Correspondence (letters to the editor): Interventional Surgical Treatment Options

We thank Wölber et al. for their excellently structured article explaining the symptoms, diagnostic algorithms, and therapeutic options for vulvar pruritus (1). The comprehensive article highlights a well-known phenomenon, namely that the symptoms are relevant for different medical specialties—among others, gynecology, dermatology, urology, and internal medicine. While the causes of particular forms of vulvar pruritus are easily addressed with standard treatments if the diagnosis is correct, lichen sclerosus et atrophicus (LSC) and lichen planus present challenges because they take a chronic course and are prone to recurrences—even if local treatment was initially successful. The sequelae are skin atrophy, mucosal adhesions, ranging as far as problems while urinating as seen in our patients. Our intention is to add a new therapeutic option for LSC patients to round up the article by Wölber et al.. The novel therapy is successfully used in gynecological centers (2) for the treatment of genital lichen sclerosus. Adipose tissue aspirates obtained by liposuction contain—aside from fat cells—fibroblasts, endothelial cells and pluripotent stem cells (3). Clinical studies performed by plastic and reconstructive surgeons have shown that transplanting autologous fat has a remodeling effect, with better scarring and skin elasticity. The lipoaspirate has anti-inflammatory and analgetic properties—which makes it ideal for the use in inflammatory skin diseases, e.g. chronic genital wound repair or cutaneous autoimmune diseases. Our long term results of using autologous fat transplants for LSC patients show an improvement of genital lichen sclerosus with a reduction in vulvar pruritis, pain, genital adhesions, and improved well-being of patients. In this context, extensive prospective randomized clinical trials are needed—as stipulated in the S3 guideline (4)—to confirm beneficial long-term effects of this novel therapeutic option and thus make the treatment accessible as a standard treatment for LSC patients.