LICHEN
SCLEROSUS

DISEASE AWARENESS PAGE FOR R3 STEM CELL – LICHEN SCLEROSUS

WHAT IS LICHEN SCLEROSUS?

Lichen sclerosus is a not so common skin condition that commonly affects the skin of the genital and perianal regions. This condition can also develop on the skin of the torso, upper arms, breasts or any other parts of the body, although, very less commonly. It is a long-term skin condition characterized by the appearance of small whitish patches that are thinner than normal.

Lichen sclerosus cannot be spread through contact, i.e. not contagious. It is also not a sexually transmitted infection, and so, cannot be spread through sexual intercourse.

The actual causes of lichen sclerosus are rather still unknown as the understanding of the condition is incomplete. However, research is ongoing to accurately pinpoint the cause(s), and to find a lasting solution, as there is currently no cure for it. At the moment, doctors think it may be genetic, hormonal, due to infection or a combination of those things.

Another theory suggests that it may be an autoimmune disease. An auto-immune disorder occurs when your immune system labels your normal body tissues as foreign and begins to attack them, in defense.

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HOW PREVALENT IS LICHEN SCLEROSUS, AND WHO IS AT RISK?

The disease is prevalent among women who are past menopausal age – between 40 and 60 years of age. The number of women with the condition is not statistically clear, but researchers think the number could be anywhere between 1 in 300 to 1 in 1000 women, in the United States. Women are six times more likely to develop the condition than men. Lichen sclerosus least affects children, but when it does, it is usually in girls who are yet to reach puberty.

The following factors may increase one’s risk of developing lichen sclerosus:

Age: For women, the risk of developing lichen sclerosus increases after menopausal age. Men are rarely affected, so age is not a factor.
Sex: Women are six times as likely to develop the condition as men. However, men who are uncircumcised have a higher risk because the condition usually affects the foreskin.
Family history
Previous damage to the skin because of other skin conditions
Hormone imbalances

WHAT ARE THE SYMPTOMS OF LICHEN SCLEROSUS?

Mild form of lichen sclerosus may present no symptoms at all. However, if there are any signs, they may include the following:

Pain or discomfort.
Redness.
Bleeding.
Blisters.
Itching (pruritus) – can be intense.
Small white spots on the skin of the affected parts, usually early on in the disease.

Small white spots later grow into bigger patches. The skin over these patches appear thin and wrinkled.
Skin that bruises and tears.
Family history
Skin that becomes scarred.
Painful sexual intercourse.

There are several complications that can arise due to lichen sclerosus, however, these complications are rare. Lichen sclerosus can cause cracking and bleeding of the skin in the affected region. When the affected area is the genital area, it can be especially sore and painful. Scarring can result in severe cases of this condition. The walls of the vagina may become tightened or shrunken due to scarring, making sexual intercourse very difficult and painful.

Lichen sclerosus predisposes women who have them in their genital area to developing some forms of skin cancer, especially women who have not managed their symptoms through treatment. However, this predisposition accounts for less than 5% of women with the condition.

Other complications may be urinary retention, constipation – especially in young girls with the condition, and an inability to retract the foreskin in males.

HOW IS LICHEN SCLEROSUS DIAGNOSED?

If you observe the symptoms of lichen sclerosus, then, you should visit a doctor as soon as possible, as early diagnosis paves way for prompt treatment, and consequently, better disease management. Doctors are often able to make a diagnosis by performing a physical examination of the affected areas. A thin sample of skin tissue from the affected area may also be collected.

for examination in a laboratory, under a microscope – a process called biopsy – to confirm that the condition is lichen sclerosus. In certain cases, where lichen sclerosus may present no symptoms, a doctor may only be able to diagnose the condition during examination of the affected part for other unrelated reason.

In the course of getting a diagnosis and being treated for the condition, you may be asked to visit a dermatologist (a doctor who treats the skin), a gynecologist (a doctor who treats the female reproductive system), a urologist (a doctor who treats the urinary or urogenital tract), and primary health care providers.

WHAT ARE THE TREATMENT OPTIONS AVAILABLE?

As of now, lichen sclerosus has no cure. However, there are several ways of effectively managing the condition, and to provide relief from its symptoms. When lichen sclerosus affects other parts of the body apart from the genital and perianal areas, it can sometimes clear up spontaneously. Lichen sclerosus in the genital area may, however, be treated in any of the following ways:

Application of a corticosteroid cream or ointment: Steroids have proven effective in the treatment of lichen sclerosis. Steroids help to control inflammation, which in turn help to reduce itching, soreness and scarring, consequently preventing the condition from getting worse. In the beginning of this treatment, your doctor will ask you to use the cream twice daily. Then, after a few months, the period of application will be brought down to twice a week in order to prevent a recurrence. During this period, your doctor monitors the side effects attributed to prolonged use of topical steroids.

If corticosteroid cream or ointment fails to work, other treatment options like vitamin A-like drugs called retinoids, ultraviolet light therapy, or tacrolimus ointment may work. Tacrolimus ointment help your immune system label lichen sclerosus an invader so that the immune system can destroy it.

Surgery: Surgery is not usually performed to remove patches on the genital area of women, this is because the patches usually return after the surgery. However, surgery can be carried out if a woman has severe scarring in her vagina that has caused her problems with sex. In men, lichen sclerosus can be effectively treated with surgery to remove the foreskin of the penis – circumcision, with a very low chance of it returning.

Living with lichen sclerosus can be made more comfortable by observing the following measures:

Make an appointment with your health primary health care provider if you think you have the signs and symptoms of lichen sclerosus. You may be referred by your doctor to a dermatologist who specializes in the diagnosis and treatment of skin conditions. You can prepare yourself for the meeting by making a list of the following:

Since symptoms are what only you can feel, you can help your doctor by taking note of your symptoms prior to checkup, and writing them down.
Keeping record of your key medical information like any previous medical diagnosis, any prescription you are have been on, including supplements and vitamins.
Questions to ask your doctor.

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References:

Here are answers to many of the frequently asked questions we receive.

MANAGEMENT

Magnetic resonance imaging (MRI) is required to understand the nature of an Achilles tendon tear—partial or full tear. A partial tear can recover with a leg cast, brace, or splint, but may require surgery in some cases. For a full tear of the Achilles tendon, surgery is mandatory.

Symptomatic relief of Achilles tendon tear include rest of the foot, ice at the area, elevation of the foot and over-the-counter pain medications (ibuprofen, acetaminophen and naproxen). Recovery may take between 2 – 6 weeks, depending upon the severity of the tear. Individuals who had an Achilles tear once are at greater risk for similar injury in the future.

During surgery, an incision is made to access the muscle and tendon. Usual risks associated with such surgical interventions include the side effects of anesthesia and a lengthy recovery process.

INNOVATIVE THERAPIES

Platelet Rich Plasma (PRP) is obtained by concentrating the patient’s blood sample to obtain a platelet-rich fraction. It has been shown that soft tissue healing happens most efficiently when platelet concentration is greater than 1,000,000/μl, as compared with a normal platelet count of 200,000/μl (average). Several studies have demonstrated the usefulness of PRP solutions in the healing of tendon injuries and Achilles tendinitis. [2] [3] [4]

Unlike reconstructive surgery that may permanently weaken the tendon and associated structures, PRP therapy aims to rebuild and strengthen tissues. Moreover, patients with partial tendon tears may take anti-inflammatory agents and pain medication to control the swelling and pain, but the side effects of these drugs may be too unpleasant to continue medication use. In this regard, Platelet Rich Plasma therapy offers easy intervention measures for effective and lasting repair as well as as the control of painful symptoms.

A small volume of solution (containing the PRP) is injected around the painful ligament, tendon insertions or adjacent joint spaces. The cells secrete factors, such as platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-b), vascular endothelial growth factor (VEGF) and epithelial growth factor (EGF), which promotes natural repair and regeneration.

R3 Stem Cell has achieved Institutional Review Board (IRB) approval for the following study, please read about it here on ClinicalTrials.gov:

SAFETY AND CLINICAL OUTCOMES WITH AMNIOTIC AND UMBILICAL CORD TISSUE THERAPY FOR NUMEROUS MEDICAL CONDITIONS

[1] Baer GS, Keene JS. Tendon injuries of the foot and ankle. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:section D.

[2] Vora A, Borg-Stein J, Nguyen RT. Regenerative injection therapy for osteoarthritis: fundamental concepts and evidence-based review. PM R. 2012 May;4(5 Suppl):S104-9.

[3] de Mos M, van der Windt AE, Jahr H, et al. Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med. 2008 Jun;36(6):1171-8. Epub 2008 Mar 7.

[4] Monto RR.Platelet rich plasma treatment for chronic Achilles tendinosis. Foot Ankle Int. 2012 May;33(5):379-85.

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