J Craniofac Surg 16:1043–1054
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 1:64–73
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 24:889–893
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 11:459–463
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 21:287–293
Kleintjes WG (2010) Treatment of basal cell carcinoma with autogenous growth factors and adipose-derived stem cells. Plast Reconstr Surg 126:312e–313e
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 169:690–694
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 4:1317–1323
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)
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 63:3344–3353
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 23:953–955
Bolanča Ž, Goren A, Getaldić-Švarc B, Vučić M, Šitum M (2016) Platelet-rich plasma as a novel treatment for lichen planopilaris. Dermatol Ther 29:233–235
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 40:864–873
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 28:258–263
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 76:505–513
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 26:910–913
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 16:356–364
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 16:2822–2827
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
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
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 10:34–39
Kirtschig G (2016) Lichen sclerosus-presentation, diagnosis and management. Dtsch Arztebl Int 113:337–343
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
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 75:62–66
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):2113–2116
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 139:471–475
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
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–211e
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:S307
Conflict of interest
All the authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study received authorization for publication by the Regional Ethics Committee (358REG2016).
Specific informed consent was obtained from all patients included in the study.
About this article
Cite this article
Casabona, F., Gambelli, I., Casabona, F. et al. Autologous platelet-rich plasma (PRP) in chronic penile lichen sclerosus: the impact on tissue repair and patient quality of life. Int Urol Nephrol 49, 573–580 (2017). https://doi.org/10.1007/s11255-017-1523-0
- Platelet-rich plasma
- Lichen sclerosus
- Male genitalia
- Penile disease
- Tissue repair
- Quality of life