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Santos LC, Lana GL, Santos GS, Visoni SBC, Brigagão RJ, Santos N, Sobreiro R, da Cruz Silva Reis A, Rodrigues BL, Ferrari S, Tambeli CH, Lana JF. The Biological Role of Platelet Derivatives in Regenerative Aesthetics. Int J Mol Sci 2024; 25:5604. [PMID: 38891792 PMCID: PMC11172268 DOI: 10.3390/ijms25115604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Bioproducts derived from platelets have been extensively used across various medical fields, with a recent notable surge in their application in dermatology and aesthetic procedures. These products, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), play crucial roles in inducing blood vessel proliferation through growth factors derived from peripheral blood. PRP and PRF, in particular, facilitate fibrin polymerization, creating a robust structure that serves as a reservoir for numerous growth factors. These factors contribute to tissue regeneration by promoting cell proliferation, differentiation, and migration and collagen/elastin production. Aesthetic medicine harnesses these effects for diverse purposes, including hair restoration, scar treatment, striae management, and wound healing. Furthermore, these biological products can act as adjuvants with other treatment modalities, such as laser therapy, radiofrequency, and microneedling. This review synthesizes the existing evidence, offering insights into the applications and benefits of biological products in aesthetic medicine.
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Affiliation(s)
| | - Giselle Lobo Lana
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
| | - Gabriel Silva Santos
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
| | - Silvia Beatriz Coutinho Visoni
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
| | - Rayssa Junqueira Brigagão
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
| | - Napoliane Santos
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
| | - Rafaela Sobreiro
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
| | - Andreza da Cruz Silva Reis
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
| | - Bruno Lima Rodrigues
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
| | - Sabrina Ferrari
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
| | | | - José Fábio Lana
- Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.L.L.); (S.B.C.V.); (R.J.B.); (N.S.); (R.S.); (A.d.C.S.R.); (B.L.R.); (S.F.); (J.F.L.)
- Medical School, Max Planck University Center (UniMAX), Indaiatuba 13343-060, Brazil
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, Brazil
- Clinical Research, Anna Vitória Lana Institute (IAVL), Indaiatuba 13334-170, Brazil
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Donnelly C, Minty I, Dsouza A, Wong YY, Mukhopadhyay I, Nagarajan V, Rupra R, Charles WN, Khajuria A. The role of platelet-rich plasma in androgenetic alopecia: A systematic review. J Cosmet Dermatol 2024; 23:1551-1559. [PMID: 38284294 DOI: 10.1111/jocd.16185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/21/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Androgenetic alopecia (AGA), also referred to as male or female pattern hair loss, is the commonest cause of chronic hair loss and affects up to 80% of men by the age of 70. Despite a high prevalence, there are few approved therapies, which show minimal efficacy. OBJECTIVES This systematic review aims to evaluate the efficacy of platelet-rich plasma (PrP) in the treatment of AGA in male patients. METHODS MEDLINE, EMBASE, Cochrane (CENTRAL), CINAHL, clinicaltrials.gov, Google Scholar and the Science Citation Index database were searched to identify eligible studies. All randomized controlled trials (RCTs) and prospective cohort studies related to PrP use in AGA were included. Primary outcomes included changes in hair density and hair count. Methodological quality was assessed using bias assessment tools. RESULTS Eight RCTs and one cohort study were included in the review with a total of 291 participants. Six studies reported a statistically significant increase in hair density in the PrP group versus the control. Five studies reported a statistically significant increase in hair count with PrP. Seven studies showed moderate risk and two showed low risk of bias. CONCLUSION In a methodologically robust review on the effectiveness of PrP on male AGA, PrP demonstrated some potential to be used therapeutically. However, the low quality of evidence, moderate risk of bias, and high heterogeneity of included studies limit inferences and call for more robust designs to investigate this further.
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Affiliation(s)
- C Donnelly
- Green Templeton College, University of Oxford, Oxford, UK
| | - I Minty
- University College Hospital, London, UK
| | - A Dsouza
- Kasturba Medical College, Manipal, Karnataka, India
| | - Y Y Wong
- University of Glasgow, Glasgow, UK
| | | | - V Nagarajan
- University Hospital Leicester, Leicester, UK
| | - R Rupra
- Norfolk & Norwich University Hospital, Norwich, UK
| | - W N Charles
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Khajuria
- Department of Surgery and Cancer, Imperial College London, London, UK
- Kellogg College, University of Oxford, Oxford, UK
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Li M, Qu K, Lei Q, Chen M, Bian D. Effectiveness of Platelet-Rich Plasma in the Treatment of Androgenic Alopecia: A Meta-Analysis. Aesthetic Plast Surg 2024; 48:977-984. [PMID: 37644190 PMCID: PMC10980625 DOI: 10.1007/s00266-023-03603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Androgenetic alopecia (AGA) is a common yet difficult-to-treat condition, which is an important psychosocial problem. Platelet-rich plasma (PRP) therapy has been considered as a promising treatment for AGA. However, the current evidence on the efficacy of PRP for treating AGA is still controversial. This study evaluated the efficacy of PRP monotherapy in the treatment of AGA. METHODS We searched PubMed, Embase, Cochrane Library and Web of Science to collect randomized controlled trials on use of PRP in AGA for a meta-analysis. RESULTS Ten trials with a total 555 treatment units were identified. The hair density in PRP group was significantly higher than control group [MD = 25.09, 95%CI: 9.03-41.15, p = 0.002], but there was no significant difference in hair diameter between two groups [SMD = 0.57, 95%CI: - 0.23 to 1.38, p = 0.16]. Subgroup analyses indicated that hair density was significantly higher among the male-only trials than in the mixed-sex samples (p = 0.02). In addition, neither the split-head design nor the year of publication affected hair density (p = 0.05, p = 0.06). However, hair density was significantly higher in trials with a sample size less than 30 (p = 0.0004). CONCLUSIONS PRP treatment increased hair density in participants with AGA, but not hair diameter. In terms of hair density, PRP elicits stronger effects in male patients. There was a trend toward differed treatment effect by gender with PRP injection, which warrants further investigation. Especially in the case of female. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .
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Affiliation(s)
- Meijia Li
- Department of Burn and Plastic Surgery, The 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250001, China
| | - Kaipan Qu
- Department of Burn and Plastic Surgery, Shandong Provincial Third Hospital, Jinan, China
| | - Qiang Lei
- Department of Burn and Plastic Surgery, The 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250001, China
| | - Mingrui Chen
- Department of Burn and Plastic Surgery, The 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250001, China
| | - Donghui Bian
- Department of Burn and Plastic Surgery, The 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250001, China.
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Wang S, Li D, Zou M, Wu J, Wang X, Yang Y, Li X, Yang W. Efficacy of autologous platelet-rich plasma combined with a non-cross-linked hyaluronic acid compound in the treatment of female androgenetic alopecia: A retrospective, case-series study. J Cosmet Dermatol 2023; 22:3268-3275. [PMID: 37337401 DOI: 10.1111/jocd.15861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/15/2023] [Accepted: 05/29/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Female androgenetic alopecia (FAGA) is a condition that affects women and involves the gradual loss of terminal hair in specific areas of the scalp. The limited treatment options for FAGA necessitate the development of new strategies. This study aimed to evaluate the potential benefit of using a combination therapy composed of autologous platelet-rich plasma (PRP) and a non-cross-linked hyaluronic acid (HA) compound in the treatment of FAGA. METHODS This was a retrospective, case-series study, which enrolled nine female patients with FAGA between September 2021 and December 2022. The non-cross-linked HA compound (Hearty®, Imeik Technology Development Co., Ltd.) and PRP were implanted into the areas of hair loss over four treatment sessions separated by 4-week intervals. Patients were monitored for overall improvement in their hair loss, hair count, treatment satisfaction, and adverse events at 1, 3, and 6 months follow-up. RESULTS The improvement rates, subjectively evaluated by the study physician, were 88.89% at the 1-month and 100% at the 3-month follow-up, relative to baseline. Moreover, the quantitative evaluation results showed that the FAGA patients' hair density increased by 54.51% at the 1-month and by 77.25% at the 3-month follow-up. CONCLUSION The combination of PRP and non-cross-linked HA compound appeared to be a certain positive effective procedure for FAGA without serious adverse event. We envisage that this work will contribute to the development of new treatment options for women suffering from this condition.
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Affiliation(s)
- Shiwei Wang
- Department of Medical, Imeik Technology Development Co., Ltd., Beijing, China
| | - Dongmei Li
- Department of Medical Cosmetology, Beijing Huaxia Medical Beauty Hospital, Beijing, China
| | - Muyan Zou
- Department of Medical, Imeik Technology Development Co., Ltd., Beijing, China
| | - Jiaxu Wu
- Department of Medical, Imeik Technology Development Co., Ltd., Beijing, China
| | - Xuehan Wang
- Department of Medical Cosmetology, Beijing Huaxia Medical Beauty Hospital, Beijing, China
| | - Yu Yang
- Department of Medical Cosmetology, Beijing Huaxia Medical Beauty Hospital, Beijing, China
| | - Xin Li
- Department of Medical, Imeik Technology Development Co., Ltd., Beijing, China
| | - Wei Yang
- Department of Medical Cosmetology, Beijing Huaxia Medical Beauty Hospital, Beijing, China
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Sebbagh P, Hirt-Burri N, Scaletta C, Abdel-Sayed P, Raffoul W, Gremeaux V, Laurent A, Applegate LA, Gremion G. Process Optimization and Efficacy Assessment of Standardized PRP for Tendinopathies in Sports Medicine: Retrospective Study of Clinical Files and GMP Manufacturing Records in a Swiss University Hospital. Bioengineering (Basel) 2023; 10:bioengineering10040409. [PMID: 37106596 PMCID: PMC10135571 DOI: 10.3390/bioengineering10040409] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Platelet-rich plasma (PRP) preparations have recently become widely available in sports medicine, facilitating their use in regenerative therapy for ligament and tendon affections. Quality-oriented regulatory constraints for PRP manufacturing and available clinical experiences have underlined the critical importance of process-based standardization, a pre-requisite for sound and homogeneous clinical efficacy evaluation. This retrospective study (2013–2020) considered the standardized GMP manufacturing and sports medicine-related clinical use of autologous PRP for tendinopathies at the Lausanne University Hospital (Lausanne, Switzerland). This study included 48 patients (18–86 years of age, with a mean age of 43.4 years, and various physical activity levels), and the related PRP manufacturing records indicated a platelet concentration factor most frequently in the range of 2.0–2.5. The clinical follow-up showed that 61% of the patients reported favorable efficacy outcomes (full return to activity, with pain disappearance) following a single ultrasound-guided autologous PRP injection, whereas 36% of the patients required two PRP injections. No significant relationship was found between platelet concentration factor values in PRP preparations and clinical efficacy endpoints of the intervention. The results were in line with published reports on tendinopathy management in sports medicine, wherein the efficacy of low-concentration orthobiologic interventions appears to be unrelated to sport activity levels or to patient age and gender. Overall, this study confirmed the effectiveness of standardized autologous PRP preparations for tendinopathies in sports medicine. The results were discussed in light of the critical importance of protocol standardization for both PRP manufacturing and clinical administration to reduce biological material variability (platelet concentrations) and to enhance the robustness of clinical interventions (comparability of efficacy/patient improvement).
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Affiliation(s)
- Patrick Sebbagh
- Regenerative Therapy Unit, Plastic, Reconstructive & Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (P.S.); (N.H.-B.); (C.S.); (P.A.-S.); (W.R.); (A.L.); (G.G.)
| | - Nathalie Hirt-Burri
- Regenerative Therapy Unit, Plastic, Reconstructive & Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (P.S.); (N.H.-B.); (C.S.); (P.A.-S.); (W.R.); (A.L.); (G.G.)
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Corinne Scaletta
- Regenerative Therapy Unit, Plastic, Reconstructive & Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (P.S.); (N.H.-B.); (C.S.); (P.A.-S.); (W.R.); (A.L.); (G.G.)
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Philippe Abdel-Sayed
- Regenerative Therapy Unit, Plastic, Reconstructive & Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (P.S.); (N.H.-B.); (C.S.); (P.A.-S.); (W.R.); (A.L.); (G.G.)
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
- DLL Bioengineering, STI School of Engineering, Ecole Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland
| | - Wassim Raffoul
- Regenerative Therapy Unit, Plastic, Reconstructive & Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (P.S.); (N.H.-B.); (C.S.); (P.A.-S.); (W.R.); (A.L.); (G.G.)
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Vincent Gremeaux
- Sport Medicine Unit, Division of Physical Medicine and Rehabilitation, Swiss Olympic Medical Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
| | - Alexis Laurent
- Regenerative Therapy Unit, Plastic, Reconstructive & Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (P.S.); (N.H.-B.); (C.S.); (P.A.-S.); (W.R.); (A.L.); (G.G.)
- Manufacturing Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland
| | - Lee Ann Applegate
- Regenerative Therapy Unit, Plastic, Reconstructive & Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (P.S.); (N.H.-B.); (C.S.); (P.A.-S.); (W.R.); (A.L.); (G.G.)
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, CH-8057 Zurich, Switzerland
- Correspondence: ; Tel.: +41-21-314-35-10
| | - Gerald Gremion
- Regenerative Therapy Unit, Plastic, Reconstructive & Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (P.S.); (N.H.-B.); (C.S.); (P.A.-S.); (W.R.); (A.L.); (G.G.)
- Sport Medicine Unit, Division of Physical Medicine and Rehabilitation, Swiss Olympic Medical Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
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Sebbagh P, Cannone A, Gremion G, Gremeaux V, Raffoul W, Hirt-Burri N, Michetti M, Abdel-Sayed P, Laurent A, Wardé N, Applegate LA. Current Status of PRP Manufacturing Requirements & European Regulatory Frameworks: Practical Tools for the Appropriate Implementation of PRP Therapies in Musculoskeletal Regenerative Medicine. Bioengineering (Basel) 2023; 10:bioengineering10030292. [PMID: 36978683 PMCID: PMC10044789 DOI: 10.3390/bioengineering10030292] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023] Open
Abstract
Providing accurate and up-to-date practical tools enabling oversight of platelet-rich plasma (PRP) legislation and of the appropriate standards to be implemented for its manufacture and use in Europe is a demanding task. This is due to rapid medico-technological advancements, slowness and disparity in legislation updates and enforcement between member states, and many reported gray-zone practices, notably for autologous PRP use. The levels of risk associated with blood manipulation processes generally dictate the manufacturing requirements for PRP preparations, which have gradually shifted toward good manufacturing practices (GMP) for standardization and overall quality enhancement. This work firstly outlines Western European and Swiss legislation for PRP products/preparations, providing key simplified information and recommendations for medical doctors seeking to implement this biological-based therapy for safe use in hospital settings, clinics, or private offices. This work secondly shows the importance of PRP-based product manufacturing standardization, which subsequently enables sound clinical evaluation of therapeutic interventions. Although the applicable legal bases provide guidelines for GMP manufacturing infrastructure and basic process design, paramount importance is set on the definition of workflows, technical specifications, and key parameters for PRP preparation and delivery. Overall, the development of simple and robust technologies and processes for PRP preparation is critical for guaranteeing the high therapeutic quality of the intervention, in collaboration with qualified GMP manufacturing platforms. Importantly, this work aims to serve as a practical tool for clinicians based in Western Europe who are willing to appropriately (i.e., administratively and technically) implement autologous PRP treatments in musculoskeletal regenerative medicine workflows, to ensure they make informed and optimal regulatory or process-based decisions.
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Integrative and Mechanistic Approach to the Hair Growth Cycle and Hair Loss. J Clin Med 2023; 12:jcm12030893. [PMID: 36769541 PMCID: PMC9917549 DOI: 10.3390/jcm12030893] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
The hair cycle is composed of four primary phases: anagen, catagen, telogen, and exogen. Anagen is a highly mitotic phase characterized by the production of a hair shaft from the hair follicle, whereas catagen and telogen describe regression and the resting phase of the follicle, respectively, ultimately resulting in hair shedding. While 9% of hair follicles reside in telogen at any time, a variety of factors promote anagen to telogen transition, including inflammation, hormones, stress, nutritional deficiency, poor sleep quality, and cellular division inhibiting medication. Conversely, increased blood flow, direct stimulation of the hair follicle, and growth factors promote telogen to anagen transition and subsequent hair growth. This review seeks to comprehensively describe the hair cycle, anagen and telogen balance, factors that promote anagen to telogen transition and vice versa, and the clinical utility of a variety of lab testing and evaluations. Ultimately, a variety of factors impact the hair cycle, necessitating a holistic approach to hair loss.
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Paichitrojjana A, Paichitrojjana A. Platelet Rich Plasma and Its Use in Hair Regrowth: A Review. Drug Des Devel Ther 2022; 16:635-645. [PMID: 35300222 PMCID: PMC8922312 DOI: 10.2147/dddt.s356858] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Platelet rich plasma (PRP) was described as a small volume of plasma containing higher concentrations of platelets than those found in peripheral blood and initially used as a transfusion product for treatment of thrombocytopenia. To date, it was discovered that there are several growth factors and cytokines that can accelerate wound healing and tissue regeneration, leading to a wider range of applications in the medical field, such as in sport medicine, regenerative medicine, and aesthetic medicine. Several studies have shown that PRP can be used effectively for treatment of hair loss. Although it has been widely used, the exact mechanism of action of PRP is still not fully elucidated. In this article, we aim to review and update current information on the definition, classification, mechanism of action, clinical efficacy in hair regrowth, and adverse events of PRP.
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Affiliation(s)
- Anon Paichitrojjana
- School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
- Correspondence: Anon Paichitrojjana, School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, 36/87-88 PS Tower 25Fl, Asoke Road, Sukhumvit 21, Klong Toey Nua, Wattana, Bangkok, 10110, Thailand, Tel +66 81-9343050, Email
| | - Anand Paichitrojjana
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Gupta AK, Bamimore MA. The effect of placebo in split-scalp and whole-head platelet-rich plasma trials for androgenetic alopecia differs: Findings from a systematic review with quantitative evidence syntheses. J Cosmet Dermatol 2022; 21:1454-1463. [PMID: 35100488 DOI: 10.1111/jocd.14813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Some studies have shown that platelet-rich plasma (PRP) improves androgenetic alopecia (AGA)-while others do not. We determined whether the placebo effect significantly varies between split-scalp and whole-head trials on PRP monotherapy for AGA. Our rationale was based on the plausibility of PRP diffusing to the control (i.e., 'placebo') side of split-scalp trials. This is not possible in whole head studies. METHODS We systematically searched the literature for available data. Our choice of analyses and outcomes were determined by the available data. RESULTS Our endpoint was change in total hair density six months after baseline. Our regression showed that total hair density after six months was significantly (p<0.05) higher in the placebo arm of split-scalp trials, compared to whole-head studies, by 37 hairs/cm2 . Our one-arm meta-analyses showed that the pooled change in total hair density between the PRP side and placebo side in split scalp studies was -3 hairs/cm2 (p=0.37), that is, a slight decrease in hair density in the placebo side of the scalp. For whole head stdies the corresponding difference in total hair density between patients receiving PRP and those on placebo was -30 hairs/cm2 (p=0.000017), that is, a much larger decrease in hair density. Patients in the placebo group in whole-head trials lost significantly more hair than in the placebo side of the split-head trials where hair loss was comparatively reduced-presumably because of PRP diffusing from the treatment side of the scalp. CONCLUSIONS The association between design (i.e., split-scalp vs. whole-head) and outcome, in placebo arms of AGA trials on PRP monotherapy, had never been reported. This 'design effect' could partly reconcile the incongruent conclusions across the PRP literature for AGA; furthermore, clinical guidelines can consider 'design effect' when selecting evidence to base care practices on.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc, London, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
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Klifto KM, Othman S, Kovach SJ. Minoxidil, Platelet-Rich Plasma (PRP), or Combined Minoxidil and PRP for Androgenetic Alopecia in Men: A Cost-Effectiveness Markov Decision Analysis of Prospective Studies. Cureus 2021; 13:e20839. [PMID: 35141088 PMCID: PMC8800610 DOI: 10.7759/cureus.20839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background Androgenetic alopecia (AGA) is the most common cause of hair loss in men. In this study, we evaluated the cost-effectiveness of minoxidil monotherapy, minoxidil and platelet-rich plasma (PRP) combined therapy, and PRP monotherapy for the long-term treatment of early-onset AGA Hamilton-Norwood stages I-V in men. Methodology Markov modeling was performed to analyze the base-case parameters from 18 level I/II studies. The model base-case assumes a healthy 25-year-old man presenting to a dermatologist or plastic surgeon’s office as a new patient for the evaluation and treatment of AGA Hamilton-Norwood stages I-V (non-severe AGA in men). Simulations began at an age of 25 years and ran over 35 years. Analyses were conducted from healthcare and societal perspectives. Outcomes included incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness-to-pay (WTP) thresholds were set at $50,000 and $100,000. Deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty over 10,000 simulations. Results From a healthcare perspective, compared to minoxidil monotherapy, the ICER for minoxidil+PRP was $52,036/quality-adjusted-life-year (QALY) and the ICER for PRP monotherapy was $439,303/QALY. The NMB of minoxidil monotherapy was $914,887, minoxidil+PRP was $914,350, and PRP monotherapy was $904,572 at a WTP threshold of $50,000. When the WTP threshold was increased to $100,000, the NMB of minoxidil+PRP was $1,843,908, minoxidil monotherapy was $1,831,237, and PRP monotherapy was $1,822,246. Societal trends were similar. Conclusions Minoxidil 5% topical twice-daily monotherapy provided cost-effective treatment for men with AGA Hamilton-Norwood stages I-V at a WTP threshold of $50,000, whereas combining minoxidil 5% with PRP provided cost-effective treatment at a WTP threshold of $100,000. Level of evidence: Level II.
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Laufer Britva R, Keren A, Ginzburg A, Ullmann Y, Paus R, Gilhar A. Evidence from a humanized mouse model of androgenetic alopecia that platelet-rich plasma stimulates hair regrowth, hair shaft diameter and vellus-to-terminal hair reconversion in vivo. Br J Dermatol 2021; 185:644-646. [PMID: 33763895 DOI: 10.1111/bjd.20084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 01/08/2023]
Affiliation(s)
- R Laufer Britva
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion -Israel Institute of Technology, Haifa, Israel.,Departments of, Plastic and Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel.,Department of, Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - A Keren
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion -Israel Institute of Technology, Haifa, Israel.,Departments of, Plastic and Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
| | - A Ginzburg
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion -Israel Institute of Technology, Haifa, Israel
| | - Y Ullmann
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion -Israel Institute of Technology, Haifa, Israel.,Departments of, Plastic and Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
| | - R Paus
- Dr. Philipp Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Centre for Dermatology Research, University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester, UK.,Monasterium Laboratory, Münster, Germany
| | - A Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion -Israel Institute of Technology, Haifa, Israel.,Departments of, Plastic and Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
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Investigating the Safety and Efficacy of Platelet-Rich Plasma (PRP) Treatment for Female Androgenetic Alopecia: Review of the Literature. ACTA ACUST UNITED AC 2021; 57:medicina57040311. [PMID: 33806169 PMCID: PMC8066895 DOI: 10.3390/medicina57040311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 12/18/2022]
Abstract
Background: female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women, affecting approximately 40% of women by age 50, bearing a significant psychosocial burden on affected patients. Platelet-rich plasma (PRP) has been widely investigated as a potential effective treatment for several dermatological conditions, including male androgenetic alopecia (MAGA). However, few studies have been conducted focusing on the use of PRP in FAGA. The aim of this review was to identify reports that investigated the use of PRP for the treatment of FAGA. Methods: Electronic databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to September 2020 have been searched using different combinations of the following terms: “androgenetic alopecia,” “FAGA,” “female pattern hair loss,” “platelet-rich fibrin,” “platelet-rich plasma,” and “PRP”. Results and conclusions: Eight (n = 8) clinical studies consistent with our research were identified. A total of 197 subjects has been enrolled in the included studies. All of them were adult female patients (mean age: 38.9) affected by female pattern hair loss. PRP is a well-tolerated procedure which showed promising results in males-only and mixed populations of AGA patients. PRP showed to produce high levels of satisfaction and improvement in the quality of life in patients affected by FAGA. In the light of this evidence, PRP may be proposed in patients who did not respond or did not tolerate topical minoxidil, as well as in combination with topical and oral treatments.
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Gupta AK, Venkataraman M, Quinlan EM. Artificial hair implantation for hair restoration. J DERMATOL TREAT 2021; 33:1312-1318. [PMID: 33565339 DOI: 10.1080/09546634.2021.1887442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Artificial hair implantation is considered an alternative treatment when the donor area is depleted or unsuitable for hair transplantation. The use of artificial hair implants remains controversial, particularly because this practice has been banned by the US FDA. OBJECTIVE To summarize various aspects of artificial hair implantation. METHODS We discuss the history of artificial hair implantation, development of new biocompatible fibers (Biofibre®, Nido Z-type), patient eligibility for this treatment, implantation technique, follow-up, immune response to the implanted fibers, and post-implantation complications. We performed a methodological quality assessment of the clinical studies that investigated artificial hair implantation using the Canadian Institute of Health Economics (IHE) Quality Appraisal Tool for Case Series (Interventional). RESULTS Although the studies evaluating the use of artificial hair fibers appear promising, the methodological quality of most of them was between 'poor' and 'fair', due to lack of randomization, absence of control groups, improper study design, and inappropriate outcome measures. CONCLUSIONS Artificial hair implantation has been received with skepticism among physicians due to the complications reported. Further high-quality research needs to be performed to ascertain the safety and efficacy of artificial hair implantation.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc, London, Canada.,Department of Medicine, Division of Dermatology, University of Toronto School of Medicine, Toronto, Canada
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Hooper D. Platelet-rich plasma has a place in the treatment of androgenetic alopecia. J Am Acad Dermatol 2020; 84:1186-1187. [PMID: 33253835 DOI: 10.1016/j.jaad.2020.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Deirdre Hooper
- Audubon Dermatology and the Departments of Dermatology at Louisiana State University and Tulane University, New Orleans, Louisiana.
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