Platelet-rich plasma injection is effective and safe for the treatment of alopecia

Patient Satisfaction and Clinical Effects of Platelet-Rich Plasma on Pattern Hair Loss in Male and Female Patients

Introduction

Hair loss is a widespread condition in both genders. Over the past decade, platelet-rich plasma (PRP) has become a common treatment for hair loss. Our goal was to analyze patient satisfaction and the clinical effects of PRP on male and female pattern hair loss.

Methods

Over a period of 12 months, we treated a total of 56 patients for androgenetic alopecia with PRP. All of these patients were included in this study; 15 cc of whole blood was spun in an ACP double syringe (Arthrex Inc., Naples, Forida) for five minutes. The yielded 5 to 6 cc of PRP were then injected into the scalp. Forty-nine patients were treated with a series of three injections at monthly intervals, three patients with a series of four injections, two patients with a series of five injections, one patient was treated with a series of seven injections, and one patient with a series of eight injections. Follow-ups were conducted one month after the last treatment. A self-drawn questionnaire was used to assess the satisfaction and clinical results from the patient's and the clinician's perspectives.

Results

The average age was 41 years (20-68 years). Fifty-seven percent of all patients were male and 43% female. In total, the patients were satisfied with the treatment results. The average score was 7.29 on a scale from 0 to 10. The clinician's rating was similar (6.46). Moreover, with an average score of 8 on a scale from 0 to 10, it is very likely that the patients will recommend PRP treatments to friends. The probability of occurrence of clinical effects among the entire study population was reported as follows: improvement in hair density (patient‘s rating: 64%; clinician's rating: 46%), thickness (38%; 45%), quality (46%; 54%), sheen/lustre (27%; 21%), new hair growth (57%; 68%), less hair loss (48%; 20%), other positive effects (5%, 2%), no effects (4%; 4%), negative effects (0%; 0%).

Conclusion

Our study revealed encouraging results for the treatment of male and female pattern hair loss with PRP. The autologous treatment was rated with high satisfaction scores and can be considered a safe and effective treatment modality.

Combination of Platelet-Rich Plasma and Platelet Gel in Treatment of Resistance Androgenic Alopecia: a Case Series Study

BACKGROUND

Androgenic alopecia is a common genetic disorder that characterized by progressive hair follicles and hair atrophy. Despite of all available therapeutic techniques, there is low patient satisfaction rate. It seems finding new treatment options for androgenic alopecia is necessary. In the past decade Platelet-rich plasma (PRP), an autologous collection of concentrated platelets with haemostatic and tissue repairing effects has received developing attention for androgenetic alopecia treatment as a valuable therapeutic technique.

METHODS

In this study 8 patients suffering from resistance androgenic alopecia were enrolled. The PRP and platelet gel was prepared and a total volume of 10 cc of the combination of PRP and platelet gel was injected in the scalp androgen-related areas using 23-gauge syringe. The treatment was performed one month, and 3 months after first injection (three times). The hair pull test was done before treatment. The outcome was evaluated 3, 6 and 9 months after treatment by hair pull test, dermoscopy, photography and patient's satisfaction.

RESULTS

A significant reduction in hair loss was observed before and after treatment. Hair count (density) increased from average number of 72 (hair/cm2) to 210 hair/cm2). Also the hair diameter was significantly increase before and after treatment for all patients (P<0.05). After the treatment, the pull test was significantly decrease in 8 patients (P<0.05).

CONCLUSION

This study supports the combination therapy of PRP and platelet gel for resistance androgenic alopecia treatment. This technique is an uncomplicated, feasible and cost effective treatment option for resistance androgenic alopecia, with high patient satisfaction.

Combination therapy with platelet-rich plasma and minoxidil leads to better clinical results than monotherapy with these methods in men with androgenetic alopecia

Platelet-rich plasma (PRP) therapy is a new method for the treatment of androgenetic alopecia (AGA), the effectiveness and safety of which continues to be studied. Information on comparative efficacy when combining PRP with other methods of treatment is limited. The aim of the study was a comparative evaluation of the clinical efficacy of minoxidil, PRP therapy, and their combination in the treatment of men with AGA.

Comparison of 5% minoxidil lotion monotherapy versus its combination with autologous platelet rich plasma in androgenetic alopecia in hundred males

Background

Androgenetic alopecia (AGA) is the most common form of alopecia in men, affecting 70% by the age of 20 years. The present study was conducted with the objective of comparing the efficacy of monotherapy with topical 5% minoxidil and its combination with intradermal platelet rich plasma (PRP), in male AGA.

Methods

This observational study was conducted at the dermatology department of a tertiary care hospital over a duration of 2 years. 100 patients with AGA were selected and divided randomly into 2 treatment arms: Group A (MM): received topical 5% Minoxidil monotherapy for 12 months and; Group B (M + PRP): received combination therapy of PRP and topical 5% Minoxidil for 12 months. The following parameters were subsequently analyzed on follow up: Physician-assessed global photography by a 4-point improvement scale and trichoscopic improvement of mean hair diameter.

Results

The combination was statistically superior to the monotherapy group in promoting hair growth in men with AGA for both measures of hair growth - photographic assessment and trichoscopic mean diameter.

Conclusion

We hereby conclude that intradermal PRP injections should be offered to all patients with AGA along with the existing therapeutic modalities, for faster hair regrowth and improved compliance.

Systematic review of platelet-rich plasma in treating alopecia: Focusing on efficacy, safety, and therapeutic durability

Considering the different forms, alopecia could be a very common condition with particular therapeutic concerns; thus, recent therapies still require further assessments. Aim of this systematic review was to evaluate efficacy, safety, and therapeutic durability of platelet rich plasma (PRP) in treating various forms of alopecia. A total of 64 articles were found through a systematic search, and eight original articles were included in the study, based on inclusion/exclusion criteria. In most studies (62.5%) patients' conditions had improved by receiving PRP therapy; these cases experienced an increase in growth and thickness of hair. Simultaneous use of PRP and Minoxidil demonstrated the highest rate of improvement and satisfaction. The highest efficacy in patients with alopecia areata was 76% and the lowest efficacy was 31.7% and in patients with androgenetic alopecia the highest efficacy was 42.75% and the lowest reported efficacy was 25.55%. The main side effect was pain due to PRP injection, which disappeared after ending the treatment and only one article reported more serious side effects. Recurrence after treatment was also reported in only one article. PRP is a safe and easy method for treating hair loss and has limited adverse effects. Optimization of this method depends on dosage, number of sessions and their intervals, and injection techniques. According to the results, the use of PRP due to its relatively high efficiency, low and tolerable side effects, and low recurrence rate can be a good method for the treatment of alopecia and hair loss.

Platelet-rich plasma in androgenetic alopecia

The goal of these recommendations is to provide a framework to practitioners for implementing useful, evidence-based recommendations for the preparation of platelet-rich plasma (PRP) and its use in androgenetic alopecia (AGA). The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these recommendations to its taskforce on PRP. A comprehensive literature search was done in the English language on the PRP across multiple databases. The grade of evidence and strength of recommendation were evaluated on the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) framework. A draft of clinical recommendations was developed on the best available evidence, which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, the final consensus statement was prepared. A total of 30 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], and case series) were critically evaluated, and the evidence thus gathered was used in the preparation of these recommendations. This expert group recommends use of manual double-spin method for the preparation of PRP for AGA. Minimum three to five sessions of PRP are recommended for AGA with a gap of 1 month between the two sessions. Patients with Grade II to V Norwood Hamilton classification of AGA are the ideal subset for PRP. A total of 5 to 7 mL of PRP and 0.05 to 0.1 mL/cm² is the recommended dose of PRP for AGA. Activation of PRP is not required when it is used for AGA. About 1 to 1.5 million platelets/μL of platelets in PRP is the recommended platelet concentration in PRP for the treatment of AGA. I-PRF (injectable platelet-rich fibrin) has also been found to be useful in AGA, although further studies are required to establish its role. PRP can also have an adjunctive role in hair transplantation procedures.

Comparison of efficacy of platelet-rich plasma therapy with or without topical 5% minoxidil in male-type baldness: A randomized, double-blind placebo control trial

Background

Male-type baldness is a common chronic hair loss disorder among males. Male type baldness is characterized by stepwise miniaturization of the hair follicle, due to alteration in the hair cycle dynamics, leading to transformation of the terminal hair follicle into a vellus one. Platelet-rich plasma (PRP) seems to be a new technique which may improve hair regrowth. We planned a randomized, double-blinded placebo control trial to see the efficacy of PRP with and without topical minoxidil and to compare with placebo and standard treatment.

Materials and Methods

The study design was a randomized, double-blind placebo control trial. The sample size was calculated, and randomization was done. Patients with male type baldness were allocated into four groups; first group topical minoxidil only, the second group PRP with minoxidil, the third group normal saline (NS), and fourth group PRP only. Interventions were done monthly for 3 months and patients were followed up for the next 2 months. Effects of interventions were assessed by hair density, patient self-assessment, and clinical photography.

Results

A total of 80 patients were included. The maximum improvement was found in PRP with minoxidil group. Increase in hair density (in descending order) was PRP with minoxidil group, PRP-alone group, minoxidil-alone group, while a decrease in hair density was found in NS group, after 5 months. The maximum patient satisfaction was found in PRP with minoxidil group followed by (in descending order), PRP-alone group, minoxidil-alone group, and NS group.

Limitation

Long-term follow up of patients was not done. Hair counts and hair thickness estimation were not estimated.

Conclusion

In our study, we found PRP with topical minoxidil is more effective than PRP alone and topical minoxidil alone.

The Physician's Guide to Platelet-Rich Plasma in Dermatologic Surgery Part II: Clinical Evidence

BACKGROUND

Platelet-rich plasma (PRP) is an increasingly popular treatment modality for various dermatologic conditions, but there are limitations in both the published literature and clinician knowledge.

OBJECTIVE

To create a high-yield, in-depth analysis of PRP in procedural dermatology by reviewing available data on its role in hair restoration, soft-tissue remodeling, resurfacing, and rejuvenation; identifying practice gaps and controversies; and making suggestions for future research that will establish dermatologists as pioneers of regenerative medicine.

MATERIALS AND METHODS

A two-part systematic review and expert analysis of publications before October 2018.

RESULTS AND CONCLUSION

Most studies on PRP report favorable outcomes with the strongest level of evidence existing for androgenetic alopecia followed by postprocedure wound healing, scar revision, striae, rejuvenation, and dermal filling. There is a dearth of large randomized controlled trials, considerable heterogeneity in the variables studied, and lack of specificity in the preparatory protocols, which may influence clinical outcomes. Future investigations should use consistent nomenclature, find ideal solution parameters for each cutaneous indication, determine significant outcome metrics, and follow double-blinded, randomized, controlled methodologies. Addressing these deficiencies will take sound scientific inquiry but ultimately has the potential to benefit the authors' specialty greatly.

Comparative Evaluation of the Clinical Efficacy of PRP-Therapy, Minoxidil, and Their Combination with Immunohistochemical Study of the Dynamics of Cell Proliferation in the Treatment of Men with Androgenetic Alopecia

Platelet-rich plasma (PRP) therapy has been considered as a promising treatment for androgenetic alopecia (AGA). The aim of the study was comparative evaluation of the clinical efficacy of PRP-therapy, minoxidil, and their combination in the treatment of men with AGA and to evaluate the effects of PRP on the proliferation of hair follicle (HF) cells in skin biopsy.

MATERIALS AND METHODS

The study involved 69 men who were divided into 3 groups who received PRP therapy, minoxidil, and their combination. The clinical efficacy of the therapy was evaluated by the dynamics of morphometric of hairs. To assess cell proliferation antibodies to β-catenin, CD34, Ki67, and to Dkk-1 were used.

RESULTS

PRP treatment was more effective than minoxidil therapy (p = 0.005). Complex therapy turned out to be more effective than minoxidil monotherapy (p < 0.0001) and PRP monotherapy (p = 0.007). After applying PRP the absolute and relative values of the β-catenin and CD34 expression area increased; an increase in Ki67+ index was also significant.

CONCLUSIONS

PRP can be considered as a treatment option for AGA. Combined PRP and minoxidil use seems promising for the treatment of AGA. PRP increase in the proliferative activity of HF cells and improves hair morphology in patients with AGA.

A small scale study to evaluate the efficacy of microneedling in the presence or absence of platelet-rich plasma in the treatment of post-clipping alopecia in dogs

BACKGROUND

Post-clipping alopecia often has a clinically poor response to therapy and prolonged alopecia is a source of anxiety for some owners. In humans and dogs, superficial microtrauma via a microneedling (MN) device induces mechanical stimulation of the hair follicle with resultant hair regrowth. Human studies suggest that concurrent application of platelet-rich plasma (PRP) with MN induces more rapid regrowth of better-quality hair than microneedling alone.

HYPOTHESIS

Microneedling with PRP will induce more rapid regrowth of better quality hair.

ANIMALS

Four unrelated client-owned dogs diagnosed with post-clipping alopecia.

METHODS AND MATERIALS

This was a prospective study. The affected site was divided in half, with the first half treated with MN alone and the second half treated with MN + PRP. Hair regrowth was assessed by clinician and owner using a hair growth assessment scale (HGAS) at one, three, six and 12 months.

RESULTS

At three months, all dogs had improved and three exhibited greater hair regrowth on the MN + PRP side. A similar response was noted bilaterally in three dogs, which had improved by 76-100% at six months and remained unchanged at 12 months. One dog improved by < 26% at six months, but had> 50% re-growth by 12 months. The small sample size precluded statistical analysis.

CONCLUSIONS AND CLINICAL IMPORTANCE

In dogs with post-clipping alopecia, MN + PRP appeared to induce more rapid hair regrowth than MN; however, overall results were visibly equivalent by six months regardless of method. Both MN and MN + PRP proved successful for treating post-clipping alopecia.

Dermoscopic pre- and posttreatment evaluation in patients with androgenetic alopecia on platelet-rich plasma-A prospective study

BACKGROUND

Platelet-rich plasma is rich in growth factors that promote differentiation and growth of dermal papilla cells by various signaling pathways. Dermoscopy is handy, bedside tool that helps to improve diagnostic accuracy in various hair disorders.

OBJECTIVES

To evaluate and study the role of dermoscopy in patients with androgenetic alopecia (AGA) pre- and posttreatment with platelet-rich plasma (PRP).

METHODS

It is a prospective comparative study. Twenty male patients with AGA, aged 18-45 years with modified Norwood-Hamilton classification grade II-VI were included in this study. Patients were given platelet-rich plasma injections every 3 week for a period of 3 months. Dermoscopy was performed with 10 x magnifications in polarized mode at baseline and at 3 months from the baseline and photographs were taken. Patients were evaluated based on following dermoscopic findings (a) hair count, (b) hair density, (c) hair diameter diversity, perifollicular pigmentation, yellow dots, multi-hair follicular units, honeycomb pigment pattern and white dots, (d) patient's hair growth assessment score.

RESULTS

Posttherapy, patients showed significant improvement in hair count (27.4%), hair diversity (84.2%), increase in number of thick, terminals hairs, reduction in yellow dots (60%), perifollicular pigmentation (92.3%) was appreciated. Hair pull test negative after treatment in 10 patients (50%). Patient's hair growth assessment score showed 50%-75% improvement in 7 (35%) patients.

CONCLUSION

Dermoscopy helps to easily evaluate and compare the therapeutic response pre- and posttreatment which can be easily documented and visualized at every visit.

Platelet rich plasma for treatment of non-scarring hair loss: systematic review of literature

BACKGROUND

Although there are many studies showing the role of platelet rich plasma (PRP) in bone grafts, teeth osteosynthesis, and wound healing, there have been little peer reviewed studies about the safety and efficacy of PRP application in the treatment of hair loss.

MATERIALS AND METHODS

In this systematic review, we searched Ovid Medline, Scopus and Web of Knowledge till November 2015 for human studies evaluating the efficacy of PRP for the treatment of non-cicatricial alopecia.

RESULTS

Among 704 articles retrieved in first search, 18 articles matched our inclusion criteria, 14 for androgenic alopecia and four for alopecia areata. They included two case reports, eight case series, six controlled clinical trials and only two randomized controlled trials.

CONCLUSIONS

Most of the available evidence has shown low quality and controversial results about the efficacy of PRP in treating non-cicatricial alopecias, including androgenetic alopecia and alopecia areata. Further randomized controlled studies with more sample size and standard protocols regarding the number and interval of treatment sessions, number of platelets, method of activation, etc., are required to investigate the efficacy and safety of PRP in treating hair loss.

Platelet-rich plasma for androgenetic alopecia: Does it work? Evidence from meta analysis

INTRODUCTION

The use of platelet-rich plasma (PRP) has increased among different surgical specialities for the treatment of various conditions. Androgenetic alopecia is a common condition, with severe attendant psychosocial implications. PRP injections for hair restoration have become a popular practice among plastic surgeons. We performed a meta-analysis comparing local injection of platelet-rich plasma versus control to evaluate this issue in order to investigate the effectiveness of PRP local injections for androgenetic alopecia.

METHODS

A systematic literature search was performed. Primary outcome was the increase in number of hairs. Secondary outcomes were the increase in hair thickness and the percentage increase in hair number and thickness. We performed random-effect analysis.

RESULTS

Six studies involving 177 patients were retrieved and included in the present analysis. A significantly locally increased hair number per cm² was observed after PRP injections versus control (mean difference (MD) 17.90, 95%CI 5.84-29.95, P=.004). Similarly, a significantly increased hair thickness cross section per 10^-4  mm² (MD 0.22, 95%CI 0.07-0.38, P=.005) favoring PRP group. The pooled results did not show statistically significant differences in percentage increase in hair number (MD 24.12%, 95%CI -12.76-60.99, P=.20) and hair thickness (MD 32.63%, 95%CI -16.23-81.48, P=0.19) among patients treated with PRP.

CONCLUSIONS

Local injection of PRP for androgenic alopecia might be associated with an increased number of hairs and some hair thickness improvement in the treated areas with minimal morbidity. The results of this meta-analysis should be interpreted with caution as it consists of pooling many small studies. Larger randomized studies can verify this perception.

Autologous Platelet-Rich Plasma for the Treatment of Pattern Hair Loss

Platelet-rich plasma (PRP) is a solution derived from whole blood that is enriched in the platelet fraction. Platelets serve as a reservoir of growth factors and cytokines. When platelets are activated in vivo, signaling molecules are released into the immediate microenvironment and activate receptors for various pathways. Historically, PRP has been applied to wound beds to promote healing of complex wounds. Over the last decade, it has served as a valuable therapeutic tool in various specialties such as maxillofacial surgery, plastic surgery, orthopedics and sports medicine. Only recently has PRP been utilized for dermatologic purposes, more specifically, for the treatment of male and female pattern hair loss. In this review, we discuss molecular and cellular pathways upregulated by PRP important in hair folliculogenesis, and examine clinical evidence from all previously published studies involving the use of PRP for pattern hair loss.

Systematic review of the use of platelet-rich plasma in aesthetic dermatology

Platelet-rich plasma (PRP) is a highly concentrated autologous solution of plasma prepared from a patient's own blood. PRP contains platelets that are purported to release numerous growth factors that may be valuable in numerous dermatologic applications. Here, we review systematically the clinical cosmetic applications of PRP including: androgenetic alopecia, scar revision, acne scars, skin rejuvenation, dermal augmentation, and striae distensae to understand the potential and best practices for PRP use. A systematic search was conducted on three databases: Pubmed, Embase, and Web of Science. Publications were included if they were in English, investigated the clinical applications of PRP in aesthetic dermatology and reported clinical results either as case reports or clinical studies. There were a total of 22 manuscripts that fulfilled these criteria. Four evaluated hair-related applications, eight evaluated the treatment of scars and postprocedure recovery, eight evaluated skin rejuvenation and dermal augmentation, and two evaluated treatment of striae distensae. PRP is a relatively new treatment modality with studies suggesting its utility in aesthetic dermatology. The combination of PRP with other therapies is particularly interesting. Future studies should include controls, including incorporation of split-face comparisons, to reduce intersubject variability.