The Stem Cell Lift® Procedure: New Hope in Treatment of Lichen Sclerosus Et Atrophicus
By: Nathan Newman, MD
New Hope for Treating Lichen Sclerosus: Autologus Stem Cell Therapy
Revolutionary advancements in stem cell therapy are transforming the practice of medicine and providing an array of new, safe and effective treatment options for many disease conditions, such as Lichen Sclerosus, that until now did not have any effective solution. This new field of medicine is being termed Regenerative Medicine; since it utilizes the natural regenerative and reparative powers of stem cells to target damaged tissues and restore them to health. Over the last decade, I have innovated The Stem Cell Lift®, a procedure that harnesses the power of your own body’s stem cells for use in reconstructive and cosmetic purposes. As patients become more aware of this treatment, they approach me to seek treatment for their various medical conditions. Today, we have seen remarkable results with the Stem Cell Lift® procedure for reconstruction of post-cancer scarred defects, for painful or damaged joints, ligaments and muscles, for wound healing and for Lichen Sclerosus.
The Stem Cell Lift® procedure offers a new and effective treatment for Lichen Sclerosus.
What is Lichen Sclerosus?
Lichen Sclerosus et atrophicus (LS) is a chronic inflammatory disorder of the skin and mucous membranes usually involving the genital and anal areas. The disease is most prevalent in women, especially post-menopausal women, followed by men, and rarely children. It is hypothesized that patients possessing a genetic predisposition to developing an “over-active” immune system may develop a localized auto-immune response from a certain trigger, such as infection, stress, hormonal changes, or trauma. Although it is not clear how many people are afflicted with this condition, estimated prevalence of the disease is between 1 in 30 post-menopausal women and up to 1 in 300 patients seen by dermatologists and gynecologists. In addition to unbearable itching similar to a chronic yeast infection, the disease may cause scarring of the vaginal tissues it affects and consequently, narrows the vagina, which results in painful intercourse. Many women lose their desire for intercourse for fear of the pain. In men, the term balanitis xerotica obliterans is used to describe Lichen Sclerosus of the penis. Less commonly, extra-genital Lichen Sclerosus appears on the upper body, breasts, and upper arms Lichens Sclerosus is not contagious.
While there are thousands of Lichens Sclerosus sufferers, many doctors are not familiar enough with the disease, and therefore, are not able to diagnose the disease correctly. Many patients are forced to see numerous doctors before a correct diagnosis is made. Lichen Sclerosus, as with many other chronic skin diseases, has had limited effective medical treatments for managing the disease. In most cases, doctors prescribe a strong corticosticosteroid ointment or cream, to provide temporary relief of the itching and discomfort.
The Stem Cell Lift® procedure offers new and effective treatment for Lichen Sclerosus. Now, patients with Lichen Sclerosus et atrophicus are finding relief from the pain and discomfort of this disease by using their own body’s stem cells. The Stem Cell Lift® is a novel procedure that shows promising results in the treatment of Lichen Sclerosus.
The fat in our bodies contains the most concentrated amount of adult stem cells of any body tissue. These cells are genetically programmed to naturally heal and repair damaged tissues in our bodies. For more than seven years, I have used the Stem Cell Lift® procedure to treat patients for cosmetic and reconstructive purposes with very positive long term results. In more recent years, I have utilized the Stem Cell Lift® procedure to treat chronic skin diseases such as Lichen Sclerosus, non-healing wounds in diabetics and for musculoskeletal conditions such as arthritis and other ailments involving knees, ankles, shoulders, wrists, hands and other joints, tendons and muscle with marked improvement in the patient’s condition.
What Causes Lichen Sclerosus?
Although the exact cause is unknown, Lichen Sclerosus is a disease of multi-factorial etiology. Associated factors include: genetic predisposition, epigenetic factors, autoimmune diseases, hormonal influences, infectious triggers, and a stressed immune system. Lichen Sclerosus may be more common in some families and can often be triggered by trauma, hormonal changes, infection, and surgery. Patients with Lichen Sclerosus have a higher risk of developing other autoimmune disorders, which develop when the immune system attacks and injures your own body’s tissues. Associated autoimmune disorders may include thyroid disease, anemia, diabetes, alopecia areata, and vitiligo.
Misdiagnosing Lichen Sclerosus
Many women with Lichen Sclerosus may have symptoms of their disease for many years before a proper diagnosis is made. The most common misdiagnoses include a yeast infection, herpes infection, low estrogen, vitiligo or psychological disorders. The diagnosis of Lichen Sclerosus may not be made until the disease has advanced and altered the normal anatomy.
What Are The Signs And Symptoms Of Lichen Sclerosus?
Lichen Sclerosus is a chronic disease that has a spectrum of symptoms, from asymptomatic to mild to severely progressive. Most of the symptoms are from inflammation of the affected areas that may include the clitoris, vulva, vaginal opening, perineum and anal area. Early in the disease, small white shiny and smooth spots appear on the skin and mucosa in the genital and anal areas. Many patients may not notice the disease as they may not have any symptoms. As the disease progresses, the spots grow into bigger patches and the skin becomes thin and crinkled. Bright red or purple bruises and patchy white and dark skin color changes are common. The skin becomes very fragile tearing easily with the slightest friction. Eventually chronic inflammation results in scarring of the tissues and loss of normal anatomy. Fusing of the labia minora to the labia majora, narrowing of the vaginal opening, and scarring over the clitoris are common signs of disease progression. Lichen Sclerosus does not affect the inner reproductive organs, such as the vaginal canal and uterus.
The symptoms of lichen sclerosus in women include:
Vulvar itching – The most common symptom of Lichens Sclerosus is itching. It may be so severe that it interferes with sleep or wearing pants.
Discomfort or pain (Vulvodynia)
Anal itching - fissures, bleeding, and pain
Painful sexual intercourse (dyspareunia) – This can occur as a result of repeated cracking or tearing of the skin (fissuring) or from narrowing of the vaginal opening due to scarring.
Can People With Lichen Sclerosus Have Sex?
Women with severe Lichen Sclerosus in the genitals may not be able to have sex due to the discomfort associated with it. The scarred and thinned tissues in the genitals result in tears, bleeding, soreness and pain with the slightest amount of friction. The disease can cause progressive scar constriction around the vaginal opening and may require the use of dilator devices to maintain the narrowed vaginal opening.
Is Lichen Sclerosus Related to Cancer?
Women and men with Lichen Sclerosus are at increased risk of developing skin cancer. Although Lichen Sclerosus itself is not believed to cause cancer, chronic wounds and inflammation that result from Lichen Sclerosus may rarely develop into squamous cell carcinoma.
Disease Course of Lichen Sclerosus
The severity of Lichen Sclerosus varies from person to person. Almost all individuals experience flare-ups, that may be associated with hormonal changes, trauma, or periods of stress, during which time the LS symptoms become more severe, and tissue damage, alterations or scarring is rapid. Potent topical steroids may be used with the hopes of reducing inflammation, providing symptomatic comfort and minimizing tissue damage. There are also periods of remission experienced where the symptoms may not be noted and the disease is stable.
Lichen Sclerosus in Men
Lichen Sclerosus in men is also called Balanitis Xerotica Obliterans (BXO). Men who develop Lichen Sclerosus are usually uncircumcised, and the foreskin can become tight, shrunken, and scarred over the head of the penis. Lichen Sclerosus in men may result in difficulty pulling back the foreskin, decreased sensation at the tip of the penis, painful erections, or problems with urination.
Extra genital Lichen Sclerosus
Lichen sclerosus may also cause lesions to occur in areas outside the genitals, especially the upper body, breasts, and upper arms. Extra genital Lichen Sclerosus appears to be more common in women and may affect one in five patients with Lichen Sclerosus. These lesions tend to be white, flat or raised, and are not as itchy as the affected skin of the genitals or anus.
How Is It Diagnosed? In most cases the history of the course of the disease and the clinical appearance of affected areas is sufficient to make the diagnosis of Lichen Sclerosus. A biopsy specimen may be taken to confirm the diagnosis.
Excluding other conditions — Tests may be done to exclude other conditions that could cause symptoms similar to those of Lichen Sclerosus, such as:
Lichen planus (a skin disease that can also cause itching and fusing of the genital skin. Lichen planus can occur together with Lichen Sclerosus.)
Low estrogen level (can cause vaginal dryness, thinning of tissues and painful intercourse.)
Vitiligo (an autoimmune skin disorder that can cause white skin patches similar to those of lichen sclerosus. Vitiligo can occur together with Lichen Sclerosus.)
Pemphigoid (a rare blistering skin disorder that also causes scarring of the vulva.)
Hemorrhoids (which can also cause cracks in the skin of the anus.)
How Was Lichen Sclerosus Treated?
Men who have Lichen Sclerosus are generally treated with circumcision, which removes the foreskin of the penis. After circumcision the condition typically resolves.
In women, and in men whom do not wish to undergo circumcision, the most common therapy has been the use of potent corticosteroids such as clobetasol. The anti-inflammatory effect of the medication may help alleviate symptoms and reduce the damage to the tissues in the short term. Chronic long-term use of this medication may result in thinning of the tissues, exacerbating the symptoms of the disease and creating dependence of the treated areas on the drug.
Other treatments have been less effective but have shown benefit in some patients. Hormonal treatment, immune modulators such as tacrolimus, and light or laser treatments may provide some relief from the symptoms of Lichen Sclerosus but usually do not stop the progression of the disease.
Surgical vaginal reconstruction has been used to cut and remove scar tissue and to improve the structural appearance of the female genitalia. There are many risks and complications associated with this procedure. More importantly, the symptoms of Lichen Sclerosus may even get worse after surgical repair.
Problems with Conventional Treatment Options
To date there has been no effective treatment for Lichen Sclerosus. Most treatments use anti-inflammatory steroids such as betamethasone or hormones to reduce the symptomatic itching, burning and inflammation. However, these drugs are not addressing the disease but merely reducing the symptoms and over time are associated with side effects such as thinning of the skin and tissues. The long-term use of steroids can cause dependence of the skin on the steroid and when it is discontinued abruptly it can result in a rebound flare. This becomes a vicious cycle of steroid dependence as “the flare” is from steroid “withdrawal” is difficult to differentiate from that of Lichen Sclerosus. When this happens, the tissues need to be weaned off the steroids gradually to prevent the rebound “flare” reaction. Lasers and focused ultrasound treatments also have been used with little success to address the symptoms of lichen sclerosus but these treatments may result in reduce blood flow and cause scarring of the tissues.
The Stem Cell Lift® Procedure
The Stem Cell Lift® is a minimally invasive procedure performed under local anesthesia. To alleviate anxiety and for patient comfort, oral sedative and/or intramuscular injections are usually administered. The procedure is carried out in three stages. First, the area from where you wish the fat to be taken from is marked and tumescent local anesthesia is slowly injected using a blunt instrument. After a short wait to allow for the anesthetic medication to work, the fat is removed under local anesthesia using a mini-liposuction method through specially designed instruments. Second, the obtained fat is processed to concentrate the stem cells and increase their ratio to the fat cells being prepared for injection. Third, local anesthesia is administered and the super-charged adult stem cells from your own body's fat along with some fat cells are injected. Specially designed blunt instruments are used to inject the stem cell enhanced fat into the affected Lichen Sclerosus tissues targeted for treatment. A bandage is placed on the area where the fat was taken. The entire procedure is done all in the same day in about four hours. Patients are able to walk and resume normal daily activities almost immediately after the Stem Cell Lift® procedure.
How does it work?
Lichen Sclerosus is a chronic inflammatory autoimmune condition that over time causes scar-like fibrotic changes in the skin and mucus membrane. These changes result in the physical symptoms that are seen and felt by each person. Over time the chronic inflammation causes poor blood circulation, loss of elasticity, and nerve sensory hypersensitivity. The Stem Cell Lift® method delivers an enhanced amount of the stem cells found in your fat to the affected areas. These cells are tasked with reducing inflammation, improving circulation, repairing the collagen scaffolding, restoring elasticity, and repairing damaged cells and tissues. The autoimmune response may also be mitigated through the effects of the stem cells. In the first three months after the procedure the stem cells attach and become permanently incorporated into their new surroundings. They may continue to improve the tissues for about one year after the procedure. In doing so, patients report marked improvement in their symptoms, with noted reduction in pain, burning, itching, and improved look and feel of the anatomy of the treated areas. Patients treated with the Stem Cell Lift® procedure report having less frequent flare ups that are shorter in duration with far less intense pain and discomfort. Most patients are able to discontinue the use of topical steroids and hormones and may be able to resume intimacy and sexual intercourse.
What Happens After the Procedure?
During the first 24 hours you will have drainage of the excess tumescent solution from where the fat was removed. You may experience some discharge in the treated areas for a few days. You will feel sore in both the area where the fat was removed and in the Lichen Sclerosus areas treated with the Stem Cell Lift® procedure. Cool compresses and Tylenol® (acetaminophen) may help reduce the discomfort. The soreness may last about 2 weeks and may feel similar to muscle soreness after strenuous activity. You may experience a flare up of the Lichen Sclerosus symptoms that may last a few days to weeks. Gradually, as the stem cells settle into their new environment, their positive effects start to improve the damaged tissues; you will experience much relief from the symptoms of LS. Depending on the stage and severity of your Lichen Sclerosus you may wish to have a second or third procedure to optimize the treatment. In general, I wait about three to six months before the Stem Cell Lift® procedure is repeated, to allow for the stem cells to take and to see your response to the treatment.
Risks and Limitations of Stem Cell Lift®
The risks of a Stem Cell Lift® procedure are mostly the same as with any injection into the body, and include bleeding, bruising, inflammation, and infection. Lichen Sclerosus patients may experience soreness and even a flare for about two weeks. Although rare, other risks include uneven skin, lumps under the skin, loose skin, scarring, and no improvement in Lichen Sclerosus symptoms. As this is a new treatment, long-term results in terms of duration of benefits are not yet known. You may need to have a series of treatments to achieve the desired improvement and relief from Lichen Sclerosus symptoms.
Benefits of Stem Cell Lift®
Unlike non-autologus stem cell therapies that use cells from other sources, the Stem Cell Lift® procedure takes your own stem cells found in your fat, concentrates them without changing them, and in the same day's procedure injects them back into the desired areas. Since these cells are yours and are not being changed in any way there is no concern of allergic reaction, rejection, and other problems associated with non-autologus cell grafting. The Stem Cell Lift® procedure is performed under local anesthesia, thereby avoiding the risks, complications and cost associated with general anesthesia. Patients with Lichen Sclerosus who have undergone the Stem Cell Lift® procedure have shown to have great improvement in their symptoms for extended periods of (1 to 2 years and counting), however, since this is a relatively new treatment for this disease the duration of the improvement achieved is not yet known. There is an additive effect from each treatment that should allow patients see improvement in their tissues and to be symptom free for longer periods each time, enabling most patients to discontinue using topical steroids, hormones and other medications.
Can PRP Be Combined With The Stem Cell Lift® Procedure?
Platelet Rich Plasma (PRP) may be used in conjunction with the Stem Lift® Procedure. PRP is an autologus blood derived product that may improve wound healing, tissue graft take and enhance stem cell activity. Blood is taken from you and centrifuged to concentrate the platelets. The concentrated platelets are taken with some plasma from your centrifuged blood and added to the stem cells for injection. The added PRP is more likely to cause a flare of the Lichen Sclerosus symptoms. No data exists to evaluate if and how much adding PRP to the Stem Cell Lift® may improve the results of the treatment.
Advantages of the Stem Cell Lift® over Conventional Therapy
The Stem Cell Lift® is unique as it:
Using your own body’s cells that are genetically tasked with repair, restoration and maintenance of tissues
Reduces pain and discomfort from scar contraction through scar remodeling
Improves and relieves signs and symptoms of lichen sclerosus
Provides immune modulating activity that may diminish or stop the autoimmune reaction
May be repeated as needed and has additive effect from each treatment
May be added with Platelet Rich Plasma (PRP)
May alleviate the need for topical treatments (steroids and hormones)
And it is:
Not a drug
Not a hormone
Autologus, from your own body
Not rejected by the body
And it requires:
No allergy testing
No incisions (cuts)
No general anesthesia
Minimal down time or recovery period
The Stem Cell Lift® procedure offers a new and effective treatment for Lichen Sclerosus. In my experience with Lichens Sclerosus patients, regardless of how long they have suffered from LS or how severe the disease, they experience significant improvement after the Stem Cell Lift® procedure. The degree of improvement after each treatment varies amongst individuals. To optimize the results, Lichen Sclerosus should be treated as soon as possible to prevent tissue damage and scaring. Although at this time we do not know how many years the improvements from the Stem Cell Lift® procedure will last, it is the best treatment option available to Lichens Sclerosus sufferers.
Dr. Nathan Newman is a board certified dermatologist, a cosmetic surgeon, on the forefront of regenerative medicine, and the innovator of the Stem Cell Lift®. For more information about Dr. Newman and how you may benefit from his innovative and advanced medical and cosmetic treatments, please visit NathanNewmanMD.com and Stem-Cell-Lift.com, or please call his office in Beverly Hills, California at (310) 273-3344 to schedule a personal consultation.
Dr. Nathan Newman is a world-renowned cosmetic surgeon in Beverly Hills, and innovator of the Stem Cell Lift®. To schedule a private consultation,
please contact Dr. Newman's office.