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Platelet-Rich Plasma in Combination With 5% Minoxidil Topical Solution and 1 mg Oral Finasteride for the Treatment of Androgenetic Alopecia: A Randomized Placebo-Controlled, Double-Blind, Half-Head Study



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Platelet-Rich Plasma in Combination With 5% Minoxidil Topical Solution and 1 mg Oral
Finasteride for the Treatment of Androgenetic Alopecia: A Randomized Placebo-Controlled,
Double-Blind, Half-Head Study
Platelet-rich plasma (PRP) has been identied as a new
therapy for androgenetic alopecia (AGA). Recently, we
published a randomized placebo-controlled, double-
blinded, half-head study to assess theefcacy of PRP on
the treatment of AGA.
Patients treated with pure PRP
had a statistically signicant improvement in hair
regrowth at 3 and 6 months. Several studies of treat-
ment with PRP in AGA have been described, although
most of the available literature focused on patients who
received treatment with PRP alone.
Patients who
received any topical and/or systemic treatments for
AGA in the previous 6 or 12 months are typically
excluded from studies with PRP.
As in clinical practice, most patients with the diagnosis of
AGA are undergoing therapy for their alopecia, and we
hypothesized if PRP could also improve hair regrowth if
used simultaneously with the patients current medica-
tion. In the second phase of our study,
we performed
a randomized placebo-controlled, double-blinded, half-
head study to assess the efcacy of PRP in combination
with minoxidil or nasteride on the treatment of AGA.
In this study, healthy male patients with clinical diagnosis
of AGA (Stage II to V, according to HamiltonNorwood
classication) and healthy female patients with AGA
(Stage I to III, according to Ludwig Classication) were
recruited. Thirteen patients treated with 1 mL 5%
topical minoxidil solution twice daily and 12 patients
medicatedwith1mg/doralnasteride were enrolled for
a total of 25 patients. Twenty-four patients completed
the entire protocol and were included in the main analysis
(Table 1). One patient was lost to follow-up.
Patients provided written informed consent before
participating. All patients were evaluated over 4 visits:
V1, baseline and beginning of the study; V2, second
treatment; V3, third treatment; and V4, follow-up. In
the rst 3 visits, a total of 3 treatments were given with
an interval of 1 month from each other. Patients were
followed for 6 months.
TABLE 1. Baseline Patient Demographic and
Clinical Characteristics
Demographic Data
Group B
(n = 24)
Age (mean), yrs 39.9 (18–65)
Female n = 13 (54.2%)
Male n = 11 (45.8%)
Family History
Positive n = 21 (87.5%)
Mother n = 5 (23.8%)
Father n = 16 (76.2%)
Negative n = 3 (12.5%)
Beginning of AGA, yrs
<25 n = 12 (50%)
$25 n = 12 (50%)
Smoking status
Yes n = 4 (16.7%)
No n = 20 (83.3%)
Ethnic origin
Caucasian n = 24 (100%)
Classification (n = 11)
Stage II n = 2 (18.2%)
Stage III n = 7 (63.6%)
Stage IV n = 1 (9.1%)
Stage V n = 1 (9.1%)
Ludwig classification (n = 13)
Stage I n = 3 (23.1%)
Stage II n = 9 (69.2%)
Stage III n = 1 (7.7%)
AGA, androgenetic alopecia.
© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 1076-0512 ·Dermatol Surg 2017;0:14·
© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
PRP was prepared with a closed system using sterile and
disposable kits (Proteal; Soluciones Bioregenerativas, SL,
Barcelona, Spain). Samples collected were handled in
accordance with the manufacturers instructions. Each
patient received injections of pure PRP in one side of the
head; the other half was injected with a placebo solution
(saline solution) (Figure 1). Platelet-rich plasma admin-
each half-head of the scalp: one frontal and one occipital).
Platelet-rich plasma (4 mL total) was administered as
0.15 to 0.20 mL per point of injection.
Figure 1. A 28-year-old woman with androgenetic alopecia treated with PRP on the left half-head and placebo on the right half-
head. Global photographs of the scalp were performed at baseline (A), 3 months (B), and 6 months (C). PRP, platelet-rich plasma.
TABLE 2. Relevant Hair Growth Parameters for the Half-Head Areas Treated With PRP and Placebo at
Baseline, 3 and 6 Months
Placebo (n = 24) PRP (n = 24) Placebo vs PRP
Mean 6SD p Mean 6SD p p
Hair count (hairs/0.65 cm
Baseline 97.9 629.2 >.05 96.8 627.5 >.05 >.05
3 mo 99.8 628.1 >.05 105.3 632.3 <.05 >.05
6 mo 95.9 627 >.05 108.2 633.3 <.05 <.05
Hair density (1/cm
Baseline 150.8 646.1 >.05 149.5 642 >.05 >.05
3 mo 153.3 642.2 >.05 160.5 647.1 <.05 >.05
6 mo 147.5 641.6 >.05 163.6 647.1 <.05 <.05
Terminal hair density
Baseline 142.4 643.8 >.05 141.3 640.4 >.05 >.05
3 mo 145.2 642.2 >.05 145.9 645.8 >.05 >.05
6 mo 136.8 644.1 >.05 152.9 644.6 <.05 <.05
Anagen hair (%)
Baseline 68.6 613.2 >.05 67.5 615.6 >.05 >.05
3 mo 69.9 69.9 >.05 70.5 614.7 >.05 >.05
6 mo 69.1 69.9 >.05 72.7 610.7 <.05 >.05
Telogen hair (%)
Baseline 31.6 613.2 >.05 32.5 615.6 >.05 >.05
3 mo 30.1 69.9 >.05 29.7 614.6 >.05 >.05
6 mo 30.9 69.9 >.05 27.3 610.7 <.05 >.05
Anagen/telogen ratio (%)
Baseline 173.7 6159.6 >.05 168.9 6155.8 >.05 >.05
3 mo 176.6 6156.5 >.05 228 6238.3 >.05 >.05
6 mo 158.2 6119.3 >.05 213.6 6152.4 >.05 >.05
Data assessed by Trichoscan analysis.
Bold indicates p< .05 statistical significant.
PRP, platelet-rich plasma; SD, standard deviation.
© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
The evaluation criteria were assessed in all patients by
TrichoScan analysis using the system FotoFinder;
TrichoScan Professional Version. The hair growth
parameters were evaluated in all visits and data
compared with the baseline and between treatment
and control areas (placebo). All analysis was per-
formed with SAS statistical software version 9.4 (SAS
Institute Inc., Cary, NC).
At baseline, there were no signicant differences in
hair count, hair density, terminal density, and anagen
or telogen hairs between the treatment (PRP + minox-
idil 5% solution or PRP + oral nasteride) and control
areas of the scalp (placebo + minoxidil 5% solution or
placebo + oral nasteride). The detailed hair growth
parameters are described in Table 2.
The results show that the administration of PRP led to
a statistically signicant increase in the mean hair
count (hairs/0.65 cm
) and mean hair density (1/cm
versus baseline values at 3 months (p< .05; month 3 vs
Six months after the rst treatment, mean hair count
(hairs/0.65 cm
), hair density (1/cm
), terminal hair
density (1/cm
), anagen hairs (%), and telogen hairs
(%) showed a statistically signicant positive effect of
PRP associated with medication versus baseline
(p< .05; month 6 vs baseline). In addition, the changes
observed in the mean hair count, hair density, and
terminal density were statistically signicant versus
placebo (p< .05; control vs treatment). No differences
in anagen/telogen ratio between the PRP and placebo
areas were observed.
The hair parameters were also evaluated for compar-
ison between PRP and minoxidil versus PRP and
nasteride (Table 3).
In the areas treated with placebo, there were no
statistical differences between minoxidil or nasteride.
The combination of PRP and minoxidil 5% solution in
comparison with PRP and nasteride 1 mg displayed
a total mean hair count change of 9.8 626.9 hairs
versus 0.6 610.8 hairs; a total mean hair density of
12.3 634.2 hairs/cm
versus 1.8 616.7 hairs/cm
a mean anagen hairs (%) of 5.5 619.7 versus -2 6
12.2, respectively (p< .05: PRP + minoxidil vs PRP +
nasteride). Overall, after 6 months, combination of
TABLE 3. Description of Hair Growth Parameters
Regarding the 2 Different Subgroups: PRP and
Minoxidil 5% and PRP and Finasteride, at 6
Month 6
Placebo PRP
Mean 6SD Mean 6SD
Hair count
(hairs/0.65 cm
(n = 11)
0.9 616.3 0.6 610.8
Minoxidil 5%
(n = 13)
3.7 614.5 9.8 626.9
p0.4004 0.0105
Hair density
(n = 11)
1.4 625.1 1.8 616.7
Minoxidil 5%
(n = 13)
5.1 623.9 12.3 634.2
p0.2831 0.0104
Terminal hair
(n = 11)
21.9 628.3 3.9 615.2
Minoxidil 5%
(n = 13)
5.6 621.9 3.2 638.4
p0.1379 0.1749
Anagen hair (%)
(n = 11)
22.1 615 22612.2
Minoxidil 5%
(n = 13)
1.5 613.8 5.5 619.7
p0.0777 0.0015
hair (%)
(n = 11)
2.1 615 1.8 612.2
Minoxidil 5%
(n = 13)
21.7 614 25.5 619.9
p0.0724 0.0019
ratio (%)
(n = 11)
240.5 6169.7 26.6 6155.7
Minoxidil 5%
(n = 13)
1.7 6192.5 69.6 6234
p0.1667 0.0179
Data assessed by Trichoscan analysis.
Bold indicates p< .05 statistical significant.
PRP, platelet-rich plasma; SD, standard deviation.
0:0:MONTH 2017 3
© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
PRP and minoxidil 5% showed superiority in mean
hair count, hair density, anagen and telogen percen-
tages, and mean anagen/telogen ratio in comparison
with the association of PRP and nasteride 1 mg
(p< .05: PRP + minoxidil vs PRP + nasteride).
Minoxidil is known to promote hair regrowth and
a possible effect of minoxidil is the increased expres-
sion of some growth factors (GFs) such as vascular
endothelial GF in cultured dermal papilla (DP) cells as
shown by Lachgar and colleagues
This could induce
angiogenesis. Platelet-rich plasma is known to
produce different GFs and that might lead to an intense
with increased proliferation of
human DP cells.
Although this is a novelty in the treatment of AGA, and
the mechanism is not fully understood, the association
of 5% minoxidil topical solution with pure PRP might
have a cumulative effect in DP cells and promote
greater angiogenesis and improvement in hair
regrowth of AGA patients.
Our study is limited by the short follow-up. An
advantage of the study is as both treatment and placebo
are performed in the same patient, the baseline char-
acteristics are the same for both groups. This minimizes
the inuence of bias. No adverse effectswere reported.
Based on this study, we conclude the following: (1) the
administration of PRP associated with ongoing
medication is effective on the evolution of AGA; (2) the
application of PRP improved the mean hair parame-
ters, and that was statistically signicant versus base-
line at month 6; (3) both minoxidil or nasteride with
PRP improved hair regrowth; and (4) PRP in combi-
nation with minoxidil showed a greater improvement
than PRP with nasteride, at 6 months.
The use of PRP is effective, safe, and worthwhile as
a complementary treatment for AGA, but additional
placebo-controlled studies are needed to compare the
efcacy of PRP with minoxidil solution versus PRP
with nasteride. Larger samples sizes and longer
follow-up periods are needed.
1. Alves R, Grimalt R. Randomized placebo-controlled, double-blind, half-
head study to assess the efcacy of platelet-rich plasma on the treatment
of androgenetic alopecia. Dermatol Surg 2016;42:4917.
2. Gupta AK, Carviel JL. Meta-analysis of efcacy of platelet-rich plasma
therapy for androgenetic alopecia. J Dermatolog Treat 2016;28:14.
3. Lachgar S, Charveron M, Gall Y, Bonafe JL. Minoxidil upregulates the
expression of vascular endothelial growth factor in human hair dermal
papilla cells. Br J Dermatol 1998;138:40711.
4. Uebel CO, da Silva JB, Cantarelli D, Martins P. The role of platelet
plasma growth factors in male pattern baldness surgery. Plast Reconstr
Surg 2006;118:145866.
5. Li ZJ, Choi HI, Choi DK, Sohn KC, et al. Autologous platelet-rich
plasma: a potential therapeutic tool for promoting hair growth.
Dermatol Surg 2012;38:10406.
Rubina Alves, MD
Ramon Grimalt, MD, PhD
Department of Dermatology
Universitat Internacional de Catalunya
Barcelona, Spain
The authors have indicated no signicant interest with
commercial supporters.
© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
... Key amongst those are (1) whether PRP is more effective than standard of care (Minoxidil and Finasteride) in reversing hair loss and (2) whether the effects of PRP can be compounded with that of minoxidil and finasteride to increase hair growth. In an attempt to address these questions, Alves et al. (99) in 2018 conducted a randomized controlled doubleblind half-head clinical trial involving 11 male patients with grade II-V AGA (Hamilton-Norwood Scale) and 13 female patients with grade I-III AGA (Ludwig Scale). For a duration of 3 months, half the patients received 1 mg of oral finasteride daily while the other half received twice-daily topical 5% minoxidil application. ...
... Clinical trial numbers are also provided for the studies that were performed in the U.S. and/or registered on Of the seventeen studies, excluding the two by Kapoor et al. and Butt et al. fifteen were evaluated and discussed within this narrative review(92)(93)(94)(95)(96)(97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108). ...
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Androgenetic alopecia (“AGA”) is the most prevalent type of progressive hair loss, causing tremendous psychological and social stress in patients. However, AGA treatment remains limited in scope. The pathogenesis of androgenetic alopecia is not completely understood but is known to involve a hair follicle miniaturization process in which terminal hair is transformed into thinner, softer vellus-like hair. This process is related to the dysregulation of the Wnt/β-catenin signaling pathway, which causes premature termination of the anagen growth phase in hair follicles. Historically used for wound healing, platelet rich plasma (“PRP”) has recently been at the forefront of potential AGA treatment. PRP is an autologous preparation of plasma that contains a high number of platelets and their associated growth factors such as EGF, IGF-1, and VEGF. These factors are known to individually play important roles in regulating hair follicle growth. However, the clinical effectiveness of PRP is often difficult to characterize and summarize as there are wide variabilities in the PRP preparation and administration protocols with no consensus on which protocol provides the best results. This study follows the previous review from our group in 2018 by Cervantes et al. to analyze and discuss recent clinical trials using PRP for the treatment of AGA. In contrast to our previous publication, we include recent clinical trials that assessed PRP in combination or in direct comparison with standard of care procedures for AGA such as topical minoxidil and/or oral finasteride. Overall, this study aims to provide an in-depth analysis of PRP in the treatment of AGA based on the evaluation of 17 recent clinical trials published between 2018 and October 2021. By closely examining the methodologies of each clinical trial included in our study, we additionally aim to provide an overall consensus on how PRP can be best utilized for the treatment of AGA.
... PRP combined with minoxidil 5% revealed superior results concerning hair density, mean hair count, anagen and telogen percentages, and mean anagen/telogen ratio, compared to the combination of PRP and finasteride 1 mg (p< .05: PRP plus minoxidil vs. PRP plus finasteride) in a randomized placebo-controlled, double-blind, half-head study [15]. According to Shah et al., microneedling with PRP plus topical minoxidil 5% has been significantly more effective than topical minoxidil 5% alone [16]. ...
... Several randomized controlled trials have demonstrated synergistic effects of the combination of PRP with oral finasteride and topical minoxidil. [31][32][33][34] Overall, the evidence suggests that PRP is a safe and effective treatment for hair loss due to AGA. ...
Regenerative medicine refers to the restoration of the form and function of damaged and diseased tissues by upregulation of natural regenerative processes present in the human body. Applications of regenerative medicine in dermatology are numerous, ranging from the acceleration of wound healing, hair restoration, mesenchymal stem cell augmented fat transfer, skin rejuvenation, enhancing results, and reducing downtime postprocedure and postlaser, etc. In modern aesthetic practice, the most prominent among current regenerative treatments are platelet-rich plasma (PRP), stem cells, growth factors, and most recently, exosomes. Most of the modalities available at present lack high-quality evidence supporting their use and good quality clinical trials are required for the optimization of cellular source, dose, and administration intervals before these modalities are deemed acceptable for use at a wider scale.
... The effect was even greater in the group treated with PRP and minoxidil combination compared to the PRP and finasteride combination group. 164 169 Ongoing hair loss will affect the density and cosmetic appearance of a hair transplant procedure so it is often useful to combine transplantation with medical therapy. ...
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Background Androgenetic alopecia (AGA) is the most common form of hair loss consisting of a characteristic receding frontal hairline in men and diffuse hair thinning in women, with frontal hairline retention, and can impact an individual's quality of life. The condition is primarily mediated by 5-alpha-reductase and dihydrotestosterone (DHT) which causes hair follicles to undergo miniaturization and shortening of successive anagen cycles. Although a variety of medical, surgical, light-based and nutraceutical treatment options are available to slow or reverse the progression of AGA, it can be challenging to select appropriate therapies for this chronic condition. Aims To highlight treatment options for androgenetic alopecia taking into consideration the efficacy, side effect profiles, practicality of treatment (compliance), and costs to help clinicians offer ethically appropriate treatment regimens to their patients. Materials and Methods A literature search was conducted using electronic databases (Medline, PubMed, Embase, CINAHL, EBSCO) and textbooks, in addition to the authors' and other practitioners' clinical experiences in treating androgenetic alopecia, and the findings are presented here. Results Although topical minoxidil, oral finasteride, and low-level light therapy are the only FDA-approved therapies to treat AGA, they are just a fraction of the treatment options available, including other oral and topical modalities, hormonal therapies, nutraceuticals, PRP and exosome treatments, and hair transplantation. Discussion Androgenetic alopecia therapy remains challenging as treatment selection involves ethical, evidence-based decision-making and consideration of each individual patient's needs, compliance, budget, extent of hair loss, and aesthetic goals, independent of potential financial benefits to the practitioners.
Male androgenetic alopecia is a common condition and represents a major concern for patients who experience this condition. While there are different treatments to stop hair loss and improve hair density, the 5-alpha reductase inhibitors have demonstrated to be effective in improving androgenetic alopecia in men and can maintain a positive response for many years. Oral finasteride 1 mg is a US FDA-approved option, but dutasteride 0.5 mg has been proven to induce better responses, especially in the frontal area. Both have been shown to be safe in clinical trials but there is widespread concern about sexual adverse effects among patients. The use of topical finasteride has increased during the last few years as a useful option to avoid systemic therapy. The efficacy of topical finasteride 0.25% daily has been demonstrated in clinical trials, with a less marked decrease in serum dihydrotestosterone levels than with oral intake. Mesotherapy with dutasteride has also become more widespread recently, although evidence of its effectiveness is limited to retrospective studies in real clinical practice. The use of oral minoxidil in androgenetic alopecia has not been approved by the FDA, however several clinical studies have shown that it is an effective treatment option. The initial dose recommended to treat male hair loss is 2.5 mg daily, although the dose is frequently increased to 5 mg daily. The main adverse effect of oral minoxidil is hypertrichosis, followed by dizziness or lower limb edema, which are much less common. Platelet-rich plasma is a non-pharmacological option to treat male androgenetic alopecia, with some clinical trials demonstrating an improvement in hair count after several months. Among the published studies, the main limitation to compare its efficacy is the heterogeneity of the procedure. The most frequent regimens propose treatment every 4 weeks for 3 months initially to assess the individual response. Another treatment alternative is the use of light devices with wavelengths of between 630 and 660 nm, known as low-level laser therapy. These devices can be used at home every day for 15-30 min. Their efficacy has been shown in a limited number of clinical trials; however, there is a lack of evidence about the efficacy of these devices compared with other medical options or as a complementary therapy in hair loss. The pipeline of potential new treatments for male androgenetic alopecia is strong. Pyrilutamide and GT20029 are being studied as topical antagonists of the androgen receptor, while cetirizine is another topical option with some initial promising results. Furthermore, according to isolated studies with heterogeneous treatment schemes, the use of botulinum toxin in the scalp might improve androgenetic alopecia, and lastly, scalp threading might increase the total hair count as growth factors are released during implantation.
Platelet-rich plasma (PRP) therapy is a new method for the treatment of androgenetic alopecia (AGA), the effectiveness and safety of which continues to be studied. Information on comparative efficacy when combining PRP with other methods of treatment is limited. The aim of the study was a comparative evaluation of the clinical efficacy of minoxidil, PRP therapy, and their combination in the treatment of men with AGA. Materials and methods: The study included 69 men. The patients were divided into three observation groups: the main group (25 people, received applications of a 5% solution of minoxidil in combination with PRP injections), the comparison group (22 people, received intradermal injections of PRP), and the control group (22 people, received applications of a 5% solution of minoxidil). The clinical efficacy of the therapy was evaluated by the dynamics of morphometric indicators of hair growth using a digital camera and the software. Results: It was established that after complex therapy in the form of minoxidil applications and injections of PRP, the hair density increased by 32% (P = 0.00004), the diameter of the hair shafts by 26% (P = 0.00004), the share of vellus hair decreased by 30% (P = 0.00082), and the proportion of telogen hair decreased by 39% (P = 0.00008). The results of using complex therapy significantly exceeded the clinical effect of platelet-rich plasma and topical applications of a 5% solution of minoxidil. Conclusions: The data obtained allows suggesting that PRP and minoxidil potentiate each other's action when used together and their complex application seems promising for the treatment of androgenetic alopecia.
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Even though a variety of treatments for androgenetic alopecia (AGA) currently have been using in clinical, satisfactory therapeutic methods are still lacking. We aimed to compare and rank these treatments for AGA according to their differences in efficacy via Bayesian network meta-analysis, suggesting the optimal therapy for clinical utility to refer. A systematic search of PubMed, Embase, Web of Science, and Cochrane Library database was performed and we included eligible randomized controlled trials. We compared differences in treatment effects of monotherapies and combination therapies using the Bayesian network model. The average difference in alteration from baseline of hair density and hair diameter, and variation value (Mean±SD) between the pre- and post-intervention were selected for main outcome measure and secondary outcome measure. Total 49 RCTs involving 3133 patients and 6 interventions were included. Regardless of based on hair density or hair diameter, topical/systemic combined with adjunctive therapeutics had the best treatment efficacy among all interventions (SMD: 40.11; 95% CrI 25.65–54.59), followed by topical combined with systemic medical therapeutics (SMD: 36.41; 95% CrI 17.54–55.24). In addition, in terms of hair density, treatment efficacy had significant difference sequentially among topical medical therapeutics (SMD: 22.15; 95% CrI 12.88–31.42), systemic medical therapeutics (SMD: 19.91; 95% CrI 6.504–33.22), and adjunctive therapeutics (SMD: 18.60; 95% CrI 8.020–29.10) compared to placebo. In recent years, combination therapies are showing significant promise as potential therapies. Taken together with the outcomes of this study, despite the specific mechanism of the effect of combination therapies was not clear and further studies are needed, it may be the best treatment for AGA. This article is protected by copyright. All rights reserved.
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.
Androgenetic alopecia (AGA) is the most common form of hair loss characterized by progressive reduction and miniaturization of terminal hair follicles on the scalp. While this condition is benign in nature and often considered part of the normal aging process, it is a familiar cosmetic concern encountered by dermatologists as it negatively impacts patient’s quality of life. Developing a therapeutic regimen for patients is often challenging as treatment options are limited, not well tolerated by all patients and may result in sub-optimal treatment outcomes. In this chapter, we discuss the use of PRP as an adjuvant therapy for treatment of AGA.
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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.
Background: Platelet-rich plasma (PRP) therapy is used as an off-label treatment for androgenetic alopecia (AGA); however, published efficacy evidence is still preliminary. Objective: Conduct a meta-analysis of current trial data to estimate efficacy. Methods: Thirteen studies which investigated the use of PRP for treatment of AGA were identified from the literature. A meta-analysis was used to analyze results from four trials (N = 60) where sufficient quantifiable data extraction was possible. All 13 studies were analyzed qualitatively. Results: When comparing PRP treatment to baseline, the overall standardized mean difference was 0.51 [95% confidence interval (CI): 0.14, 0.88; I(2 )=( )0%] in favour of PRP treatment. Conclusion: Preliminary results suggest that the investigation of PRP for the treatment of AGA is promising. Controlled trials with quantifiable measures of treatment success are now required to confirm these results.
Background: Platelet-rich plasma (PRP) was identified as having a beneficial effect in alopecia and has been postulated as a new therapy for androgenetic alopecia (AGA). Objective: To assess the efficacy of PRP for the treatment of AGA. Materials and methods: This was a randomized, placebo-controlled, double-blind study in 25 patients with AGA. Platelet-rich plasma was injected in half-head and the other half-head with placebo. Each patient received a total of 3 treatments of PRP, 1 month apart. Results: Six months after the first treatment with PRP, significant differences were seen in mean anagen hairs (67.6 ± 13.1), telogen hairs (32.4 ± 13.1), hair density (179.9 ± 62.7), and terminal hair density (165.8 ± 56.8) when compared with baseline (p < .05). Platelet-rich plasma was also found to increase hair density when comparing with the control side (p < .05). For the first time, the authors found a correlation between anagen hairs and patients >40 years and beginning of AGA ≥25 years old (p < .05) and hair density and male sex, age ≤40 years, positive family history of AGA and >10 years of duration of the disease (p < 0.05). Conclusion: Application of PRP showed a positive effect on AGA and could be regarded as an adjuvant therapy for AGA.
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.
The hair follicle dermal papilla which controls hair growth, is characterized in the anagen phase by a highly developed vascular network. We have demonstrated in a previous study that the expression of an angiogenic growth factor called vascular endothelial growth factor (VEGF) mRNA varied during the hair cycle. VEGF mRNA is strongly expressed in dermal papilla cells (DPC) in the anagen phase, but during the catagen and telogen phases. VEGF mRNA is less strongly expressed. This involvement of VEGF during the hair cycle allowed us to determine whether VEGF mRNA expression by DPC was regulated by minoxidil. In addition, the effect of minoxidil on VEGF protein synthesis in both cell extracts and DPC-conditioned medium, was investigated immunoenzymatically. Both VEGF mRNA and protein were significantly elevated in treated DPC compared with controls. DPC incubated with increasing minoxidil concentrations (0.2, 2, 6, 12 and 24 mumol/L) induced a dose-dependent expression of VEGF mRNA. Quantification of transcripts showed that DPC stimulated with 24 mumol/L minoxidil express six times more VEGF mRNA than controls. Similarly, VEGF protein production increases in cell extracts and conditioned media following minoxidil stimulation. These studies strongly support the likely involvement of minoxidil in the development of dermal papilla vascularization via a stimulation of VEGF expression, and support the hypothesis that minoxidil has a physiological role in maintaining a good vascularization of hair follicles in androgenetic alopecia.