Understanding Vulvar Lichen Sclerosus
Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin condition that mainly affects the genital and perianal areas. Although it can occur in both sexes and at any age, it is most common in women, particularly after menopause.
The disease is not contagious. Its origin is believed to be autoimmune, with genetic, hormonal, and environmental factors also playing a role.
Common symptoms include white patches, fragile skin, itching, burning, pain (due to erosions and rhagades), and sometimes painful intercourse or narrowing of the vaginal opening. Over time, scarring can change the architecture of the vulva, atrophy the labia minora, and bury the clitoris. These changes can seriously affect physical comfort, emotional well-being, and intimate relationships.
Because of embarrassment or lack of awareness, many women wait a mean of 5-15 years before receiving a correct diagnosis. This delay allows the disease to progress and, in rare cases, may increase the risk of vulvar cancer. For this reason, early diagnosis and treatment are essential.
Current standard of care
The first-line therapy for active VLS is a high-potency corticosteroid cream (usually clobetasol propionate 0.05% When used properly, it reduces inflammation and relieves symptoms in most patients.
However, some women continue to experience discomfort or relapse when the treatment is reduced. Others are reluctant to use corticosteroids long-term due to local side effects such as thinning of the skin. For these patients, regenerative medicine offers new possibilities.
What Is Regenerative Medicine in VLS?
Regenerative medicine aims to repair and restore damaged tissues using the body’s own biological resources. In the case of vulvar lichen sclerosus, two promising techniques use fat obtained from the patient herself:
- Nanofat combined with Platelet-Rich Plasma (PRP)
- Nanofat combined with Stromal Vascular Fraction (SVF)
Both treatments begin with a small liposuction under sedation or general anaesthesia, usually from the abdomen or inner thigh. The extracted fat is then processed to obtain a suspension rich in adipose-derived regenerative cells and growth factors. These cells have anti-inflammatory, healing, and tissue-regenerating properties.
The resulting mixture is injected into the affected vulvar and perianal areas to help restore the skin’s structure, improve elasticity, and reduce chronic inflammation.
Clinical results observed
Women treated with nanofat combined with PRP or SVF have shown remarkable improvement in symptoms such as itching, burning, and pain, as well as better skin texture and colour.
Biopsies taken before and after treatment have revealed a clear reduction in inflammation, improved blood supply, and regeneration of the affected tissue.
Patients also report a better quality of life, being able to sit, walk, and enjoy intimacy without discomfort.
Importantly, both therapies use the patient’s own cells, which makes them safe, natural, and free from risk of rejection or allergy. No serious side effects have been reported, only temporary swelling or mild tenderness that resolves within a few days.
Why fat-based regenerative therapies work
Fat tissue is a rich and easily accessible source of regenerative cells. These cells release bioactive molecules that calm the immune system, reduce scarring, and stimulate the formation of new blood vessels and collagen.
When combined with platelet-rich plasma or with the stromal vascular fraction - both powerful sources of growth factors—their regenerative effect is multiplied, helping to rebuild healthy and flexible skin.
The patient experience
The whole procedure takes 1.5 hours and patients can go home after a few hours (4-6) in the hospital and can resume normal activities within a short period of time, usually 4-5 days.
Many describe the change as life-changing, not only because of the relief of symptoms, but because they feel they have regained quality of life, comfort, self-confidence, and a sense of normalcy in their intimate lives.
Future directions
While results to date are encouraging, regenerative therapies should still be considered a complement to traditional treatment, not a replacement.
Low-dose topical corticosteroids are still needed in most cases to prevent recurrence.
Ongoing studies continue to refine protocols and confirm long-term benefits in larger groups of patients.
Key take-aways
- Vulvar lichen sclerosus is a chronic inflammatory condition that can seriously affect comfort and quality of life.
- Standard treatment relies on potent topical corticosteroids, which may not be effective for all women.
- Regenerative medicine using Nanofat + PRP or Nanofat + SVF utilizes the body’s own regenerative cells to restore damaged tissue.
- Clinical experience shows clear improvement in symptoms, skin quality, and patient well-being, with an excellent safety profile.
- These innovative, science-based treatments represent a new hope for women living with this long-neglected disease.
Selected references
- Gutierrez-Ontalvilla P et al. The Effect of Lipofilling and Platelet-Rich Plasma on Patients with Moderate–Severe Vulvar Lichen Sclerosus. Aesthetic Plastic Surgery. 2022; 46:2469-2479.
- Gutierrez-Ontalvilla P et al. Clinical and Histopathological Investigation of Stromal Vascular Fraction and Nanofat in Vulvar Lichen Sclerosus. Aesthetic Surgery Journal. 2025; sjaf148.
- Onesti MG et al. The use of human adipose-derived stem cells in the treatment of vulvar dystrophies. Stem Cells Int. 2016; 2016:2561461.
- Boero V et al. Vulvar lichen sclerosus: a new regenerative approach through fat grafting. Gynecol Oncol. 2015; 139:471-475.
- Krapf JM et al. Vulvar lichen sclerosus: current perspectives. Int J Women’s Health. 2020; 12:11-20.