Article

A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata

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Abstract

Alopecia areata (AA) is a common autoimmune condition, causing inflammation-induced hair loss. This disease has very limited treatment possibilities, and no treatment is either curative or preventive. Platelet-rich plasma (PRP) has emerged as a new treatment modality in dermatology, and preliminary evidence has suggested that it might have a beneficial role in hair growth. To evaluate the efficacy and safety of PRP for the treatment of AA in a randomized, double-blind, placebo- and active-controlled, half-head, parallel-group study. Forty-five patients with AA were randomized to receive intralesional injections of PRP, triamcinolone acetonide (TrA) or placebo on one half of their scalp. The other half was not treated. Three treatments were given for each patient, with intervals of 1 month. The endpoints were hair regrowth, hair dystrophy as measured by dermoscopy, burning or itching sensation, and cell proliferation as measured by Ki-67 evaluation. Patients were followed for 1 year. PRP was found to increase hair regrowth significantly and to decrease hair dystrophy and burning or itching sensation compared with TrA or placebo. Ki-67 levels, which served as markers for cell proliferation, were significantly higher with PRP. No side-effects were noted during treatment. This pilot study, which is the first to investigate the effects of PRP on AA, suggests that PRP may serve as a safe and effective treatment option in AA, and calls for more extensive controlled studies with this method.

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... 30 For Alopecia Areata: Three patchy AA studies met inclusion criteria; however, not enough quantitative data were included to conduct a meta-analysis. [36][37][38] Only 2 studies (2/3 = 67%) were randomized and controlled, comparing PRP with a placebo and an active comparator (minoxidil or triamcinolone ace-tonide). 36,37 One study used a half-head design,37 and PRP sessions were delivered monthly across all included studies (Table 1). ...
... [36][37][38] Only 2 studies (2/3 = 67%) were randomized and controlled, comparing PRP with a placebo and an active comparator (minoxidil or triamcinolone ace-tonide). 36,37 One study used a half-head design,37 and PRP sessions were delivered monthly across all included studies (Table 1). [36][37][38] Two studies evaluated the efficacy of PRP both in men and women, 36,37 and one study did not report gender. ...
... 36,37 One study used a half-head design,37 and PRP sessions were delivered monthly across all included studies (Table 1). [36][37][38] Two studies evaluated the efficacy of PRP both in men and women, 36,37 and one study did not report gender. 38 Two studies also reported the use of activation (calcium gluconate) 36,37 and only one study reported platelet concentration (3.5× whole blood). ...
... In patients treated with PRP, an increased expression of Ki-67, an indicator of cellular proliferation is seen. [90] Furthermore, in AA, β-catenin and basic FGF act on melanocyte differentiation and melanin synthesis to encourage the growth of pigmented hairs. [91,92] PRP may also be effective in AA through anti-inflammatory mechanisms owing to its ability to suppress MCP-1, a chemokine involved in generating a local inflammatory reaction around the hair bulb. ...
... TGF-β, an immune modulator is normally released by HFs to create a local "immune privileged" environment and its levels are significantly reduced in patients with AA. [95] In a double-blinded, placebo and active-controlled triamcinolone acetonide (TAC) injections (2.5 mg/mL), halfhead, parallel group study on 45 patients of AA, PRP was found to significantly improve HRG and to decrease hair dystrophy as well burning and pruritus sensation without any side effects. [90] Moreover, 96% of the patients treated with PRP appeared to regrow pigmented hairs from the beginning of hair regrowth compared with 25% of those treated with TAC. ...
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Platelet-rich plasma (PRP) contains several growth factors and cellular adhesion molecules which promote wound healing, angiogenesis and accelerate the rejuvenation of skin and hair follicles. With its proven regenerative and regrowth potential in a plethora of conditions, PRP has been deemed as the “futuristic elixir.” Current evidence suggests that PRP effectively stimulates angiogenesis, collagen as well as elastin regeneration, and is a safe, easy to prepare, minimally invasive technique with limited downtime, and negligible risk of allergic/hypersensitivity reactions owing to its autologous nature. It has shown excellent results when utilized as monotherapy or in combination with microneedling or ablative lasers in acne scars, post-burn or post-traumatic scars, melasma, striae distensae, chronic ulcers, and lichen sclerosus. PRP injections or PRP combined with microneedling are increasingly being utilized for skin rejuvenation and recently have been utilized to provide non-invasive face lifts. A novel technique combining non-cultured epidermal cell suspension suspended in PRP results in superior repigmentation outcomes in case of vitiligo. Use of PRP alone or in combination with hair transplant in androgenetic alopecia is another well-researched indication and its use has been successfully extrapolated to indications such as alopecia areata, chronic telogen effluvium, and cicatricial alopecia. In spite of its established efficacy in such a vast number of indications, PRP should be used with utmost caution. These growth mediators exert their own endocrine, paracrine, and enzymatic effects, the complete influence of which still remains a mystery and only years of experience, in the times to come will unravel the absolute power of our “mighty dragon warrior.”
... Elmaadawi et al. [13] reported that 35% of AA patients treated with autologous stem cells or by autologous follicular stem cell injection achieved ≥ 50% hair regrowth. Trink et al. [14] who used platelet-rich plasma (PRP) to treat AA also reported that 60% of PRP treated patients achieved complete remission. Li et al. [15] demonstrated that patients with severe AA showed improvement of hair regrowth and quality of life after receiving stem cell educator therapy. ...
... Time-dependent effects of ASC-CM/fractional CO 2 laser or microneedling combination therapy; Responders (Patients 1-9) and non-responders (Patients[10][11][12][13][14] ...
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Management of alopecia areata (AA) is often challenging especially when patients have AA lesion refractory to conventional treatments such as corticosteroids, contact immunotherapy, and systemic therapy. Reports indicate adipocyte-derived stem cell conditioned media (ASC-CM) can activate hair growth and micro-injury using fractional laser or microneedling can also induce wound healing and hair regeneration, which suggests ASC-CM combined with fractional laser or microneedling might provide alternative therapeutic option for a refractory patch of AA. This study aimed to evaluate the clinical efficacy and safety of ASC-CM combined with 10,600 nm carbon dioxide fractional laser or microneedling for the treatment of refractory patch of AA. This retrospective study was based on evaluations of 14 patients with a refractory patch of AA treated with ASC-CM, combined with a 10,600 nm carbon dioxide fractional laser, or microneedling from March 2017 to August 2020. The efficacy of treatment was assessed by extents of hair regrowth percentages of involved areas. Of the 14 enrolled patients, 9 (64.3%) showed > 50% hair regrowth and 6 patients (42.9%) showed complete recovery. In the responder group (n = 9), mean period to achieve > 50% hair regrowth was 11.3 weeks (range 8–16 weeks). In the non-responder group (n = 5), 4 patients (28.6%) showed < 25% of hair regrowth and 1 patient show slight hair regrowth (7.1%) after 3 months of treatment. This study showed ASC-CM combined with 10,600 nm carbon dioxide fractional laser or microneedling may offer effective and safe treatment options for a refractory patch of AA.
... Trink et al. performed a randomized, double-blinded, placebo and active-controlled, half-head study on 45 AA patients. They found that three PRP treatments with 1 month interval could significantly increase hair regrowth compared with placebo or baseline [177]. Importantly, their results showed that PRP had significantly better dermoscopic results than intralesional TAC (2.5 mg/ml) [177]. ...
... They found that three PRP treatments with 1 month interval could significantly increase hair regrowth compared with placebo or baseline [177]. Importantly, their results showed that PRP had significantly better dermoscopic results than intralesional TAC (2.5 mg/ml) [177]. In other randomized controlled trials, PRP has shown a superior efficacy to minoxidil 5%, and a comparable response to the injection of ICs [178,179]. ...
Article
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Alopecia areata (AA) is a common chronic tissue-specific autoimmune disease, resulting in hair loss, that affects up to 2% of the general population. The exact pathobiology of AA has still remained elusive, while the common theory is the collapse of the immune privilege of the hair follicle caused by immunological mechanism. Multiple genetic and environment factors contribute to the pathogenesis of AA. There are several clinical treatments for AA, varying from one or multiple well-defined patches to more diffuse or total hair loss of the scalp (alopecia totalis) or hair loss of the entire body (alopecia universalis). The available treatments for AA, such as corticosteroids and other immunomodulators, minoxidil, and contact immunotherapy, are of limited efficacy with a high risk of adverse effects and high recurrence rates, especially for patients with severe AA. Recent insights into the pathogenesis of AA have led to the development of new treatment strategies, such as Janus kinase (JAK) inhibitors, biologics, and several small molecular agents. In addition, modern therapies for AA, including antihistamines, platelet-rich plasma (PRP) injection, and other novel therapies have been well explored. In this review, we discussed the recent advances in the pathogenesis, diagnosis, and treatment of AA.
... 20,27 Recent studies have shown PRP to be a promising therapy for other types of inflammatory alopecias. [28][29][30][31][32] In a randomized controlled trial, PRP injections in patients with alopecia areata significantly increased hair regrowth compared to placebo while also decreasing the number of dysmorphic hairs. 29 The one patient with DM in our review had a largely positive outcome in pruritus, scale, and hair loss after treatment with PRP; there have also been cases of PRP successfully preventing further hair shedding and diminishing scale and itch in cicatricial alopecias. ...
... [28][29][30][31][32] In a randomized controlled trial, PRP injections in patients with alopecia areata significantly increased hair regrowth compared to placebo while also decreasing the number of dysmorphic hairs. 29 The one patient with DM in our review had a largely positive outcome in pruritus, scale, and hair loss after treatment with PRP; there have also been cases of PRP successfully preventing further hair shedding and diminishing scale and itch in cicatricial alopecias. 31,32 Though its level of evidence for scalp DM is low, PRP injections for DM associated alopecia may warrant further investigation given its success in treating other types of hair loss. ...
Article
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Cutaneous involvement of the scalp is a common manifestation of dermatomyositis (DM), occurring in up to 82% percent of adults with DM. Scalp DM predominantly affects women and is characterized by dermatitis, alopecia, pruritus, and/or burning. While cutaneous dermatomyositis negatively impacts quality‐of‐life, scalp symptoms in particular are often severe, debilitating, and recalcitrant to standard DM therapies. Currently, there is a paucity of guidelines to inform management of scalp symptoms in patients with cutaneous dermatomyositis. In this narrative review, we summarize the treatments utilized to manage scalp DM and highlight potential areas for future research. We identified 8 studies that reported on 27 treatments focused on cutaneous DM and described outcomes on scalp symptoms. A majority of the treatments were standard therapies for cutaneous DM and resulted in no or minimal improvement in scalp symptoms. Five therapies did result in complete resolution of scalp symptoms and were recommended as potential areas of future research. These included low‐dose naltrexone and platelet‐rich plasma, as well as two frequent and one less common therapy for cutaneous dermatomyositis respectively: intravenous immunoglobulin, rituximab, and apremilast. Though the literature was not systematically assesed in this review, these findings illustrate not only that strategies for refractory scalp DM are lacking, but also that those demonstrating potential efficacy are limited by low levels of evidence. Additional studies, especially randomized controlled trials, are needed to better inform management of scalp DM.
... A randomized, double-blinded study has shown that both PRP and TrA significantly increased the levels of Ki-67 in AA patches compared to placebo. [5] Various treatment modalities are available for AA. The effect of a single intralesional corticosteroid injection has been observed to persist for up to 9 months. ...
Article
Alopecia areata (AA) is an autoimmune, nonscarring, inflammatory disorder of the scalp and/or body resulting in hair loss. Extensive AA such as alopecia totalis is increasingly unresponsive to conventional treatment modalities. We report a case of alopecia totalis showing a promising response with the application of platelet-rich plasma therapy modified with triamcinolone acetonide.
... First report to establish the efficacy of PRP as a treatment modality in AA was published by Trink et al in 2013. 7 This study showed PRP therapy to be superior to TCA and Placebo in growing pigmented hair in AA patches. Another study by Taieb et al showed PRP therapy to be effective in AA but inferior to Minoxidil. ...
Article
Alopecia areata, an auto-immune disorder characterised by the appearance of non-scarring bald patches affecting the hair bearing areas of the body, it can be extremely difficult to treat and has a poor prognosis despite many therapeutic options. Platelet Rich Plasma (PRP) has been previously used to treat variety of alopecia including alopecia areata. A 21-year old girl presented with asymptomatic loss of hair from the scalp for the last more than two years. On examination, there was diffuse loss of hair all over the scalp with few small, thin light-coloured hair in the occipital region. Histopathological examination showed miniaturised hair follicles surrounded by variable inflammatory lymphohistiocytic infiltrate with a marked reduction in terminal-vellus hair ratio to 1:1.The response to previous treatments was poor at the end of 1 year. A trial of PRP was given with no adjuvant treatment with a total of eight sessions of PRP. Dramatic response was noted after 2 sessions in the form of improvement in hair diameter and total volume. Resistant areas also started showing hair growth. There are a few studies assessing the role of PRP therapy in AA. First report to establish the efficacy of PRP as a treatment modality in AA, showed PRP therapy to be superior to TCA and Placebo in growing pigmented hair in AA patches. A case report with ophiasis type AA resistant to intralesional steroid injections showed excellent response to PRP therapy. Previous studies have demonstrated beneficial role of PRP therapy in cases of patchy alopecia areata, in contrast ours was a case of chronic diffuse AA. Inspite of many treatment modalities tried for more than a year, the response was unsatisfactory. PRP therapy yielded amazing results in the form of hair growth over resistant areas and overall increase in pigmented hair which were sustained at one and a half year follow up. Our case was unique in the way that excellent response to PRP treatment was noted (a) In a case of diffuse alopecia areata. (b) In a case non- responsive to standard modalities. (c) In a case with no other supportive treatment.
... Their study reported a mean increase of hair density by 2.9%. Cervelli et al. [13] found 19% gain in mean hair density when they used aPRP in AGA patients, while Trink et al. [16] noticed better results with aPRP in alopecia areata patients. In our study, we used aPRP as we wanted to ensure most optimum concentration of growth factors to hair follicles which in turn would show more efficacy. ...
... This was evidenced by a statistically significant improvement of mSALT and all dermoscopy parameters. As regards to the patient who showed relapse in the area treated by ILC, previous literature reported a higher rate of this complication [15]. Previous reports in literature compared different concentrations of intralesional injections of triamcinolone acetonide, and concluded that a concentration of 5 mg/ml in alopecia areata was considerably safe and effective [16,17]. ...
Article
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Alopecia Areata (AA) is a common autoimmune disease, with an unpredictable course and no standard treatment with guaranteed outcome. Intralesional corticosteroids is the most commonly used treatment for patchy AA, but with a common side effect of localized atrophy. Thirty patients with localized AA, with three patches were included in this study. Each alopecic patch in each patient was subjected to treatment by intralesional carbon dioxide injection (carboxy therapy), intralesional corticosteroids (ILC) and a combination of both. Sessions were done every 2 weeks for a total of 12 weeks, followed by a 2-month follow-up period. Evaluation was done at baseline, after treatment and after follow-up, clinically by modified SALT score (a novel modification of the SALT score), dermoscopically (yellow dots, black dots, tapered hair, regrowing hair) and by photography. All treatment regimens resulted in significant improvement of mSALT score and dermoscopic parameters. Comparison of the three treatment modalities revealed a 79.2% hair regrowth following the combined regimen, 69.5% improvement after ILC, and 50% improvement after carboxy therapy, with a statistical difference. The combined regimen also produced the largest significant increase in regrowing hair after treatment. Side effects included temporary pain during injection and relapse in the alopecic patch treated by ILC in one patient. All treatment regimens proved effective for treatment of patchy alopecia areata, with highest efficacy encountered following the combined modality as it caused the greatest and earliest hair regrowth. Study registered in Protocol Registration and Results System (clincaltrials.gov). Registration number: NCT04228029
... A, In MTX group. B, In TrA group In addition, a higher patient satisfaction and a lesser number of sessions in MTX group compared to TrA group demonstrating that MTX is promising in treatment of AA in adults, but with insignificant difference.This is in contrast to Trink et al.19 who reported that 38% of the intralesional corticosteroid-treated patients showed recurrence within 6-month follow-up. This might be due to longer periods of follow up in their study.In the present study, significant negative correlation was found between regrowth scale and duration of disease in both groups. ...
Article
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Background Multiple therapeutic modalities are available for alopecia areata (AA) but still a challenging disease with variable severity, recurrence and a major cosmetic concern. Aims Compare the effectiveness and safety of intralesional methotrexate (MTX) versus triamcinolone acetonide (TrA) in the treatment of localized AA in adults, both clinically and trichoscopically. Patients/Methods 40 adult patients with localized AA were recruited and divided into 2 groups. 20 patients were treated by intralesional TrA and the other 20 patients were treated by intralesional MTX every 3 weeks, for maximum 4 sessions. Clinical and trichoscopic evaluation at baseline, each session and for 3 months after the last session was performed. Results At the end of sessions (12 weeks), regrowth scale was significantly higher in TrA group compared to MTX group (P value = 0.028). But, after 3 months follow up, regrowth scale was higher in MTX group compared to TrA group (P value = 0.153). A statistically significant reduction in AA specific trichoscopic signs after 12 weeks and at the 3 months follow up in both groups. Local adverse events in both groups were transient and disappeared during the follow up period. Conclusion Intralesional MTX in treatment of localized AA in adults can be promising and comparable to intralesional TrA with the need for further controlled and extensive trials. Trichoscopy can reveal early clinical response through disappearance of AA specific trichoscopic signs and also early detection of adverse effects.
... The main studies on facial rejuvenation are reported in Table 3. In addition to their dental indications, APCs may be used as treatment modalities in different medical indications, such as autoimmune diseases, oral lichen planus [86] and alopecia areata [87]. Further studies will be needed to determine whether platelet concentrates are a valid aid in dermatology and if they can be considered as an alternative or support to other therapies. ...
Article
Full-text available
Growth factors (GFs) play a vital role in cell proliferation, migration, differentiation and angiogenesis. Autologous platelet concentrates (APCs) which contain high levels of GFs make them especially suitable for periodontal regeneration and facial rejuvenation. The main generations of APCs presented are platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and concentrated growth factor (CGF) techniques. The purpose of this review is to provide the clinician with an overview of APCs’ evolution over the past decade in order to give reliable and useful information to be used in clinical work. This review summarizes the most interesting and novel articles published between 1997 and 2020. Electronic and manual searches were conducted in the following databases: Pubmed, Scopus, Cochrane Library and Embase. The following keywords were used: growth factors, VEGF, TGF-b1, PRP, PRF, CGF and periodontal regeneration and/or facial rejuvenation. A total of 73 articles were finally included. The review then addresses the uses of the three different techniques in the two disciplines, as well as the advantages and limitations of each technique. Overall, PRP is mainly used in cases of hard and soft tissue procedures, while PRF is used in gingival recession and the treatment of furcation and intrabony defects; CGF is mainly used in bone regeneration.
... Moreover, in aesthetic dermatology, PRP has been reported to have a therapeutic effect in treating hair loss caused by androgenetic alopecia [23]. Combining platelets with fractional laser or fat grafting can improve scar revision [24,25] and may provide benefits in skin rejuvenation and dermal augmentation [26,27]. Thus, platelet therapy is expected to be a new therapeutic avenue for regenerative medicine and tissue engineering. ...
Article
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As a standard clinical treatment, platelet transfusion has been employed to prevent hemorrhage in patients with thrombocytopenia or platelet dysfunctions. Platelets also show therapeutic potential for aiding liver regeneration and bone healing and regeneration and for treating dermatological conditions. However, the supply of platelets rarely meets the rising clinical demand. Other issues, including short shelf life, strict storage temperature, and allogeneic immunity caused by frequent platelet transfusions, have become serious challenges that require the development of high-yielding alternative sources of platelets. Human pluripotent stem cells (hPSCs) are an unlimited substitution source for regenerative medicine, and patient-derived iPSCs can provide novel research models to explore the pathogenesis of some diseases. Many studies have focused on establishing and modifying protocols for generating functional induced platelets (iPlatelets) from hPSCs. To reach high efficiency production and eliminate the exogenous antigens, media supplements and matrix have been optimized. In addition, the introduction of some critical transgenes, such as c-MYC, BMI1, and BCL-XL, can also significantly increase hPSC-derived platelet production; however, this may pose some safety concerns. Furthermore, many novel culture systems have been developed to scale up the production of iPlatelets, including 2D flow systems, 3D rotary systems, and vertical reciprocal motion liquid culture bioreactors. The development of new gene-editing techniques, such as CRISPR/Cas9, can be used to solve allogeneic immunity of platelet transfusions by knocking out the expression of B2M. Additionally, the functions of iPlatelets were also evaluated from multiple aspects, including but not limited to morphology, structure, cytoskeletal organization, granule content, DNA content, and gene expression. Although the production and functions of iPlatelets are close to meeting clinical application requirements in both quantity and quality, there is still a long way to go for their large-scale production and clinical application. Here, we summarize the diverse methods of platelet production and update the progresses of iPlatelets. Furthermore, we highlight recent advances in our understanding of key transcription factors or molecules that determine the platelet differentiation direction. 1. Introduction In mammals, platelets are produced by mature megakaryocytes (MKs) in the bone marrow and differentiate from pluripotent stem cells in hematopoietic tissues. The primary function of platelets is coagulation and hemostasis; once blood vessel injury occurs, platelets are rapidly activated, adhere to the wound, and aggregate to form a platelet clot. As a result, they are known as the “band-aids” of the bloodstream. Platelets play an executive role in the clinical treatment of blood diseases, such as acute myeloid leukemia, immune thrombocytopenia, and idiopathic thrombocytopenic purpura [1]. Platelets are overlooked immune regulators; they play significant roles in inflammation and infection [2] as they can recognize exterior pathogens and produce many chemoattractants to activate and recruit leukocytes into the site of infection and inflammation, thereby enhancing their lethality to pathogens [3]. The roles of platelets in assisting liver regeneration, bone regeneration, and in the treatment of dermatological conditions, have also increased the demand for platelets in clinical treatment [4–6]. The discovery of platelet-derived serotonin involved in hepatic regeneration and the correlation between impaired platelets and liver cell proliferation suggest that platelets play a significant role in liver regeneration [7, 8]. Platelet transfusion can improve CCl4-induced liver fibrosis in mice with severe combined immune deficiency [9]. The transfer of coding and regulatory RNA between platelets and hepatocytes can promote hepatocyte proliferation and liver regeneration [10–12]. After hepatectomy, platelets coordinate with liver sinusoidal endothelial cells and Kupffer cells via the release of various growth factors, including human growth factor, insulin-like growth factor, and vascular endothelial growth factor (VEGF), or through direct contact with hepatocytes [13–15]. As the therapeutic role of platelets in many diseases is being studied, the application of platelet-rich plasma (PRP) products has gained extensive attention in regenerative medicine. PRP is an autologous biological product derived from centrifuging or apheresis of blood and is a solution with high concentration of platelets [16, 17]. PRP treatment utilizes platelets with abundant biological factors and chemoattractive cytokines associated with tissue regeneration and remodeling. Moreover, the hydrogel properties of activated PRP make it a suitable medicine delivery vehicle [7, 8, 18]. Platelets dynamically regulate the process of bone remodeling by releasing proinflammatory cytokines to activate the inflammatory phase of early bone healing and then enhance the repair phase of the healing process [19, 20]. PRP treatment has been widely studied in orthopedic and oral/maxillofacial injuries to aid hemostasis and musculoskeletal regeneration [5, 18, 21, 22]. Moreover, in aesthetic dermatology, PRP has been reported to have a therapeutic effect in treating hair loss caused by androgenetic alopecia [23]. Combining platelets with fractional laser or fat grafting can improve scar revision [24, 25] and may provide benefits in skin rejuvenation and dermal augmentation [26, 27]. Thus, platelet therapy is expected to be a new therapeutic avenue for regenerative medicine and tissue engineering. Previously, donor-derived platelets were the primary platelet source for the treatment of certain clinical diseases such as idiopathic thrombocytopenic purpura (ITP). However, the insufficient supply of donor blood limits its application worldwide. The complexity and doubts surrounding platelet donation have discouraged many donors, and current blood supplies do not meet clinical needs, causing severe shortages [28]. In addition to this problem, there are also several inevitable challenges in platelet transfusion. The first is platelet preservation; platelets can only be stored at room temperature for a short time; otherwise, there is a significant risk of bacterial contamination. Although cold storage can reduce bacterial reproduction and prolong shelf life of the platelets, it also changes platelet structure, molecules, and metabolism [29]. Second, exogenous platelets may cause excessive immune rejection in platelet recipients. Frequent platelet transfusions will cause allogeneic immunity, which results from the generation of multiple antibodies, such as human leukocyte antigen (HLA) antibodies and human platelet antigen antibodies in patients. Residual red blood cells (RBCs) in platelets can also induce RBC antibody production after transfusion [30]. Exploring safe and high-quality alternative sources of platelets for clinical use will markedly benefit the field of regenerative medicine. Pluripotent stem cells (PSCs), including embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs), which have the advantages of unlimited self-renewal and multiple directional differentiation capabilities, have become reliable platelet sources in regenerative medicine. Numerous studies have demonstrated that iPSCs can differentiate into various functional cell types, such as cardiomyocytes, nephron progenitor cells, kidney organoids, oligodendrocyte progenitor cells, and melanocytes [31–34]. Systems for generating induced platelets (iPlatelets) from human PSCs (hPSCs) have also been established using various methods [35–38]. Using gene-editing techniques, such as CRISPR/CAS9, PSCs with great genetic maneuverability can be developed; this makes PSCs more convenient and useful for overcoming some difficulties currently encountered by the use of platelets, such as allogeneic immunity. Therefore, hPSC-derived iPlatelets can overcome the limitations in the current blood donor-dependent system and solve a series of problems in platelet production for clinical application in the near future. However, there are still many challenges to overcome. This review summarizes current approaches for generating hPSC-derived iPlatelets, presents the current status, compares the advantages and disadvantages, limitations, and defects, and suggests future research direction. 2. The Progress and the Current Approaches for iPlatelets Many previous studies have reported that MKs are an essential intermediate product during hPSC differentiation into platelets, providing a new perspective for research and blood transfusion medicine. These studies are listed in Table 1; they describe MK differentiation and platelet generation in vitro (Figure 1). Cell source Feeder cells Multiple stages Intervention factors Specific markers Production Year hESCs OP9 MK TPO Not reported Hardly 2006 [39] hESCs C3H10T1/2, OP9 HPC, MK VEGF, TPO, SCF, heparin CD41a⁺CD42b⁺ platelets/hESC 2008 [35] hESCs According to stage Hemangioblasts/blast, MK BMP4, VEGF, SCF, TPO CD41a⁺CD42b⁺ platelets/MK 2011 [40] hESCs / HPC, MK BMP4, SCF, VEGF, FGF2 CD41a⁺CD42b⁺ Not provided 2013 [41] hPSCs C3H10T1/2 HPC, MK HUVECs (2D bioreactor) CD41a⁺ or CD42b⁺ Higher than static condition 2013 [42] hiPSCs / HPC, HEC, MKP, MK Multiple cytokines CD41a⁺CD42b⁺ About 30 platelets/MK 2014 [38] hPSCs C3H10T1/2, OP9 HPC TAL1, GATA2 Not reported Not provided 2014 [43] hiPSCs C3H10T1/2 imMKCLs BMI1, BCL-XL, c-MYC CD41a⁺CD42b⁺ 250 MKs/imMKCL 2014 [44] hPSCs / HPC, MK GATA1, FLI1, TAL1 CD41a⁺/CD42b⁺ About 7 platelets/MK 2016 [45] hPSCs / MK Shear stress (3D bioreactor) β1-Tubulin1⁺Hoechst⁻CD41⁺CD42b⁺ ~42 platelets/MK, ~350 platelets/h 2014 [46] 2016 [47] hiPSCs / HG/CD42b⁺MK SCF, TPO, IL-9, IL-6 FV⁺CD42b⁺ Not provided 2017 [48] hiPSCs C3H10T1/2 imMKCLs Turbulent flow, shear stress CD41⁺CD42b⁺ ~70–80 platelets/MK 2018 [49] hiPSCs C3H10T1/2, OP9 HSC, HPC, MK B2M KO CD41⁺CD42b⁺ Not provided 2020 [50] hESCs: human embryonic stem cells; hPSCs: human pluripotent stem cells; hiPSCs: human induced pluripotent stem cells; MK: megakaryocyte; HPC: hematopoietic progenitor cell; HEC: hematopoietic endothelial cell; MKP: megakaryocyte progenitor; HSC: hematopoietic stem cell; imMKCL: immortalized megakaryocyte progenitor cell line; TPO: thrombopoietin; VEGF: vascular endothelial growth factor; BMP4: bone morphogenetic protein 4.
... Among all these applications, PRP has also been used in aesthetic applications, such as skin rejuvenation procedures [214][215][216] and hair restoration, showing better outcomes than conventional treatments [216,217]. ...
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Osteoarthritis (OA) is the most common articular disease in adults and has a current prevalence of 12% in the population over 65 years old. This chronic disease causes damage to articular cartilage and synovial joints, causing pain and leading to a negative impact on patients’ function, decreasing quality of life. There are many limitations regarding OA conventional therapies—pharmacological therapy can cause gastrointestinal, renal, and cardiac adverse effects, and some of them could even be a threat to life. On the other hand, surgical options, such as microfracture, have been used for the last 20 years, but hyaline cartilage has a limited regeneration capacity. In recent years, the interest in new therapies, such as cell-based and cell-free therapies, has been considerably increasing. The purpose of this review is to describe and compare bioregenerative therapies’ efficacy for OA, with particular emphasis on the use of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP). In OA, these therapies might be an alternative and less invasive treatment than surgery, and a more effective option than conventional therapies.
... Platelet-rich plasma (PRP), as a regenerative treatment has been recently explored as a treatment for AGA and other dermatological conditions like acne scars, wound healing etc. Growth factors present in PRP can bind with their receptors expressed on stem cells of hair follicle and associated tissues and proliferate which leads to stimulation of hair regrowth [39][40][41][42][43]. Anitua et al., [44] reported a satisfied overall clinical improvement after PRP treatment in AGA patients after 1 year of follow-up. ...
Article
Platelet rich plasma (PRP) is a biological product defined as a portion of the plasma fraction of autologous blood with a platelet concentration above the baseline. The plasma occupies 55% of blood, which is rich in immunoglobulins and proteins that have a wide range of applications in various medical fields. Plasma therapy is applied to tackle various disorders or diseases as it induces the body to develop new healthy cells. It contains important components like antibodies, coagulation factor, enzymes, fibrinogen, proteins and albumin. PRP is a unique and advanced treatment which helps to increases the body’s natural healing process. Platelet lysate which is obtained from platelet rich plasma consist of various growth factors such as chemokines, cytokines, and antibacterial molecules and also has anti-inflammatory, immunomodulatory, anti-fibrotic and repairing effects. As PRP is rich in the proteins and several antibodies, it is used for various chronic therapies such as hemophilia and autoimmune disorders as well as in various severe health problems. Lyophilized Platelet-rich plasma (LPRP) therapy is currently used in various fields such as in tissue regeneration, wound healing, scar revision, skin rejuvenating effects, alopecia and for the coronavirus disease (COVID-19). It is also used to heal wounds and illnesses. LPRP therapy is gaining attraction by many health professionals as it is a safe, effective, efficient, and easy approach in procuring, preserving, and therapy. In this review we described the advantages and applications of using lyophilized PRP in various diseases which might found to be effective in different treatment. Keywords: Plasma, Platelet, Growth Factors, Lyophilized platelet rich plasma.
... Platelet-rich plasma (PRP), as a regenerative treatment has been recently explored as a treatment for AGA and other dermatological conditions like acne scars, wound healing etc. Growth factors present in PRP can bind with their receptors expressed on stem cells of hair follicle and associated tissues and proliferate which leads to stimulation of hair regrowth [39][40][41][42][43]. Anitua et al., [44] reported a satisfied overall clinical improvement after PRP treatment in AGA patients after 1 year of follow-up. ...
... Platelet Rich Plasma (PRP) application has been widely used in all fields of medicine as well as in dermatology for treating acne scars, rejuvenation purposes, scar treatment and some conditions affecting hair. 7,8 Studies of PRP in the treatment of AGA has shown that it decreased hair loss, increased hair density, and resulted in a high post-treatment patient satisfaction. Moreover, follicles obtained from the scalp have been put into in the patient's autologous PRP solution before hair transplantation. ...
Article
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Aim Androgenetic alopecia (AGA) is a progressive hair loss disease that occurs with the effect of androgens and genetic predisposition. Hair thinning and hair loss affect people's self-confidence and self-image more than is thought. In these patients, platelet rich plasma (PRP) treatment is used in addition to the limited medical treatments available. However, there is a lack of standardization for the application method of PRP treatment in the literature. The number of studies in which objective data and hair analysis parameters were revealed to demonstrate the effectiveness of PRP treatment is also very limited. In this study, it was aimed to show the efficacy of PRP treatment with trichoscan data in AGA patients and to compare dermapen-mediated microneedling and point by point technique injection application methods. Materials and methods The study was conducted with 62 male AGA patients, aged between 18-55 years, who applied to the University Faculty of Medicine, Department of Dermatology, and ranged from Norwood-Hamilton Stage II-V. The patients were randomly divided into two groups and one group was given microneedling with a dermapen, an electrical device that makes automatic needling, and the other group was given manual injection with point by point technique with a 30 gauge needle. Before the first treatment, each patient underwent a trichoscan hair analysis evaluation. A total of four sessions of PRP treatment were performed, as three sessions at two week intervals and the fourth session one month after the last session. Resutls The mean age of the cases was 33.13±6.36. According to Norwood-Hamilton staging, stage III was detected with the highest rate of 46% (29). Hair pulling test became significantly negative after treatment (p<0.05). Statistically significant differences were found in trichoscan analysis parameters for hair count, hair density, terminal hair count, and terminal hair density in both groups compared to pre-treatment (p<0.05). Between the groups, a statistically significant difference was found between the averages of anagen hair, telogen hair and hair length in the dermapen treated group compared to the group treated with the point by point technique. Conclusion In our study, the efficacy of PRP treatment for AGA patients was demonstrated by trichoscan parameters. Among the PRP application methods, dermapen-mediated application was found to be superior to the point by point technique in terms of anagen, telogen and average hair length parameters. This article is protected by copyright. All rights reserved.
... Compared to ILC, two studies reported greater hair regrowth and a lower relapse rate with PRP, while there was no signi cant di erence in dystrophic hairs and dysesthesia between the groups. 71,73 Compared to minoxidil, PRP showed quicker regrowth and decreased dystrophy and short vellus hairs. 72 One article shared two case reports on PRP successfully used to treat cicatricial alopecia. ...
Article
Platelet-rich plasma (PRP) has been integrated into numerous treatment regimens for medical and aesthetic dermatology. While some of these approaches are well-established, many uses are underreported in the literature. We sought to identify and summarize the emerging dermatologic applications for PRP by conducting a comprehensive PubMed search of studies published between 2000 and 2020. These studies were reviewed to synthesize collection methods, treatment schedule, adverse effects, and the impact of therapy for new and emerging uses for PRP. In general, we identified positive treatment outcomes for skin rejuvenation, scar revision, alopecia, pigmentary disorders, lichen sclerosus, leprosy-induced peripheral neuropathy, plaque psoriasis, and nail disorders. Widely, therapy was well-tolerated and suitable for all reported phototypes. The variations in collection and application sequences make concrete recommendations difficult to discern, underscoring the need for a standardized approach to preparation and treatment methods. We hope this review serves as an outline for new and interesting uses for PRP and will help readers familiarize themselves with this exciting technology for comfortable integration into their practices.
... Mindkét betegség (AA, AD) patomechanizmusában a JAK-STAT útvonal érintett, dupilumab hatására a jelátviteli út aktivitása csökken. Az AA betegek között az atópiás hajlam a leggyakoribb komorbiditás (asthma, acetonide kontrollált klinikai vizsgálatban szignifikáns hajvisszanövés jelentkezett az AA-val kezelt betegeknél (61). ...
Article
Over the past few years, better understanding of the explicit pathomechanism of alopecia areata provides new treatment opportunities for effective therapy of the disease, which may revolutionize therapeutic strategies. This exceedingly heterogeneous disease with unpredictable outcome, severely affects the quality of life. Currently, there are no standardized treatment protocols approved by the European Medicines Agency (EMA), resulting a challenge for the therapists in the choice of treatment.In this paper, the authors summarize recent and emerging therapies for severe cases of alopecia areata.
... This finding can be related to a randomized controlled study by Trink et al where they have got sustained response even at 1 year follow up after giving monthly PRP treatment for 3 months for androgenetic alopecia. 23 This leads to a hypothesis of the sustained response of PRP even after treatment and is a significant finding in relation to therapy in melasma which might be due to the persistence of growth factors in melasma lesions. But longer follow up duration is required for the justification of this finding in our study. ...
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p> Background: Melasma is one of the most common pigmentary disorders worldwide with a still unresolved pathogenesis and treatment continues to be challenging. To assess the effect of micro-needling vs combination of micro-needling followed by application of topical platelet rich plasma (PRP) in the treatment of melasma. Methods: Sixty patients having melasma were randomly grouped into A and B. Group A underwent micro-needling alone and group B was subjected to micro-needling followed by topical application of autologous PRP. The patients were subjected to 3 treatment sessions at monthly intervals. Melasma area and severity index (MASI) and patient satisfaction scores were recorded at each sitting and the final outcome was recorded one month after the last session. Results: Twenty-four patients in group A and 27 patients from group B were selected for final analysis. There was significant improvement of MASI in both groups (Group A: p=0.001, group B: p=0.0001) however, the difference in improvement of MASI between the 2 groups was not significant (p=0.0457) Group B was highly satisfied with the treatment which was statistically significant (p=0.0001) Conclusions: Combining micro-needling with topical PRP appears to be a promising therapeutic modality in the treatment of melasma. </p
... Numerous studies have shown that platelet-rich plasma (PRP) can promote the healing of complex wounds in elderly patients [67]. PRP can promote hair regrowth in mice and AGA patients by inducing HFSC activation and proliferation, which leads to hair follicle regeneration [68][69][70]. Many studies have demonstrated the importance of cell adhesion molecules (CAMs) and the extracellular matrix (ECM) in skin development, and increasing evidence also shows that the ECM is important for HF progenitor cell fate determination throughout HF development [71][72][73]. ...
Article
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The reprogramming of somatic fibroblasts into alternative cell linages could provide a promising source of cells for regenerative medicine and cell therapy. However, the direct conversion of fibroblasts into other functional cell types is still challenging. In this study, we show that dermal-papilla-cell-like cells (DPC-LCs) can be generated by treating fibroblasts, including L929 mouse fibroblast cell lines and somatic mouse fibroblasts, with small molecules. Based on alkaline phosphatase activity and other molecular markers, different compounds or their combinations are needed for converting the two different fibroblasts into DPC-LCs. Notably, we found that TTNPB alone can efficiently convert primary adult mouse fibroblasts into DPC-LCs. DPC-LCs generated from mouse fibroblasts showed a stronger hair-inducing capacity. Transcriptome analysis reveals that expression of genes associated with a hair-inducing capacity are increased in DPC-LCs. This pharmacological approach to generating functional dermal papilla cells may have many important implications for hair follicle regeneration and hair loss therapy.
... This may be due to use of non-digital centrifuge and 2 ml sodium citrate tubes in these 3 groups.The present results showed a statistically significant increase in platelet count in group IV compared with the other three studied treatment with terminal hair count (78%) and vellus hair count (22%)/cm 2 (with magnification power = 50× in C, D). (E) Trichoscopic photograph before treatment with average hair width (0.013 mm) (F) Trichoscopic photograph after treatment with average hair width (0.022 mm) (with magnification power = 200× in E, F) groups. PRP in group IV was prepared by changing all the previous parameters using digital centrifuge, large sodium citrate tube (9 ml), and low centrifugation speed (900 rpm).Our findings agree with the study of Trink et al.,12 who reported significant increase in platelet concentration of PRP prepared with low centrifugation speed (70 g or 800 rpm for 8 min) which is consistent with that obtained in our study.However, the current study disagreed with Hsu et al.,13 who found a 434% increase in platelet concentration of PRP prepared from 20 ml venous blood by means of double-spin centrifugation (2400 rpm for 10 min and 3500 rpm for 15 min). This higher increase in both centrifugation speed and platelet concentrations may be due to the use of different types of centrifuges and tubes in addition to a larger volume of blood compared with that used in our study.But, the question which of the new parameters used in group IV (digital centrifuge, size of the sodium citrate tube, or low centrifugation speed) caused the significant increase in platelet count, was answered by IV subgroups. ...
Article
Full-text available
Background Platelet-rich plasma (PRP) injection is a promising modality for hair regeneration in female pattern hair loss (FPHL). A standard protocol on best methods for PRP preparation has not been established. Objectives To optimize standard PRP preparation protocols and evaluate its clinical efficacy in FPHL. Methods Comparative study enrolled 40 female patients with FPHL divided randomly into 4 equal groups. Each group received 3 sessions of monthly intradermal injection of PRP prepared by different methods regarding number of spins, centrifugation speeds, type of the centrifuge, and the size of PRP tube. Patients were evaluated by trichoscan before and 1 month after the 3rd session for number of terminal, vellus hair, and average hair width. Results A statistically significant increase in platelet count in PRP prepared by combination of digital centrifuge, large-sized sodium citrate tube, and low centrifugation speed (900 rpm). All patients showed statistically significant increase in percentage of terminal hair and average width of hair after treatment as assessed by trichoscan, without statistically significant difference between studied groups. Conclusions Digital centrifuge, large-sized sodium citrate tubes, and a single spin with low centrifugation speed (900 rpm) were ideal for PRP preparation. PRP is an effective and safe modality in FPHL therapy.
... P latelet-rich plasma (PRP), which contains growth factors important for cell proliferation and differentiation and has anti-inflammatory properties, may be more beneficial in some patients with alopecia areata (AA) as opposed to first-line therapy. 1 First introduced in 2003 and expanded upon in 2006, platelet-rich fibrin (PRF) has been reclassified into both injectable PRF (iPRF) and advanced PRF (aPRF), with aPRF containing an increased number of neutrophils which can contribute to monocyte/macrophage differentiation and help in tissue repair and vessel formation. [2][3][4] Further, aPRF is produced by centrifuging whole blood for less time at an increased rpm, withdrawing the use of anticoagulants, and allowing it to clot. 5 The clot contains platelets and growth factors and is composed of a fibrin matrix that continuously releases more growth factors over a longer period. ...
Article
Full-text available
Platelet-rich plasma (PRP) has been shown to release a multitude of growth factors, but its preparation requires the use of anticoagulants. In contrast, advanced platelet-rich fibrin (aPRF) is produced by centrifuging whole blood and allowing it to clot. The clot contains the platelets, growth factors, and neutrophils, and it is composed of a fibrin matrix that continuously releases more growth factors over a longer time period. Advanced PRF is commonly used in dental and bone grafting procedures, but it is rarely used for cosmetic injectables because its high density makes it difficult to inject through smaller gauge needles. A technique is described whereby aPRF is reduced to an injectable form with micronization and used to treat alopecia areata (AA) in a 28-year-old patient who developed it after symptomatic COVID-19 infection a month before presentation. The patient was vaccinated in between infection, and symptoms were limited to headache and sore throat. He had complete resolution of his AA at 6-month follow-up with only two treatments as opposed to monthly intralesional steroids. We report our results using aPRF for AA with promising results as a possible future treatment for patients with this autoimmune disease.
Article
The article is of a review nature and contains up-to-date information on the application autologous platelet-rich plasma in trichology. The use of autologous platelet-rich plasma is a promising treatment. The application on this technique is to improve and accelerate the processes caused by the stimulating growth factors contained in platelets.
Article
Platelet-rich plasma (PRP) is a high-concentration platelet plasma derived from autologous blood, rich in a variety of growth factors. It can promote cell proliferation and differentiation. PRP has been widely used in oral cavity, plastic surgery, orthopedics, neurosurgery and other fields this year. This article reviews the preparation of platelet-rich plasma, the principle of treatment of androgenetic alopecia, and its clinical treatment progress, current problems and future application prospects.
Chapter
Dermal fillers have been utilized for decades, and their demand in cosmetic purposes has increased significantly. The recent introduction of autologous dermal fillers in the field of cosmetic dermatology has shifted the focus into yet a new direction, one that possibly enhances many of the desired effects, while abolishing the adverse ones. The dermatological possibilities of Platelet‐rich plasma (PRP) for skin rejuvenation were recognized, and its ability to serve as autologous dermal filler was comprehended. The preparation of PRP is a relatively simple and quick task, usually occurring without any complications with a wide variety of preassembled PRP preparation kits are available in the market. AP Sclafani has contemplated that initial overcorrection of the dermal defects is desirable when using PRP, as much of the filler is plasma volume, which is quickly absorbed within the first 3–12 hours after the procedure.
Chapter
In recent years, microneedling has been combined with platelet‐rich plasma (PRP) with the aim of augmenting cosmetic outcomes. This chapter discusses PRP and its use in combination therapies with microneedling. PRP is an autologous high concentration of platelets derived from blood plasma. Microneedling provides accelerated neocollagenesis. Collagen induction therapy, in combination with the additional growth factors and cytokines from PRP, may act synergistically with the microneedling cascade to provide enhanced collagen remodeling and patient outcomes. PRP has been utilized for many years in dentistry, orthopedics, endodentistry, and other surgical fields. PRP as monotherapy has demonstrated significant improvements in hair growth when treating androgenic alopecia. PRP and microneedling continue to evolve as therapeutic tools in dermatology and aesthetic medicine. Top evidence‐based dermatologic indications for microneedling and PRP include hair restoration and skin rejuvenation, as well as improvements in acne scars.
Article
The article presents literature data on the efficacy of using platelet-enriched autologous plasma for treatment of non-scarring alopecias (androgenetic and circumscribed alopecia).
Article
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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.
Chapter
Platelet-rich plasma (PRP) is a promising alternative to traditional hair loss therapies such as minoxidil and finasteride. By discharging growth factors and cytokines, PRP can promote cell survival, growth, and proliferation. In recently conducted meta-analyses, PRP treatments have reported a greater efficacy over placebo in terms of mean change in hair density in androgenetic alopecia (AGA) patients. PRP has also induced significantly more hair regrowth in alopecia areata (AA) patients as compared to placebo and has increased follicular yields when incorporated into hair restoration procedures. Despite the various PRP protocols and techniques investigated, the main determinant of a successful PRP solution is its contents. Effective PRP solutions should be free of red and white blood cells and have elevated levels of stimulating growth factors, cytokines, and platelets.
Chapter
Platelet-rich plasma (PRP) is an autologous solution, abstracted from the patient’s own blood, containing a small volume of plasma with a concentrated number of platelets and variable numbers of leukocytes and erythrocytes. While the basic principles are similar across most commercially available systems, there are no standards for the preparation, composition, or administration of platelet-rich plasma, and so evaluating and selecting appropriate systems can be challenging. This chapter provides an overview of PRP preparation, important distinctions in separation techniques, and controversies and future directions to better optimize these methodologies.
Article
Zusammenfassung Die Alopecia areata (AA) ist eine chronische immunvermittelte Erkrankung, die durch akuten oder chronischen, nicht vernarbenden Haarausfall gekennzeichnet ist. Die klinischen Erscheinungsformen sind sehr unterschiedlich und reichen von kleinen umschriebenen haarlosen Stellen bis hin zum vollständigen Verlust der Kopf- und Körperbehaarung. Diese Übersicht soll aktuelles Wissen zu Pathophysiologie und beteiligten Signalwegen vermitteln sowie diagnostische und therapeutische Empfehlungen geben. Aktuell verfügbare Therapieansätze bei AA, einschließlich topischer, systemischer und injizierbarer Interventionen, zeigen unterschiedlich gutes Ansprechen mit häufigen Rezidiven, was den dringenden Bedarf an effektiven zielgerichteten Therapien widerspiegelt. Neue therapeutische Ansätze und Konzepte, einschließlich Januskinase-Inhibitoren, werden mit großer Spannung erwartet. Diese Übersicht diskutiert traditionelle und neue Therapieansätze für das Management der AA. Diese Erkrankung führt häufig zu einer starken psychosozialen Belastung für die Betroffenen, kann zu Depressionen führen, Angstzustände auslösen und die Lebensqualität beeinträchtigen. Daher sollten psychosoziale Aspekte der Krankheit mit berücksichtigt, beim Patienten angesprochen und die Notwendigkeit einer psychologischen Unterstützung erwogen werden. Summary Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.
Article
Background Androgenetic alopecia (AGA) is a common disorder in male and female patients that may benefit from the use of platelet-rich plasma. Objectives To compare the safety, efficacy, and satisfaction of a lower or higher number of platelets over 6 months. Methods A prospective randomized, double-blinded, placebo, paralleled group, half-scalp IRB study among eight subjects with moderate AGA. Participants received intradermal PRP injections (baseline and month 3), according to two treatment protocols (high vs low platelet numbers) to the frontal and crown portions of the hemi-scalp and normal saline to control sites. Phototrichoscans were measured at baseline and six months, while global photography and subject and investigator satisfaction questionnaires were obtained at baseline, 3, and 6 months. Results At the end of 6-month evaluation period, both groups demonstrated numerical increases in total hair densities, follicle diameters and terminal hair densities, as well as absolute and percent changes at the frontal and crown targeted sites compared to baseline. These improvements tended to occur more often in areas treated with higher platelet numbers than with lower numbers. Vellus hair densities did not exhibit any significant changes to either PRP dosages. Treatments were assessed by investigator and subjects as “satisfied” at month-3 and were associated with no adverse reactions. Conclusions Intradermal injections with two therapeutic quantities of platelets were equally safe and efficacious among men and women with androgenetic alopecia. Findings suggest that higher numbers of platelets may have a greater effect than lower number of platelets in regard to hair densities, follicle diameters and terminal hair densities but exhibited minimal effects on vellus hair densities at the month-6 evaluation period. Further studies are required to determine whether any significant advantages occur when delivering either lower or higher numbers of platelets in AGA treatments as long as therapeutic levels are administered.
Article
Platelet-rich plasma (PRP) is a treatment that involves using a patient's own blood to treat a variety of indications, including hair loss, sports injuries, scars, wound healing and breast volume correction. Claudia McGloin shares her expertise of 8 years injecting platelet-rich plasma and discusses research papers using PRP for treating hair loss.
Article
Regenerative medicine and the role of stem cells are being studied for applications in nearly every field of medicine. The pluripotent nature of stem cells underlies their vast potential for treatment of androgenic alopecia. Several advances in recent years have heightened interest in this field, chief among them are the evolution of simpler techniques to isolate regenerative elements and stems cells. These techniques are easy, outpatient procedures with immediate injection, often single session with harvest, and minimal manipulation (usually physical). This paper seeks to critically review the existing data and determine the current evidence and their role in practice.
Article
Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.
Article
Platelet-rich plasma (PRP) has expanded its therapeutic applications into the field of aesthetic medicine. PRP is an autologous blood-derived product with an increased concentration of platelets to plasma relative to that of whole blood, which supports its therapeutic effects. Frequently promoted and marketed directly to consumers and patients, clinicians are often questioned on the efficacy and safety of PRP as a therapeutic modality. Given the rise in popularity of PRP, multiple clinical trials have been conducted to assess its application within the field of aesthetic medicine, particularly for hair loss conditions, skin rejuvenation, scarring, and conditions of dyspigmentation. We have reviewed the relevant research about the utility of PRP and associated evidence-based practices and discuss the direction for future research.
Chapter
Alopecia areata (AA) is a common cause of non-cicatricial hair loss with a sudden, unpredictable, and recurrent course that is associated with significant psychosocial burden. Current treatment options, such as topical and intralesional corticosteroids, systemic immunosuppression, topical immunotherapy, and Janus Kinase Inhibitors (JAK inhibitors), have been employed with varying success. Recently, platelet-rich plasma (PRP) and stem cells (SCs) have been introduced as minimally invasive, safe treatment options for hair loss, including AA. The literature to date suggests that PRP is comparable to intralesional corticosteroids and topical minoxidil in patchy alopecia areata with trends toward an earlier, more robust, and more sustained response. The in vitro and animal studies regarding the use of stem cells in AA are promising, but more clinical studies are required to understand its full potential as a treatment option for AA.
Article
Hair loss is a common complaint that is often stressful for patients and a challenge for practitioners to treat. Fortunately, innovations in the field have contributed to growing evidence for several promising topical, oral, and light and energy-based therapies. We have reviewed the current literature about the efficacy of these treatments, including topical agents (finasteride, latanoprost, spironolactone, caffeine, and metformin), oral minoxidil, nutraceuticals, platelet-rich plasma, low-level laser therapy, fractional lasers, and laser-assisted drug delivery. In addition, several debates related to these treatments have been discussed, including post-finasteride syndrome, effects of biotin supplementation on laboratory testing, standardization of platelet-rich plasma and low-level laser therapy, and combination treatment to enhance hair transplantation.
Article
Alopecia areata (AA) is a relatively common nonscarring hairloss disease characterized by an autoimmune response to anagen hair follicles (HFs). Accumulated evidence suggests that collapse of the HF immune privilege subsequent to triggering events, represented by viral infection, leads to autoimmune response in which autoreactive cytotoxic CD8+NKG2D+ T cells mainly target exposed HF autoantigens. AA had been recognized as type 1 inflammatory disease, but recent investigations have suggested some roles of type 2- and Th17-associated mediators in AA pathogenesis. The significance of psychological stress in AA pathogenesis is less emphasized nowadays, but psychological comorbidities, such as depression and anxiety, attract greater interest in AA management. In this regard, the disease severity may not solely be evaluated by the extent of hair loss. Use of trichoscopy markedly improved the resolution of the diagnosis and evaluation of the phase of AA, which is indispensable for the optimization of treatment. For the standardization of AA management, the establishment of guidelines/expert consensus is pivotal. Indeed, the Japanese Dermatological Association (JDA) and other societies and expert groups have published guidelines/expert consensus reports, which mostly recommend intralesional/topical corticosteroid administration and contact immunotherapy as first-line treatments, depending on the age, disease severity, and activity of AA. The uniqueness of the JDA guidelines can be found in their descriptions of intravenous corticosteroid pulse therapy, antihistamines, and other miscellaneous domestically conducted treatments. Considering the relatively high incidence of spontaneous regression in mild AA and its intractability in severe subsets, the importance of course observation is also noted. Evidenced-based medicine for AA is currently limited, however, novel therapeutic approaches, represented by JAK inhibitors, are on their way for clinical application. In this review, the latest understanding of the etiopathogenesis and pathophysiology, and update on therapeutic approaches with future perspectives are summarized for AA, following the current version of the JDA AA management guidelines.
Article
Background Mesenchymal stromal/stem cells (MSCs) are the most promising stem cells for the treatment of multiple inflammatory and immune diseases due to their easy acquisition and potent immuno-regulatory capacities. These immune functions mainly depend on the MSC secretion of soluble factors. Recent studies have shown that the metabolism of MSCs plays critical roles in immunomodulation, which not only provides energy and building blocks for macromolecule synthesis but is also involved in the signaling pathway regulation. Aim of Review A thorough understanding of metabolic regulation in MSC immunomodulatory properties can provide new sights to the enhancement of MSC-based therapy. Key scientific Concepts of Review MSC immune regulation can be affected by cellular metabolism (glucose, fatty acid and amino acid metabolism), which further mediates MSC therapy efficiency in inflammatory and immune diseases. The enhancement of glycolysis of MSCs, such as signaling molecule activation, inflammatory cytokines priming, or environmental control can promote MSC immune functions and therapeutic potential. Besides glucose metabolism, inflammatory stimuli also alter the lipid molecular profile of MSCs, but the direct link with immunomodulatory properties remains to be further explored. Arginine metabolism, glutamine-glutamate metabolism and tryptophan-kynurenine via indoleamine 2,3-dioxygenase (IDO) metabolism all contribute to the immune regulation of MSCs. In addition to the metabolism dictating the MSC immune functions, MSCs also influence the metabolism of immune cells and thus determine their behaviors. However, more direct evidence of the metabolism in MSC immune abilities as well as the underlying mechanism requires to be uncovered.
Book
Full-text available
There is no definitive cure for AA (Alopecia areata), and several commonly used treatments require proof of effectiveness, efficiency, and security. This manual provides the reader with the minimum and necessary knowledge about Evidence-Based Medicine and the dermatological disease known as AA. It also presents a broad systematic review of the medical literature on treatments (published randomized clinical trials) and analyzes each treatment’s effectiveness. Although not intended to replace specialized books, reading this manual can help decide the best (evidence-based) treatment of AA (and its variants Alopecia Totalis – AT and Alopecia Universalis - AU) for Dermatology training and various specialties trained doctors.
Book
Full-text available
Alopecia areata (AA) has no definite cure, and several commonly used treatments require robust proof of effectiveness, efficiency, and security. This handbook provides the minimum and necessary knowledge about Evidence-Based Medicine and the dermatological disease known as AA. It also presents a broad systematic review of the medical literature on treatments (published randomized clinical trials) and analyzes each treatment’s effectiveness. Although not intended to replace specialized books, reading this manual can help decide the best (evidence-based) AA treatments (including variants AT - Alopecia Totalis and AU - Alopecia Universalis ) for Dermatology training and various specialties trained doctors.
Article
Background Hair-related manifestations such as alopecia areata or telogen effluvium were reported during COVID-19 disease. Accelerated hair loss with androgenetic alopecia (AGA) pattern or management has not been discussed before. Aims This study aimed to examine the accelerated AGA pattern hair loss and management with PRP treatment. Materials and Methods This study was designed prospectively and nine patients included to study confirmed PCR test for COVID-19 infection. Patients underwent platelet-rich plasma (PRP) injections for 4 sessions. Results were accessed with the hair pull test (HPT) and self-administered hair growth questionnaire (HGQ). Results Nine patients were admitted with complaints of hair loss after an average of 220 ± 24.2 (min: 182 max: 264) day after recovery of COVID-19. Mean age of the patients was 33.8 ±8.4 years old (min: 26, max: 52). Six (66.7%) patients were male, and three (33.3%) of them were female. HPT score decreased to 6.0 ± 1.6 after the first PRP application (p = 0.007, CI 95%:2.7–5.2) and decreased to 1.2 ± 0.8 after the last PRP session (p = 0.008, CI 95%: 6.4–11.1). Five (55.5%) of the patients described the treatment as “very effective” after treatment with HGQ. Conclusions Accelerated hair loss associated with COVID-19 continues in long term and PRP treatment provides a satisfactory solution.
Article
Zusammenfassung Autologes plättchenreiches Plasma wird aufgrund seiner wundheilenden Eigenschaften vielfach angewandt u. a. in Orthopädie, Chirurgie und Dermatologie. Zunehmend stellt plättchenreiches Plasma außerdem bei bestimmten Formen der Alopezie eine interessante neue Behandlungsoption dar, sei es als alleinige Therapie oder auch als Adjuvans im Rahmen einer Haartransplantation. Kontrollierte klinische Studien an kleineren Patientengruppen zeigten vielfach positive Ergebnisse, größere Studien stehen bislang noch aus. Die Wirkung auf das Haarwachstum wird sehr wahrscheinlich über die in plättchenreichem Plasma enthaltenen Wachstumsfaktoren und Zytokine vermittelt.
Article
Platelet-rich plasma is the autologous plasma containing platelet concentration more than the baseline separated after centrifugation. It has become a very popular option for the treatment of hair loss in the past few decades. Used alone or in combination with other treatment options it has found a place as a hair restoration procedure throughout the world. However, evidence supporting its credibility is quite ambiguous with contradictory reports available in the literature. In this article, we try to analyze the available data regarding its mechanism of action, preparation protocols, and classification, with regard to hair loss.
Article
Background: Intralesional steroid treatment for alopecia areata (AA) has been developed for decades, yet the optimal concentration of triamcinolone acetonide (TrA) is not well-established. Objectives: This review aims to determine the optimal concentration of intralesional TrA in treating patchy AA. Methods: We conducted a systematic review and meta-analysis, and searched the Cochrane Library, Embase, and PubMed databases on July 4, 2021, to identify randomized or nonrandomized comparative studies reporting the response rates and/or adverse events among AA patients treated with various concentrations of TrA. The meta-analysis of proportions and odds ratios was analyzed using random-effects modeling. Results: Nineteen studies and a total of 783 participants were included. The estimated response rate of 5 mg/dl (74.82%, 95% confidence interval [CI] 64.99%–83.50%) was shown to be more efficacious than 2.5/3.33 mg/dl (38.64%, 95% CI 16.98%–62.99%) but similar to 10 mg/dl (71.06%, 95% CI 59.72%–81.20%), while pooled estimate of odds ratios revealed higher efficacy with 10 mg/dl than 5 mg/dl (odds ratio = 1.64, 95% CI 1.05–2.58, P = 0.031). The rates of skin atrophy were 18.05% (95% CI, 10.32%–27.38%), 11.49% (95% CI, 2.86%–24.84%), and 3.85% (95% CI, 1.27%–14.01%) in groups 10, 5, and 2.5/3.33 mg/dl, respectively. Higher concentration is associated with more skin atrophy in a dose-dependent fashion (P = 0.012). Heterogeneity among studies in the meta-analyses was high. Conclusion: The optimal intralesional concentration of TrA for patchy AA is probably 10 mg/dl with acceptable adverse events.
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Unlabelled: Various therapeutic agents have been described for the treatment of alopecia areata (AA), but none are curative or preventive. The aim of AA treatment is to suppress the activity of the disease. The high rate of spontaneous remission and the paucity of randomized, double-blind, placebo-controlled studies make the evidence-based assessment of these therapies difficult. The second part of this two-part series on AA discusses treatment options in detail and suggests treatment plans according to specific disease presentation. It also reviews recently reported experimental treatment options and potential directions for future disease management. Learning objectives: After completing this learning activity, participants should be able to compare the efficacy and safety of various treatment options, formulate a treatment plan tailored to individual patients, and recognize recently described treatments and potential therapeutic approaches.
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Follicular units are commonly used in baldness surgery, and they have become a global procedure for both male and female patients. The yield from micrografts varies between 70 and 85 percent. Yield is determined by factors such as quality of the harvested donor area, preparation of the units, care taken during the implantation procedure, and follicular apoptosis. To improve hair density and stimulate follicular unit growth, an experimental study was designed using platelet plasma growth factors obtained from the patient's autologous plasma. The author established a protocol within a group of 20 patients with male pattern baldness. The data showed a gaussian distribution; to compare the two procedures involved in this clinical trial, the paired t test was used. The author observed a significant difference in the yield of follicular units when comparing the experimental with the control areas of the scalp (p < 0.001). The areas treated with platelet plasma growth factors demonstrated a yield of 18.7 follicular units per cm2, whereas the control areas yielded 16.4 follicular units per cm2, an increase in follicular density of 15.1 percent. Among patients who used the experimental protocol, some experienced only 3 percent and others experienced a 52 percent increase in density. This study provides a new perspective and contribution to baldness surgery with follicular unit megasessions, and demonstrates an improvement that can be introduced into baldness surgery clinics with less morbidity and a low cost-to-benefit ratio. Further studies may improve the efficiency of the technique and allow digital programs to better evaluate the increase in hair density.
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THE IMPACT OF CERTAIN SKIN DISEASES ON THE LIVES OF THOSE AFFECTED tends to be underestimated or even dismissed as simply a "cosmetic problem." Alopecia areata exemplifies such a condition, owing to its substantial disease burden and its often devastating effects on the patient's quality of life and self-esteem.(1,2) Although alopecia areata is one of the most common autoimmune diseases, the pathobiology of this chronic, relapsing hair-loss disorder is not fully understood, and the available therapies are disappointing.(3-6) This review summarizes the pathogenesis, clinical presentation, and management of alopecia areata and synthesizes relevant background information concerning the biologic and pathobiologic features of the hair follicle. Currently available evidence suggests that alopecia areata can be considered a T-cell-mediated autoimmune disease in which the gradual loss of protection provided by immune privilege of the normal hair follicle plays an important role.(7-9)
Article
Alopecia areata (AA) may can occur on any hair-bearing region. Patients can develop patchy nonscarring hair loss or extensive loss of all body hair. Hair loss may fluctuate. Some patients experience recurrent hair loss followed by hair regrowth, whereas others may only develop a single patch of hair loss, never to see the disease again. Still others experience extensive loss of body hair. The heterogeneity of clinical presentations has led investigators conducting clinical therapeutic trials to typically group patients into three major groups, those with extensive scalp hair loss [alopecia totalis (AT)], extensive body hair loss [alopecia universalis (AU)], or patchy disease (AA). Treatment outcomes have been correlated with disease duration and extent. Recently, guidelines were established for selecting and assessing subjects for both clinical and laboratory studies of AA, thereby facilitating collaboration, comparison of data, and the sharing of patient-derived tissue. For reporting purposes the terms AT and AU, though still used are defined very narrowly. AT is 100% terminal scalp hair loss without any body hair loss and AU is 100% terminal scalp hair and body loss. AT/AU is the term now recommended to define the presence of AT with variable amounts of body hair loss. In this report the term AA will be used broadly to encompass the many presentations of this disease. Development of AA may occur with changes in other ectodermal-derived structures such as fingernails and toenails. Some investigators have also suggested that other ectodermal-derived appendages as sebaceous glands and sweat glands may be affected in patients experiencing AA. Whether or not function of these glands is truly impaired remains to be confirmed. Many patients who develop patchy or extensive AA complain of changes in cutaneous sensation, that is, burning, itching, tingling, with the development of their disease. Similar symptoms may occur with hair regrowth. The potential involvement of the nervous system in AA has led to morphologic investigations of the peripheral nervous system as well as analysis of circulating neuropeptide levels. In this article the clinical presentations of AA are reviewed. The guidelines for conducting treatment studies of AA are presented and observations on changes in cutaneous innervation are introduced. Throughout the text, unless otherwise noted, AA will be used in a general way to denote the spectrum of this disease.
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These guidelines for management of alopecia areata have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
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Recently, autologous platelet-rich plasma (PRP) has attracted attention in various medical fields, including plastic and orthopedic surgery and dermatology, for its ability to promote wound healing. PRP has been tested during facelift and hair transplantation to reduce swelling and pain and to increase hair density. To investigate the effects of PRP on hair growth using in vivo and in vitro models. PRP was prepared using the double-spin method and applied to dermal papilla (DP) cells. The proliferative effect of activated PRP on DP cells was measured. To understand the mechanisms of activated PRP on hair growth, we evaluated signaling pathways. In an in vivo study, mice received subcutaneous injections of activated PRP, and their results were compared with control mice. Activated PRP increased the proliferation of DP cells and stimulated extracellular signal-regulated kinase (ERK) and Akt signaling. Fibroblast growth factor 7 (FGF-7) and beta-catenin, which are potent stimuli for hair growth, were upregulated in DP cells. The injection of mice with activated PRP induced faster telogen-to-anagen transition than was seen on control mice. Although few studies tested the effects of activated PRP on hair growth, this research provides support for possible clinical application of autologous PRP and its secretory factors for promotion of hair growth.
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Treatments for alopecia are in high demand, but not all are safe and reliable. Dalteparin and protamine microparticles (D/P MPs) can effectively carry growth factors (GFs) in platelet-rich plasma (PRP). To identify the effects of PRP-containing D/P MPs (PRP&D/P MPs) on hair growth. Participants were 26 volunteers with thin hair who received five local treatments of 3 mL of PRP&D/P MPs (13 participants) or PRP and saline (control, 13 participants) at 2- to 3-week intervals and were evaluated for 12 weeks. Injected areas comprised frontal or parietal sites with lanugo-like hair. Experimental and control areas were photographed. Consenting participants underwent biopsies for histologic examination. D/P MPs bind to various GFs contained in PRP. Significant differences were seen in hair cross-section but not in hair numbers in PRP and PRP&D/P MP injections. The addition of D/P MPs to PRP resulted in significant stimulation in hair cross-section. Microscopic findings showed thickened epithelium, proliferation of collagen fibers and fibroblasts, and increased vessels around follicles. PRP&D/P MPs and PRP facilitated hair growth but D/P MPs provided additional hair growth. The authors have indicated no significant interest with commercial supporters.
Article
Platelet-rich plasma (PRP) promotes regeneration of bone, presumably through the action of concentrated growth factors. However, it is not clear how PRP affects the inflammatory response. The purpose of this study was to analyze the growth factors in PRP and to study the effects of PRP on monocyte cytokine release and lipoxin A(4) (LXA(4)) generation. PRP was prepared from healthy donors. Platelet-derived growth factor (PDGF)-AB, PDGF-BB, transforming growth factor-beta1, insulin-like growth factor-I, fibroblast growth factor-basic (FGF-b), epidermal growth factor (EGF), vascular endothelial growth factor, interleukin-12 (p40/70), and regulated on activation, normal T-cell expressed and secreted (RANTES) levels were evaluated by enzyme-linked immunosorbent assay and bead-based multiplexing. Peripheral blood monocytes were isolated and cultured with or without PRP. Cytokine, chemokine, and LXA(4) levels as well as monocyte chemotactic migration were analyzed. Growth factors were increased significantly in PRP compared to whole blood (WB) and platelet-poor plasma. Monocyte chemotactic protein-1 (MCP-1) was suppressed significantly by PRP, whereas RANTES was increased significantly in monocyte cultures. LXA(4) levels were significantly higher in PRP compared to WB. PRP stimulated monocyte chemotaxis in a dose-dependent fashion, whereas RANTES, in part, was responsible for PRP-mediated monocyte migration. PRP is a rich source of growth factors and promoted significant changes in monocyte-mediated proinflammatory cytokine/chemokine release. LXA(4) was increased in PRP, suggesting that PRP may suppress cytokine release, limit inflammation, and, thereby, promote tissue regeneration.
Article
Alopecia areata is a common form of nonscarring alopecia. It affects males and females equally and has no racial predilection. It usually affects the scalp, but any hair-bearing area can be involved. It presents as patchy hair loss, loss of hair on the entire scalp (alopecia totalis), or the whole body (alopecia universalis). The histopathology varies according to the disease stage, but usually a perifollicular lymphocytic infiltrate is seen. The course of the disease and response to treatment are unpredictable. Various therapeutic modalities are used including topical, intralesional, and systemic agents, although none are curative or preventive. This article will review the available topical and intralesional agents that are used in the treatment of alopecia areata and suggest a management approach based on the age of the patient and extent of the disease.
Article
The reported efficacy of various treatments for alopecia is difficult to compare based on a general lack of consideration in case reports/series and clinical trials of the spontaneous regrowth or baseline prognostic factors seen in alopecia areata and a general lack of quantification of hair growth. This report will give both the investigator and clinician guidelines for clinical trial design that will take into account variables known to effect efficacy results such as baseline severity, pattern, and duration of hair loss, age of the subject, and concomitant conditions that may impact on potential regrowth. Reliable methods of assessment of efficacy and response criteria that will enable direct comparison of results between agents will also be discussed.
Article
Ablative carbon dioxide (CO(2) ) fractional resurfacing is a promising therapeutic intervention for the treatment of acne scars, although this technique is associated with prolonged surgical site erythema and edema, which may affect the daily lives of patients. Autologous platelet-rich plasma (PRP) is known to enhance wound healing and has applications in many areas of medicine. To evaluate the synergistic effects of autologous PRP with CO(2) fractional resurfacing for acne scars. A split-face trial was conducted in 14 Korean participants with acne scars. All participants received one session of ablative CO(2) fractional resurfacing. Immediately after resurfacing, facial halves were randomly assigned to receive treatment with autologous PRP injections on one side (experimental side) and normal saline injections on the other side (control side). The participants were monitored for degree of recovery and resurfacing-associated adverse events, including prolonged erythema, edema, and other effects on days 0, 2, 4, 6, 8, 15, and 30. The intensity of erythema was objectively measured using a chromometer at the same time intervals. After one additional treatment session using the same protocol, two independent dermatologists evaluated clinical improvement using a quartile grading scale. All participants completed the study. Erythema on the experimental side improved faster than on the control side and was significantly less at day 4 (p=.01). This difference was confirmed using a chromometer (p=.049). Total duration of erythema was an average of 10.4±2.7 days on the control side and 8.6±2.0 days on the experimental side (p=.047). Edema also improved faster on the experimental side than on the control side. The total duration of edema was an average of 7.1±1.5 days on the control side and 6.1±1.1 days on the experimental side (p=.04). Participants were also assessed for duration of post-treatment crusting, with a mean of 6.8±1.0 days on the control side and 5.9±1.1 days on the experimental side (p=.04). No other adverse effects were observed in any participant. Four months after the final treatment, overall degree of clinical improvement was significantly better on the experimental side (2.7±0.7) than on the control side (2.3±0.5) (p=.03). Treatment with PRP after ablative CO(2) fractional resurfacing enhances recovery of laser-damaged skin and synergistically improves the clinical appearance of acne scarring.
Article
There is no ideal procedure for the treatment of chronic skin ulcers. The use of platelet gel (PG) in this indication is raising interest. To evaluate the safety and efficacy of a new procedure combining allogeneic single-donor PG and fibrin glue (FG) to enhance skin graft take for treating recalcitrant ulcers. Fifteen patients with 17 ulcers of various etiologies were enrolled. Skin ulcers were débrided, and the wounds covered with moist saline dressing. Three to 14 days later, the wound bed was sprayed with PG, a thin split-thickness skin graft with multiple slits was put on the wound bed, and FG was sprayed on the skin graft. A short leg polypropylene splint was used to immobilize the skin graft. Most skin grafts took well. The interval between skin graft and complete wound healing ranged from 3 weeks to 2 months. No recurrence of ulcers was noted during the 3- to 18-month follow-up period. No adverse reactions were observed. The procedure provides advantages in skin grafting for recalcitrant ulcers because PG functions as a delivery system of powerful mitogenic and chemostatic factors and FG as a hemostatic tissue sealant that avoids the use of staples or sutures.
Article
These guidelines for management of alopecia areata have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
Article
no Alopecia areata is an immunologically mediated disease characterized by extreme variability not only in the time of initial onset of hair loss but in the duration, extent and pattern of hair loss during any given episode of active loss. These variables, as well as the unpredictable nature of spontaneous regrowth and lack of a uniform response to various therapies, has made clinical trials in alopecia areata difficult to plan and implement. In fact, there are currently no drugs FDA-approved specifically for the indication of alopecia areata. To help facilitate well-controlled clinical trials for alopecia areata, this National Alopecia Areata Foundation (NAAF) sponsored subgroup of investigators/clinicians experienced in clinical trials and/or in the clinical care of patients with alopecia areata has outlined some general principles and potential endpoints for clinical studies in alopecia areata. These guidelines build on the Alopecia Areata Investigational Assessment Guidelines published in 1991 which established baseline clinical staging and background information important to gather on any alopecia areata patient involved in clinical research.
Article
Alopecia areata (AA) is a T-cell-mediated autoimmune disease. Efalizumab is a T-cell-targeted therapy approved for the treatment of psoriasis. To assess the efficacy and safety of efalizumab in the treatment of moderate-to-severe AA. Sixty-two patients were enrolled into this phase II, placebo-controlled trial. The trial consisted of three 12-week periods-a double-blind treatment period, an open-label efalizumab treatment period, and a safety follow-up. There were no statistical differences between treatment groups in percent hair regrowth, quality-of-life measures, or changes in biologic markers of disease severity after 12 or 24 weeks. In both groups, there was an approximately 8% response rate for hair regrowth (at 12 weeks). Efalizumab was well tolerated. Numbers were too small for certain analyses. A 3- to 6-month trial of efalizumab was not effective in promoting hair regrowth in this small cohort of patients with moderate-to-severe AA.
  • A Gilhar
  • A Etzioni
  • R Paus
  • Alopecia
Gilhar A, Etzioni A, Paus R. Alopecia areata. N Engl J Med 2012; 366:1515-25.