Combined radiofrequency and topical exosomes in atrophic vulvar lichen sclerosus: A case report.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatological-gynecological condition. Conventional first-line treatment comprises topical corticosteroids; however, many patients remain refractory. Energy-based devices, including radiofrequency (RF), have shown promising results in VLS, with symptomatic and functional improvement. Exosomes are vesicles containing bioactive molecules involved in tissue regeneration; their lyophilized form, stabilized for topical application, has been combined with energy-based therapies with satisfactory results in other dermatological conditions. To our knowledge, this is the first report of ablative RF combined with topical lyophilized exosomes for VLS. We present the case of a 38-year-old woman with biopsy-confirmed VLS refractory to standard treatment, who underwent ablative fractional RF combined with topical lyophilized exosomes derived from amniotic fluid stem cells. The patient showed improvement in pruritus, dyspareunia, and sexual function, and reported satisfaction with the combined therapy.