Regenerative Approaches in Vulvar Lichen Sclerosus: A Systematic Review.

Vulvar lichen sclerosus (VLS) involves chronic inflammation, immune dysregulation, and abnormal extracellular matrix remodeling, involving extracellular matrix protein 1 (ECM1) and non-coding RNAs, particularly miR-155. Platelet-rich plasma (PRP) and adipose-derived mesenchymal stem cells (ADSCs) offer regenerative potential through the release of growth factors and cytokines that promote angiogenesis, fibroblast proliferation, collagen synthesis, and tissue repair, which could potentially compensate for the disordered matrix in VLS. This systematic review aimed to evaluate the current evidence on the efficacy and safety of PRP, ADSCs, and active substances administered through mesotherapy to adult women with VLS. A search of the PubMed, Scopus, and Web of Science databases identified 251 records, of which 13 studies met the inclusion criteria (RCTs and cohort studies involving women aged ≥ 18 years who were treated with PRP, ADSCs, or mesotherapy). The reviewed studies suggest that these therapies may improve clinical symptoms, quality of life, sexual function, and tissue quality. However, their application may be constrained by procedural invasiveness and potential immunologic risks. Moreover, the current evidence base is limited by small sample sizes, a lack of control groups, and short follow-up periods. Larger, well-designed randomized controlled trials with long-term follow-up are needed to confirm their therapeutic value and establish clear clinical guidelines.