背景:外阴硬化性苔藓(VLS)的一线治疗是3个月的局部皮质类固醇治疗。然而,对于一线治疗无反应的患者,使用脂肪移植和富血小板血浆作为二线治疗的证据有限.
方法:这项前瞻性单中心随机先导试验包括20例临床和组织学诊断为中度至重度VLS的患者。治疗组(TG)的患者接受了两次浸润(间隔3个月)的纳米脂肪和富血小板血浆(PRP)混合到外阴区,而对照组(CG)接受标准的局部皮质类固醇治疗。从大腿内侧或下腹部抽吸脂肪。离心后获得微脂肪并乳化以获得纳米脂肪悬浮液。通过测量外阴皮肤弹性的变化来确定治疗效果,组织病理学,和临床症状,症状,和患者1年后的生活质量。
结果:最终评估了19例患者(9TG和10CG)。在研究结束时(1年),外阴皮肤弹性没有明显改善。然而,TG患者的症状显着改善(瘙痒,疼痛,燃烧,和性交困难)和临床体征(宫颈糜烂,裂缝,狭窄,和白斑病)。皮肤活检分析显示,TG中所有炎症细胞类型均显着减少。没有记录到与自体治疗相关的不良事件。
结论:与外用皮质类固醇相比,间隔3个月进行的两次浸润减少了外阴的炎症,并改善了与VLS相关的大多数临床体征和症状。尽管如此,自体治疗没有改善外阴皮肤弹性。
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The first-line treatment for vulvar lichen sclerosus (VLS) is 3 months of topical corticosteroid therapy. However, limited evidence is available concerning the use of fat grafting and platelet-rich plasma as a second-line treatment for patients who do not respond to first-line treatment.
This prospective single-center randomized pilot
trial included 20 patients with a clinical and histological diagnosis of moderate to severe VLS. The patients in the treatment group (TG) received two infiltrations (at 3-month intervals) of nanofat mixed with platelet-rich plasma (PRP) into the vulvar area, while the control group (CG) received standard topical corticosteroid therapy. Fat was aspirated from the medial thigh or lower abdomen regions. Microfat was obtained after centrifugation and was emulsified to obtain a nanofat suspension. Treatment efficacy was determined by measuring changes in the vulvar skin elasticity, histopathology, and clinical signs, symptoms, and patient quality of life at after 1 year.
A total of 19 patients were finally assessed (9 TG and 10 CG). At the end of the
study (1 year), there had been no significant improvement in vulvar skin elasticity. However, patients in the TG showed a significant improvement in their symptoms (itching, pain, burning, and dyspareunia) and clinical signs (cervical erosions, fissures, stenosis, and leukoderma). Analysis of skin biopsies revealed a significant decrease in all inflammatory cell types in the TG. No adverse events related to the autologous treatment were recorded.
Compared with topical corticosteroids, two infiltrations delivered 3 months apart decreased the inflammation of the vulva and improved most of the clinical signs and symptoms associated with VLS. Nonetheless, no improvement in vulvar skin elasticity was derived from the autologous treatment.
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