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In 2015, the Centers for Vulvovaginal Disorders in Washington DC began a small study testing whether platelet-rich plasma (PRP) could repair the skin damage of vulvar lichen sclerosus. The early result looked encouraging: inflammation on biopsy went down.1 But when the same team ran the proper follow-up – a placebo-controlled trial – PRP worked no better than salt water.2
So does PRP work for lichen sclerosus? On the best evidence we have, not as a standalone treatment.2
Here is what the studies actually did, what they found, and where that leaves treatment today.
What is lichen sclerosus?
Lichen sclerosus (LS) is a chronic, inflammatory skin condition that mostly affects the vulva and the skin around the anus. It can appear elsewhere on the body, and it affects men, women, people with vulvas and children. It is widely understood to be autoimmune, and it tends to wax and wane over months and years rather than progress in a straight line.
Left unchecked, the inflammation can fuse and scar delicate tissue and, in a small proportion of cases, raises the risk of vulvar cancer – which is why keeping the inflammation controlled matters, not just the itch.2
It often turns up after menopause, when falling oestrogen is already changing vulval tissue, so it can be tangled up with the genitourinary syndrome of menopause. It also shows up in premenopausal women and in children.
What is platelet-rich plasma?
PRP is not exotic. A sample of your own blood is spun in a centrifuge to concentrate the platelets, and that concentrate is injected back into the area being treated. Platelets carry growth factors that help tissue repair, which is why PRP has been tried across wound healing, tendon injuries and dermatology.3
Because it is made from your own blood, there is essentially no allergy risk, and the main downside reported in the LS trials is bruising.2 The theory in lichen sclerosus is that those growth factors might calm inflammation and help damaged skin regenerate. A reasonable theory is not the same as a proven treatment, though, which is the whole point of running trials.
What did the 2015 Centers for Vulvovaginal Disorders study find?
The pilot was led by Andrew Goldstein and colleagues. Fifteen women with biopsy-confirmed vulvar LS were given two PRP injections six weeks apart, with a repeat biopsy taken six weeks after the second injection.1 It was first presented in 2015 and published in full in 2017.
The reported outcome was modestly positive: a statistically significant reduction in the inflammation seen on biopsy, with no serious side effects.1 On the face of it, that is exactly what you would hope for.
The catch is in the design. The pilot was open-label and uncontrolled – everyone knew they were getting PRP, and there was no comparison group receiving a dummy injection.1 In a condition that naturally fluctuates, that is a setup almost designed to look promising. It is a starting point that needs proper testing before we can say more.
The placebo-controlled trial that changed the picture
To their credit, the same group went on to test PRP properly. In 2019 they published a randomised, double-blind, placebo-controlled trial: 30 women with active, biopsy-proven LS, randomised to either two PRP injections or two saline (salt water) injections, with neither the patient nor the treating doctor knowing which they received.2
The main thing they measured was inflammation on biopsy, scored by a blinded pathologist – the objective marker that actually tracks the risk LS carries.2
The results did not favour PRP. Of the 19 women who received PRP, 5 improved, 10 stayed the same and 4 got worse. Of the 10 women who received saline, 5 improved, 4 stayed the same and 1 got worse. There was no statistically significant difference between the groups (p=0.54).2
The patients’ own symptom scores told the same story: both groups improved, and the placebo group actually improved slightly more, with no significant difference between them (p=0.65).2 The trial had been deliberately sized to detect a 50% reduction in inflammation, so this was not a case of a real effect being missed for lack of numbers. The authors concluded that, on these results, autologous PRP does not adequately treat vulvar LS.2
Why one good trial outweighs several promising ones
The 2019 trial is a tidy illustration of why controlled studies matter. Both the PRP group and the saline group improved – which means a single-arm study giving everyone PRP would have looked like a success, when in fact the salt water did just as well.2
Add in a condition that flares and settles on its own, and people who are motivated enough to enrol in a trial and inject their vulva twice, and you have every ingredient for a falsely positive result. The placebo arm is what tells you whether you are watching the treatment work or watching time and attention do their thing.
This is precisely why, here at My Vagina, we read past the headline of every encouraging early study and look for the controlled trial behind it.
What the wider evidence says
Other groups have reported good news, but with the same weakness. One series of 28 women found that symptoms disappeared in 15 and partly eased in the rest, with most no longer needing steroids.4 A larger analysis of 94 patients, both men and women, reported reduced symptoms and improved quality of life and sexual function after six months.5 Encouraging numbers – but again, no placebo group.
A 2021 systematic review pulled the field together and reached a careful verdict: PRP was subjectively reported to improve quality of life, but objective measures of effectiveness were not seen, and the way PRP was prepared and given varied widely between studies.3 The reviewers suggested PRP may have a role as a symptomatic add-on, while stressing that properly controlled trials with standardised methods are still needed.3
Where this leaves treatment today
Topical corticosteroids remain the first-line treatment for lichen sclerosus, and for most people they control symptoms and, importantly, reduce the inflammation that drives long-term damage.2 PRP is still investigational – an interesting idea that has not yet earned a place as a standalone treatment, and certainly not as a replacement for steroids. A new, adequately powered placebo-controlled trial is underway to settle the adjunct question more definitively.
It is worth knowing that PRP is already marketed and sold privately for lichen sclerosus, often at significant cost and rarely covered by insurance. That gap – between how confidently a treatment is promoted and how thin the controlled evidence behind it is – is the thing to keep in mind before paying for it. A treatment being available is not the same as a treatment being proven.
In our clinical work, we meet people with LS who are worn down by steroids and chasing anything that promises regeneration. We would love PRP to be the answer. But we will not point someone towards a costly treatment that the best available trial says works no better than salt water. Our focus stays on the things that really move the needle: consistent treatment as prescribed, gentle skin care, and looking at the whole autoimmune picture – what is actually driving the inflammation, rather than only chasing the symptom.
Frequently asked questions
Is PRP a cure for lichen sclerosus?
No. There is no cure for lichen sclerosus, and the best trial to date found PRP no more effective than a placebo injection.2 It should not be thought of as a fix.
Is PRP safe?
It has a good safety profile. Because it is made from your own blood, allergy is not a concern, and the only adverse event reported in the placebo-controlled trial was bruising.2 Injections into vulval skin can, however, be quite painful.
Should I try PRP instead of steroids?
No. Steroids remain first-line and there is no good evidence PRP can replace them.2 Stopping prescribed treatment in favour of an unproven one risks letting the inflammation – and its long-term consequences – run unchecked. Always talk to your doctor before changing treatment.
Why did the early study look so positive?
Because it had no comparison group. When the same team added a placebo arm, the salt-water injections did just as well, which strongly suggests the early improvement was not the PRP itself.1–2
Can PRP still help symptoms even if it does not reduce inflammation?
Possibly, as an add-on. Several uncontrolled studies and a systematic review report improved quality of life, even though objective effectiveness has not been demonstrated.3 Whether that is a real adjunct effect or a placebo response is exactly what further controlled trials need to answer.
How much does PRP cost?
It is usually a private, out-of-pocket expense and can run to thousands of dollars across a course of treatment, with no guarantee of benefit. Given that the best trial found no advantage over a placebo injection, the cost is worth weighing carefully against the evidence.2
Is there a trial I can join?
A new randomised, placebo-controlled trial of PRP for vulvar LS is in progress. If you are interested in trial participation, your treating doctor or a vulval specialist clinic is the best place to ask.
What to do next
If you think you have lichen sclerosus, the first step is a proper diagnosis – usually confirmed by biopsy – and first-line treatment from a doctor familiar with vulval skin conditions. Do not stop or skip prescribed treatment on the strength of an online promise.
If you are weighing up PRP, go in with clear eyes: ask about the cost, the pain, and the trial evidence, and treat it as an experimental add-on rather than a cure. For self-help measures alongside medical care, some people find approaches like gently addressing fusing useful to discuss with their clinician.
If you have questions, you can ask Aunt Vadge’s Assistant using the chat widget in the bottom left of your screen, or book in with one of our practitioners for tailored guidance. For context on PRP being trialled elsewhere in vulvovaginal care, we have also covered vaginal PRP for sexual function.
This is general information, not a substitute for personalised medical advice. If you have symptoms or concerns, please see your healthcare provider.
- Goldstein AT, King M, Runels C, Gloth M, Pfau R. Intradermal injection of autologous platelet-rich plasma for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol. 2017;76(1):158–160. Full text
- Goldstein AT, Mitchell L, Govind V, Heller D. A randomized double-blind placebo-controlled trial of autologous platelet-rich plasma intradermal injections for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol. 2019;80(6):1788–1789. Full text
- Villalpando BK, Wyles SP, Schaefer LA, Bodiford KJ, Bruce AJ. Platelet-rich plasma for the treatment of lichen sclerosus. Plast Aesthet Res. 2021;8:63. Full text
- Behnia-Willison F, Pour NR, Mohamadi B, et al. Use of Platelet-rich Plasma for Vulvovaginal Autoimmune Conditions Like Lichen Sclerosus. Plast Reconstr Surg Glob Open. 2016;4(11):e1124. Full text
- Tedesco M, Garelli V, Bellei B, et al. Platelet-rich plasma for genital lichen sclerosus: analysis and results of 94 patients. Are there gender-related differences in symptoms and therapeutic response to PRP? J Dermatolog Treat. 2022;33(3):1558–1562. Full text
