Targeting Inflammation and Defective Mucosal Repair in Erosive Vulvar Lichen Planus: A Translational Rationale for MSC-Derived Cell-Free Approaches

Erosive vulvar lichen planus (VLP) is a chronic T-cell-mediated inflammatory disorder characterized by painful mucosal erosions, recurrent disease, scarring, and incomplete responses to anti-inflammatory therapy. Persistent epithelial injury, basement membrane disruption, and defective mucosal repair may contribute to disease chronicity. Mesenchymal stromal cell-conditioned medium (MSC-CM) contains soluble mediators and, depending on processing, extracellular vesicles (EVs) with reported immunomodulatory and reparative activities. This narrative review evaluates the translational rationale for MSC-derived cell-free products in erosive VLP and distinguishes evidence from living MSCs, MSC-CM, and isolated EVs. Experimental studies in vaginal cells and injury models provide evidence of epithelial repair, angiogenesis, immunomodulation, and extracellular matrix remodeling. Clinical studies of regenerative cellular interventions in vulvar and vaginal tissues provide indirect evidence of local feasibility. However, no controlled clinical studies have evaluated MSC-CM or MSC-derived EVs in erosive VLP. The available evidence therefore supports a testable translational hypothesis rather than established therapeutic efficacy and indicates the need for product standardization, indication-relevant preclinical validation, and safety assessment before clinical evaluation.