Clinical and Histopathological Investigation of Stromal Vascular Fraction and Nanofat in Vulvar Lichen Sclerosus

Autores de IIS La Fe

• Marisa Iborra Colomino

  Autor

Participantes ajenos a IIS La Fe

• Gutierrez-Ontalvilla P.
• Gomez Rojas A.
• Canikyan S.
• Kul Y.
• Duyan C.
• Codoñer P.

Grupos

• Enfermedad Inflamatoria Intestinal

Abstract

Background: Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis that impairs the quality of life through symptoms such as itching, pain, and atrophy, and has limited response to conventional corticosteroid therapy. Objectives: The authors of this study aim to evaluate the safety and efficacy of the Lichen-SVF protocol, a regenerative treatment combining nanofat and mechanically isolated stromal vascular fraction (SVF) for moderate-to-severe VLS. Methods: In this prospective, open-label study, the authors included 18 women with moderate-to-severe VLS and participants ranged from 24 to 81 years old, reflecting the broad clinical spectrum of this condition. Each received a single treatment involving intra- and subdermal injection of autologous nanofat (40 cc) and SVF (2-3 cc) into vulvar and perianal regions. Clinical follow-up occurred at 1, 3, 6, and 12 months. Symptom severity (clinical score system, CSS), itching (5D Itch Scale), quality of life (Skindex-29), and sexual function (Female Sexual Function Index, FSFI) were assessed using validated scales. Pre- and 12-month biopsies were analyzed histologically and immunohistochemically for markers such as stromal hyalinization, microvascular density, and T-cell infiltration. Results: Statistically significant reductions in CSS symptoms (from 20.12 to 4.71, P = .0025), CSS signs (from 5.79 to 2.00, P = .0014), and Itching 5D (from 6.82 to 2.35, P = .0136) were observed at 12 months. The quality of life improved (Skindex-29: from 42.88 to 24.82, P = .0313). FSFI scores showed nonsignificant improvement. Histologically, a marked reduction in stromal hyalinization (P = .0036) and CD3+ T-cell infiltration (P = .0068), along with increased microvascular density (P = .0121), confirmed regenerative effects. No serious adverse events occurred. Conclusions: The Lichen-SVF protocol offers a safe and effective regenerative option for women with VLS who do not respond to standard treatments. As low-dose corticosteroids were maintained throughout follow-up, the protocol should be viewed as a complementary approach that enhances, rather than replaces, conventional therapy. © The Author(s) 2025. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved.

Keywords

• Adult; Aged; Aged, 80 and over; Biopsy; Female; Humans; Middle Aged; Prospective Studies; Quality of Life; Severity of Illness Index; Stromal Cells; Transplantation, Autologous; Treatment Outcome; Vulva; Vulvar Lichen Sclerosus; Young Adult; calcineurin inhibitor; clobetasol; epinephrine; Ringer lactate solution; tranexamic acid; adult; Article; CD3+ T lymphocyte; cell infiltration; clinical article; clinical feature; clinical outcome; cohort analysis; controlled study; corticosteroid therapy; female; Female Sexual Function Index; follow up; histopathology; human; hyaline degeneration; immunohistochemistry; microvascular density; middle aged; open study; prospective study; pruritus; quality of life; sexual function; skindex-29; stroma; stromal vascular fraction; vulva kraurosis; aged; autotransplantation; biopsy; pathology; severity of illness index; stroma cell; therapy; transplantation; treatment outcome; vascularization; very elderly; vulva; vulva kraurosis; young adult