ArticlePDF AvailableLiterature Review

Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia

March 2019
Dermatologic Surgery 45(10):1

DOI:10.1097/DSS.0000000000001894

Authors:

Aditya Gupta

Mediprobe Research

John Cole

Cole Hair Transplant Group

Peter Everts

EmCyte Corporation, and Gulf Coast Biologics Fort Myers, United States

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Background: Platelet-rich plasma (PRP) treatment may encourage hair growth by promoting cellular maturation, differentiation, and proliferation. Objective: The objective of this study was to evaluate the effectiveness of PRP as a treatment for androgenetic alopecia (AGA). Materials and methods: A literature search combined with meta-analysis was used to calculate the overall standardized mean difference (SMD) in hair density in patients treated with PRP injections in comparison with baseline and placebo treatment. Chi squared analysis and Fisher exact test were used to investigate variation in protocols. Results: The overall SMD in hair density was 0.58 (95% confidence interval [CI]: 0.35-0.80) and 0.51 (95% CI: 0.23-0.80, p < .0004) in favor of PRP treatment when compared with baseline and placebo treatment, respectively. Conclusion: Platelet-rich plasma is beneficial in the treatment of AGA. It is recommended that 3 monthly sessions of PRP (once monthly ×3 treatments) be used followed by a 3- to 6-month maintenance period.

. Factors That Could Influence the Efficacy of Platelet-Rich Plasma

…

. Characteristics of Platelet-Rich Plasma Studies Conducted in Androgenetic Alopecia Patients Using Hair Density as a Measure of Efficacy

…

. (Continued )

…

Characteristics of Trials Used in Meta-analysis

…

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Platelet-Rich Plasma as a Treatment for

Androgenetic Alopecia

Aditya K. Gupta, MD, PhD,*

†

John Cole, MD,

‡

David P. Deutsch, MD,*

Peter A. Everts, PhD,

Robert P. Niedbalski, DO,*

Ratchathorn Panchaprateep, MD, PhD,*

Fabio Rinaldi, MD,*** Paul T. Rose, MD, JD,*

††

Rodney Sinclair, MD, MBBS,

‡‡

JamesE.Vogel,MD,*

Ryan J. Welter, MD, PhD,

Michael D. Zufelt, DO,*

¶¶

and Carlos J. Puig, DO*

BACKGROUND Platelet-rich plasma (PRP) treatment may encourage hair growth by promoting cellular

maturation, differentiation, and proliferation.

OBJECTIVE The objective of this study was to evaluate the effectiveness of PRP as a treatment for andro-

genetic alopecia (AGA).

MATERIALS AND METHODS A literature search combined with meta-analysis was used to calculate the

overall standardized mean difference (SMD) in hair density in patients treated with PRP injections in com-

parison with baseline and placebo treatment. Chi squared analysis and Fisher exact test were used to inves-

tigate variation in protocols.

RESULTS The overall SMD in hair density was 0.58 (95% conﬁdence interval [CI]: 0.35–0.80) and 0.51 (95% CI:

0.23–0.80, p< .0004) in favor of PRP treatment when compared with baseline and placebo treatment,

respectively.

CONCLUSION Platelet-rich plasma is beneﬁcial in the treatment of AGA. It is recommended that 3 monthly

sessions of PRP (once monthly ·3 treatments) be used followed by a 3- to 6-month maintenance period.

The authors have indicated no signiﬁcant interest with commercial supporters.

Platelet-rich plasma (PRP) is created through

concentrating platelets found in whole blood.

can aid in tissue regeneration, bone regeneration, and

wound repair.

2–7

Platelet-rich plasma treatment has

also been suggested to promote hair growth,

encourage cell survival and proliferation, and

prolong the anagen phase of the hair cycle.

8–13

Platelet-rich plasma is thought to exert its effects

in androgenetic alopecia (AGA) via delivery of

concentrated growth factors to the hair follicle

and surrounding area (Figure 1). Emerging

evidence has begun to characterize the dermal and

follicular response to several growth factors (e.g.,

platelet-derived growth factor, transforming

growth factor beta).

14–17

The main objective of this

article was to assess the effectiveness of PRP

as a monotherapy and adjunct treatment for male

AGA.

*International Society of Hair Restoration Surgery (ISHRS), Ad Hoc Committee on PRP;

†

Division of Dermatology,

Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada;

‡

Cole Hair Transplant

Group, Alpharetta, Georgia;

Bosley Medical, Beverly Hills, California;

EmCyte Corporation, Fort Myers,

Florida;

Northwest Hair Restoration, Tacoma, Washington;

Division of Dermatology, Department of Medicine, Faculty

of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; **International

Hair Research Foundation, Italy;

††

Hair Transplant Institute Miami, Coral Gables, Florida;

‡‡

Sinclair Dermatology,

Melbourne, Australia;

Division of Plastic Surgery, Department of Surgery, The Johns Hopkins Hospital and School of

Medicine, Baltimore, Maryland;

New England Center for Hair Restoration, Westwood, Massachusetts;

¶¶

Hair

Restoration Center of Utah, Salt Lake City, Utah;

Physicians Hair Restoration Center, Houston, Texas

ISSN: 1076-0512 ·Dermatol Surg 2019;00:1–12 ·DOI: 10.1097/DSS.0000000000001894

Platelet-Rich Plasma as a Monotherapy for Male

Androgenetic Alopecia

To analyze the effectiveness of PRP for the treatment

of AGA, a meta-analysis was undertaken. A literature

search was conducted using PubMed on September 7,

2017 and updated on May 18, 2018. The following

terms were used; “PRP,”“hair,”“platelet-rich

plasma,”“hair transplant,”“hair loss,”“androge-

netic alopecia,”and “alopecia.”Studies were included

if they evaluated the success of PRP for treatment of

AGA using hair density (hairs/cm

18–27

Studies were

excluded if they did not use direct injection, contained

less than 5 participants per treatment, included only

female participants, patients used alternative treat-

ments (5a-reductase inhibitors, minoxidil) within

6 months of study start or if insufﬁcient data were

provided. Study parameters are listed in Table 1 with

characteristics such as a larger patient population and

use of controls, comparators, randomization, and

blinding generally considered more scientiﬁcally rig-

orous. The meta-analysis was conducted using Rev-

Man 5.3 (Copenhagen, Denmark). Effect size was

measured through use of the standardized mean dif-

ference (SMD), where treatment versus comparator

results close to 0 suggest no difference and increasingly

higher scores are associated with improvement. Het-

erogeneity was evaluated using the I

statistic.

28,29

The

reported efﬁcacy was compared to baseline measures,

and a p-value < .05 was considered signiﬁcant. The

SMD in hair density was 0.58 (95% conﬁdence

interval [CI]: 0.35–0.80) in favor of PRP treatment (10

Figure 1. Mechanism of action. Platelet-rich plasma is prepared from an autologous blood sample that is subsequently

centrifuged to concentrate platelets. Platelet-rich plasma is then activated, often with the addition of calcium chloride to

stimulate the release of growth factors. Platelet-rich plasma is subsequently injected into the patient’s scalp, where various

growth factors are thought to stimulate gene upregulation associated with angiogenesis, cell survival, and proliferation.

AKT, protein kinase B; EGF, epidermal growth factor; ERK, extracellular signal-regulated kinase; FGF-7, ﬁbroblast growth

factor 7; IGF-1, insulin-like growth factor 1; mTOR, mechanistic target of rapamycin; PI3K, phosphoinositide 3-kinase; TGF-

b, transforming growth factor beta; TGFbRI, abrogated transforming growth factor beta receptor I; TGFbRII, abrogated

transforming growth factor beta receptor II; VEGF, vascular endothelial growth factor; smad2, mothers against decap-

entaplegic homolog 2; smad3, mothers against decapentaplegic homolog 3.

PRP PROTOCOL RECOMMENDATIONS

DERMATOLOGIC SURGERY2

TABLE 1. Characteristics of Trials Used in Meta-analysis

Study

No. of

Participants

Placebo or Untreated

Control Use of Comparator Randomized Blinded

Length of

Study Study Description

Alves and

Gimalt

25 Placebo No Yes Double 6 mo Half-head study

Anitua and

colleagues

19 No No No No 1 yr Pilot study

Ayatollahi and

colleagues

15 No No No No 22 wk

Borhan and

colleagues

17 No No No No 16 wk Open monocentric and

prospective study

Cervelli and

colleagues

10 Placebo No No No 12 mo Half-head study

Gentile and

colleagues

18 Placebo No Yes Double 5 mo Half-head study

Gentile and

colleagues

23 Placebo No No No 5 mo Half-head study

Gkini and

colleagues

20 No No No No 1 yr Prospective cohort study

Stevens and

colleagues

10 Untreated No No No 12 wk

Takikawa and

colleagues

26 Placebo PRP containing dalteparin and

protamine particles

No No 12 wk

PRP, platelet-rich plasma.

GUPTA ET AL

00:00:MONTH 2019 3

studies, pooled N= 165, p< .00001) (Figure 2A). This

result is consistent with a previously published meta-

analysis that also favored PRP over baseline (SMD:

0.51, 95% CI: 0.14–0.88, p= .006).

Likewise, PRP

exhibited a greater efﬁcacy over placebo treatments

(SMD: 0.51, 95% CI: 0.23–0.80, p< .0004) with the

inclusion of 6 trials (pooled N= 99)

18,22–24,26,27

(Figure 2B).

In this study, interestingly, and similar to some of the

observations from previous research,

evidence for

investigating male and female patients separately

was found. Inclusion of an all-female study

in the

current meta-analysis (otherwise composed of all male

and mostly male studies) was not possible due to an

introduction of high heterogeneity (measured I

89%), leading to the suggestion that female patients

should be investigated distinctly. This idea has prac-

tical implications for clinicians as there are few AGA

treatment options for female patients and encourages

new research directions to test this hypothesis with the

possibility of creating a unique PRP protocol targeted

directly to female patients.

Investigating methods across AGA studies, with the

exception of a few minor modiﬁcations, only 2 PRP

protocols were duplicated.

33,34

Both studies reported

that subjects treated with PRP had a greater change in

hair density compared to placebo-treated subjects.

Khatu and colleagues and Singhal and colleagues both

used an activated (calcium chloride) PRP treatment (2-

week interval between sessions, 4 sessions total) cre-

ated using a double spin technique (1,500 rpm for

6 minutes and 2,500 rpm for 15 minutes).

33,34

These 2

studies did differ in how much PRP was injected; 2 to

3 mL per injection versus 8 to 12 mL per injection.

33,34

Cervelli and colleagues and Gentile and colleagues

also used a similar protocol, administering PRP

(0.1 mL/cm

per injection) every 4 weeks for a total of

3 sessions.

22,35

Both studies used the Cascade-Selphyl-

Esforax system, centrifuging the PRP solution at

1,100gfor 10 minutes.

22,35

Cervelli and colleagues and

Gentile and colleagues reported that PRP-treated

patients had a signiﬁcantly greater mean change in hair

density as compared to placebo-treated patients (both

studies p< .0001).

22,35

Overall, the results suggest that

PRP therapy resulted in a signiﬁcantly greater increase

Figure 2. Forest plot illustrating the results of a meta-analysis of PRP as a treatment for hair loss in AGA patients. (A) Ten

studies (pooled N= 165 participants) that used hair density as a measure of efﬁcacy were compared to baseline. (B) Six

studies (pooled N= 99 participants) that used hair density as a measure of efﬁcacy were compared to placebo. AGA,

androgenetic alopecia; PRP, platelet-rich plasma.

PRP PROTOCOL RECOMMENDATIONS

DERMATOLOGIC SURGERY4

TABLE 2. Analysis of Platelet-Rich Plasma Protocols and Techniques

Collection

systems

Use of a closed system is recommended for patient safety and reproducibility

Examples of collection systems that are FDA approved (510k clearance) include the Arthex Angel

System,

Biomet GPS III,

Eclipse PRP system,

Emcyte PurePRP Genesis CS concentrating

device,

Harvest SmartPrep,

Magellan TruPRP,

RegenKit Blood Cell Therapy,

and the Selphyl

system

Each system incorporates its own feature such as an agar plug that may facilitate a high-volume PRP

yield in the Eclipse PRP system,

the compartmentalized reservoir bag that enables different

mediums (whole blood or mixture of blood and bone marrow) to be separated through

centrifugation in the Arthex Angel System,

and the use of calcium chloride in the Selphyl System to

enhance delivery of growth factors through ﬁbrin matrices created by the conversion of ﬁbrinogen to

ﬁbrin

Each collection system also varies in growth factor and cytokine concentrations, platelet capture

efﬁciencies, and resulting monocyte populations

23,38,39

A high platelet recovery rate, elevated growth factor and cytokine concentrations, and a low red blood

cell count is desired

The optimum platelet concentration has been shown to be 1.5 million per microliter (about 5-fold more

concentrated than the normal range of 150,000–400,000),

although currently there are no in vivo

studies that compare results for hair growth directly

Centrifugation

and

sonication

During centrifugation, high speeds and long durations can inadvertently precipitate platelets or

discharge growth factors (e.g., platelet-derived growth factor), inﬂuencing the efﬁcacy of PRP

53,54

As a potential alternative to centrifugation, acoustic-based particle manipulation methods could be

used to separate blood cells

Sonication can lyse platelet cell membranes, allowing the release of growth factors and be more

effective in separation of red and white blood cells

Ultrasound-generated PRP demonstrated a greater platelet recovery rate as compared to PRP obtained

through centrifugation (79 69% vs 54 610% over baseline, respectively)

Sonication may increase the survival rate of transplanted follicular units

Activation Activation using calcium chloride or calcium gluconate is frequently used in hair loss studies to induce

agranule release of growth factors from platelets

18,23,25,32–34,58–61

Extracellular matrix materials such as ACell (FDA approved to repair and remodel damaged tissue)

could also be used to activate PRP solutions, although current evidence for this technique remains

anecdotal

Alternatively, microparticles could be a functional and cheaper substitute

62,63

The combination of microparticles, adipose derived stem cells, and follicular stem cells could also be

advantageous and are currently under investigation

Scalp needling to induce inﬂammation leading to platelet activation has been suggested to be as

effective as use of an exogenous activator

Similarly, it has been suggested that exogenous activation may not make a signiﬁcant impact on

speciﬁc growth factors and cytokines, such as platelet-derived growth factor BB and transforming

growth factor b1,

although a direct comparison (n= 40) of nonactivated versus calcium chloride–

activated PRP resulted in signiﬁcantly more effective treatment in the former

Thus, although it is clear that activation is necessary for growth factor release, further research is

necessary to determine the impact of various methods of activation on the efﬁcacy of PRP

Needle size It is unknown if needle size can inﬂuence the efﬁcacy of PRP

In AGA studies, needles used to administer PRP have ranged from 20 to 32 G, with 30-G needle as the

most commonly used

18,19,21,23–26,35,59,64

Injection depth Follicles vary in length below the skin surface, averaging 4.2 mm in length

Subdermal injections have been shown to be efﬁcacious and tolerable in a blinded randomized clinical

trial (n= 40)

; success has been found with intradermal injections, injections into recipient slits

during transplantation, and injections into microneedling channels

54,67

Use of a mechanical and thus reproducible device has also been recommended for controlled delivery

of PRP

GUPTA ET AL

00:00:MONTH 2019 5

in hair density compared to baseline counts and

placebo.

There are a number of factors that could explain the

variation seen in PRP results (Table 2). Differences in

preparations and delivery have been suggested as a

possible explanation.

36,37

In addition to platelet con-

centration, white blood cell, neutrophil, and red blood

cell concentration varies with separation systems as

well.

38,39

The resulting effect on efﬁcacy is unknown;

however, individual advantages are expected with the

various systems.

For example, in direct comparison

(n= 6), the Arthex Angel System resulted in signiﬁ-

cantly improved hair density versus the Regen Cell

Therapy collection system.

Patient characteristics may also inﬂuence the results

of PRP treatment (Table 3). Variables from each

study (Table 4) were examined using a chi squared

analysis and Fisher exact test to identify any protocol

trends that led to signiﬁcant results more often than

expected. Speciﬁcally, each variable (population

demographics, centrifuge process, concentration of

platelets, injection process, needle gauge, method of

platelet activation, quantity and intervals of treat-

ment, and time of analysis) was examined in search

TABLE 2. (Continued )

Treatment

frequency and

no. of

sessions

Monthly PRP injections had a signiﬁcantly greater increase in hair count as compared to injections

every 3 mo (mean percent change of 29.6 vs 7.2%, p< .001)

Substantial improvements in hair restoration parameters (e.g., hair density, hair count) have

frequently been reported in PRP studies that administer 3 monthly sessions, suggesting that 3

sessions may be necessary to achieve desired results

18,22–24,35,60,61

A 3- to 6-mo maintenance interval after a monthly PRP treatment regimen could be beneﬁcial

Follow-up periods should extend to 12 mo post-treatment, as an early decrease in hair density

coinciding with the PRP-driven stimulation of hairs into the anagen stage is expected

AGA, androgenetic alopecia; FDA, Food and Drug Administration; PRP, platelet-rich plasma.

TABLE 3. Factors That Could Inﬂuence the Efﬁcacy of Platelet-Rich Plasma

Patient

Characteristics Evidence

Gender Male patients experienced new growth 2 wk earlier and had a higher increase in hair counts in

comparison to the female population (n= 115)

Statistically signiﬁcant increase in the mean total hair density for male patients in comparison to

female patients (n= 25)

Severity of alopecia Signiﬁcantly better response from patients with a lower grade of alopecia (Grade III–IV alopecia,

Hamilton–Norwood)

21,25,53,59,70

Disease duration Most studies observed a signiﬁcantly better response from patients with a shorter disease

duration

21,53,59

Alves and Grimalt

observed a statistically signiﬁcant increase in the mean total hair density in

patients with greater than 10 years of disease duration

Age Alves and Grimalt

observed a statistically signiﬁcant increase in the mean total hair density for

patients younger than 40 years

Borhan and colleagues

observed the best response in patients in their early 30s

Onset of alopecia Alves and Grimalt

observed a statistically signiﬁcant increase in the mean total hair density for

patients with hair loss beginning after 25 years

Presence of vellus

hair

Presence of vellus hair led to better results compared to those who had few but normal hair

25,70

PRP PROTOCOL RECOMMENDATIONS

DERMATOLOGIC SURGERY6

TABLE 4. Characteristics of Platelet-Rich Plasma Studies Conducted in Androgenetic Alopecia Patients Using Hair Density as a Measure of Efﬁcacy

Study Study Type PRP Method

Concentration

Increase

Injection

Depth

Needle

Gauge Activation

Treatment

Duration

Assessment

Date Results

Kachhawa and

colleagues

Split head study of

placebo versus PRP,

50 male patients, HN

III–VI

Double spin Intradermal 6 treatments at

21-d intervals

4 mo Density increased

signiﬁcantly

compared to baseline

and placebo

Starace and

colleagues

Pilot study, open-

label, single-group,

single-centre study;

10 female patients

not responding to

treatments; Ludwig

I–III

My Cells system 25 Every 2 wks for

4 sessions

12 and

24 wks

Mostly all positive and

increasing over time,

corresponding to

a clinical improvement

Ayatollahi and

colleagues

13 male patients, HN

III–VI uncontrolled

Regen Lab PRP

Kit—RegenACR

Estimate 1.6-fold

from Regen Lab

data

5 treatments

every 2 wks

22 wks Not signiﬁcant, p=.37

Stevens and

colleagues

10 male patients, HN

II–III

PRP and adipose-

derived stromal

vascular fraction,

Arthrex Angel

System

20 1 6 and 12 wks Hair density was

signiﬁcantly increased

after 6 and 12 wks,

p= .013, p<.013

Gupta and

colleagues

Open-label pilot study,

30 male patients, HN

III–VII

Double spin Massage into

scalp

Microneedling 6 treatments at

15-d intervals

6 mo Increase in hair density

is observed but

signiﬁcance is not

reported

Gentile and

colleagues

(study 1)

Half-head comparison

with placebo, 18

male patients, HN II–

CPunT preparation

system

5-fold 5 mm 30 3 treatments at

30-d intervals

12 wks Signiﬁcant

improvement

compared to baseline

and placebo as well as

to a previous study

p= .0029

Gentile and

colleagues

(study 2)

Half-head comparison

with comparator, 6

male patients, HN

IIIA–IIIV

Regen Blood Cell

Therapy or

Arthrex Angel

System

5-fold 25 Calcium 1 treatment 6 mo Signiﬁcant

improvement in

Arthrex Angel versus

Regen Blood Cell

Therapy

GUPTA ET AL

00:00:MONTH 2019 7

TABLE 4. (Continued)

Study Study Type PRP Method

Concentration

Increase

Injection

Depth

Needle

Gauge Activation

Treatment

Duration

Assessment

Date Results

Alves and

Grimalt

Randomized, placebo-

controlled, double-

blind, half-head

parallel-group study;

12 male patients, HN

II–V; 13 female

patients, Ludwig I–III

Single spin,

leukocyte poor

3-fold 30 Calcium 3 treatments at 1-

mo intervals

3 and 6 mo Signiﬁcant

improvement from

baseline and placebo

p<.05

Anitua and

colleagues

Uncontrolled study; 13

male patients, HN III–

VI; 6 female patients,

Lugwig II/frontal

Single spin BTI

system, leukocyte

layer not collected

2-fold 30 4 treatments at

1-mo intervals

with a ﬁnal

treatment at 7

12 mo Signiﬁcant

improvement p< .05

Tawﬁk and

Osman

Double-blinded,

randomized,

placebo-controlled,

half-head study; 30

female patients;

Ludwig I–III

Double spin Calcium 4 treatments at

1-wk intervals

7 mo Signiﬁcant

improvement p< .05

compared to placebo

and baseline

Cervelli and

colleagues

Randomized, placebo,

half-head study; 10

male patients

Cascade-Selphyl-

Esforax, 0.1 mL/

per injection,

leukocytes not

excluded

30 Calcium 3 treatments at

1-mo intervals

12 mo Signiﬁcant

improvement, control

versus treatment,

p< .0001

Gkini and

colleagues

Prospective cohort

study; 18 male

patients, HN II–V; 2

female patients;

Ludwig I–III

RegenKit BCT-3 5.8-fold 1.5–2.5 mm 27 Calcium 3 treatments at

21-d intervals,

booster at 6 mo

12 mo Signiﬁcant

improvement

at 6 wks and 12 mo

compared to baseline

Borhan and

colleagues

Open, monocentric

prospective study, 3

female and 11 male

patients, HN III–IV

Regen Lab, 4–5 mL

used per session,

0.05–0.1 mL per

injection

Superﬁcial

dermis

32 4 treatments total

at 3-wk

intervals, last

treatment at

6-wk interval

16 wk Not signiﬁcant, p= .8638

PRP PROTOCOL RECOMMENDATIONS

DERMATOLOGIC SURGERY8

TABLE 4. (Continued)

Study Study Type PRP Method

Concentration

Increase

Injection

Depth

Needle

Gauge Activation

Treatment

Duration

Assessment

Date Results

Gentile and

colleagues

Randomized, placebo-

controlled, half-head

study; 2 male

patients; HN II–IV

Modiﬁed versions

of the Cascade-

Selphyl-Esforax

system and

platelet-rich

lipotransfert

system, may

include

leukocytes

30 Calcium 3 treatments at

30-d intervals

2 yrs Signiﬁcant

improvement in

control versus

treatment, p= .001

Gentile and

colleagues

18 male patients, HN I–

V; and 5 female

patients, Lugwig I–II

5 mm with

medical

injector gun

30 3 treatments at

30-d intervals

5mo 3162% increase in hair

density for the

treatment group

versus less than 1%

increase in hair

density for the placebo

group compared to

baseline

Takikawa

and

colleagues,

Controlled,

half-head

study;

26 participants

Cascade-

Selphyl-

Esforaxsystem,

PRP mixed with

2 mg/mL

of D/P MP

6-fold Subcutaneous

injection

25 Calcium 5 treatments

at 2-wk

intervals;

last treatment at

3-wk intervals

12 wks No signiﬁcant

difference between

PRP and PRP &

(D/P MP) treatments

but signiﬁcant

improvement

from control

D/P MP, dalteparin and protamine microparticles; PRP, platelet-rich plasma.

GUPTA ET AL

00:00:MONTH 2019 9

of a similar variable appearing more often than by

random probability in the protocols of studies which

achieved statistically signiﬁcant results. The use of an

exogenous activator appeared the most connected to

achieving desirable results (p= .08) that was similar

to the conclusions of an earlier meta-analysis.

Nonetheless, this suggestion contrasts a direct com-

parison of nonactivated versus calcium chloride–

activated treatments (n= 40), which concluded the

former to be signiﬁcantly more effective.

From this

analysis combined with the results of the meta-

analysis (above), speciﬁc PRP techniques and meth-

ods are recommended (Table 5).

Conclusions

Platelet-rich plasma could be used to improve

hair restoration parameters (e.g., hair density) in AGA

monotherapy or adjunct therapy. For the former, 3 ses-

sions of PRP at 1-month intervals followed by a main-

tenance regimen is recommended.

Acknowledgments The authors wish to thank S.G.

Versteeg and Dr. M.S. Dotzert of Mediprobe

Research Inc., as well as Dr. M.A. Cole for assisting

in the writing of this manuscript.

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TABLE 5. Recommended Techniques for Platelet-Rich Plasma Treatment of Androgenetic Alopecia

Treatment frequency and no.

of sessions

Three sessions of PRP at 1-mo intervals followed by a 3- to 6-mo maintenance period

Injection depth Subdermal

Collection systems Capable of high platelet recovery rate (1.5 million platelets per microliter,

which is 5

times basal concentration), although the average reported concentration is 3 times the

basal amount and inﬂuence of the balance of white blood cells, neutrophils, and red

blood cells is still under investigation

(Kushida and colleagues, 2014)

Activation Activation should be considered; however, the best method is up for debate as use of

exogenous agents such as calcium chloride have been contrasted with alternate

techniques, such as scalp needling,

or natural contact with dermal ﬁbroblasts through

the PRP preparation and injection process

Centrifugation and

sonication

Use of sonication and microparticles is preferred

Needle size Impact is unclear

PRP, platelet-rich plasma.

PRP PROTOCOL RECOMMENDATIONS

DERMATOLOGIC SURGERY10

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Address correspondence and reprint requests to: Aditya K.

Gupta, MD, PhD, Mediprobe Research, Inc., 645

Windermere Road, London, ON, Canada N5X 2P1, or

e-mail: agupta@execulink.com

PRP PROTOCOL RECOMMENDATIONS

DERMATOLOGIC SURGERY12

Process Optimization and Efficacy Assessment of Standardized PRP for Tendinopathies in Sports Medicine: Retrospective Study of Clinical Files and GMP Manufacturing Records in a Swiss University Hospital

Article

Full-text available

Mar 2023

Platelet-rich plasma (PRP) preparations have recently become widely available in sports medicine, facilitating their use in regenerative therapy for ligament and tendon affections. Quality-oriented regulatory constraints for PRP manufacturing and available clinical experiences have underlined the critical importance of process-based standardization, a pre-requisite for sound and homogeneous clinical efficacy evaluation. This retrospective study (2013–2020) considered the standardized GMP manufacturing and sports medicine-related clinical use of autologous PRP for tendinopathies at the Lausanne University Hospital (Lausanne, Switzerland). This study included 48 patients (18–86 years of age, with a mean age of 43.4 years, and various physical activity levels), and the related PRP manufacturing records indicated a platelet concentration factor most frequently in the range of 2.0–2.5. The clinical follow-up showed that 61% of the patients reported favorable efficacy outcomes (full return to activity, with pain disappearance) following a single ultrasound-guided autologous PRP injection, whereas 36% of the patients required two PRP injections. No significant relationship was found between platelet concentration factor values in PRP preparations and clinical efficacy endpoints of the intervention. The results were in line with published reports on tendinopathy management in sports medicine, wherein the efficacy of low-concentration orthobiologic interventions appears to be unrelated to sport activity levels or to patient age and gender. Overall, this study confirmed the effectiveness of standardized autologous PRP preparations for tendinopathies in sports medicine. The results were discussed in light of the critical importance of protocol standardization for both PRP manufacturing and clinical administration to reduce biological material variability (platelet concentrations) and to enhance the robustness of clinical interventions (comparability of efficacy/patient improvement).

Effectiveness of Platelet-Rich Plasma in the Treatment of Androgenic Alopecia: A Meta-Analysis

Article

Full-text available

Aug 2023

Background Androgenetic alopecia (AGA) is a common yet difficult-to-treat condition, which is an important psychosocial problem. Platelet-rich plasma (PRP) therapy has been considered as a promising treatment for AGA. However, the current evidence on the efficacy of PRP for treating AGA is still controversial. This study evaluated the efficacy of PRP monotherapy in the treatment of AGA. Methods We searched PubMed, Embase, Cochrane Library and Web of Science to collect randomized controlled trials on use of PRP in AGA for a meta-analysis. Results Ten trials with a total 555 treatment units were identified. The hair density in PRP group was significantly higher than control group [MD = 25.09, 95%CI: 9.03–41.15, p = 0.002], but there was no significant difference in hair diameter between two groups [SMD = 0.57, 95%CI: − 0.23 to 1.38, p = 0.16]. Subgroup analyses indicated that hair density was significantly higher among the male-only trials than in the mixed-sex samples ( p = 0.02). In addition, neither the split-head design nor the year of publication affected hair density ( p = 0.05, p = 0.06). However, hair density was significantly higher in trials with a sample size less than 30 ( p = 0.0004). Conclusions PRP treatment increased hair density in participants with AGA, but not hair diameter. In terms of hair density, PRP elicits stronger effects in male patients. There was a trend toward differed treatment effect by gender with PRP injection, which warrants further investigation. Especially in the case of female. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Comparison of the efficacy of autologous platelet gel and medical chitosan in the prevention of recurrence of intrauterine adhesions after transcervical resection of adhesion: a prospective, randomized, controlled trial

Article

Full-text available

Aug 2023
ARCH GYNECOL OBSTET

Purpose Intrauterine adhesion (IUAs) in women is a debatable topic and there is no clear consensus in its management and treatment strategies. Previous treatment measures have limitations which necessitates to consider effective measures for prevention of recurrence of IUAs. Hence, the aim of this study to explore the efficacy and safety of intrauterine infusion of autologous platelet gel (APG) and medical chitosan in preventing recurrence of IUAs in females after transcervical resection of adhesion (TCRA). Methods A prospective, randomized controlled trial was conducted among 80 patients presented with moderate to severe IUAs. Patients were randomized into two groups, APG group (n = 40) and medical chitosan group (n = 40). All patients were injected with either APG or medical chitosan after TCRA. Results The postoperative recurrence rate of adhesions in APG group was significantly lower than those in medical chitosan group (21% vs 49%). The median AFS score during the second-look hysteroscopy was significantly lower in APG group than in medical chitosan group (P = 0.008). The median AFS score reduction after TCRA surgery was significantly higher in APG group than in medical chitosan group (median, 95% CI 7.000, 6.0 to 8.3 vs. 6.000, 5.0 to 7.0, P = 0.004). Subgroup analysis of platelet concentration (1000 as cut-off value) into high- and low-dose subgroups reported no significant correlation existed between APG and baseline characteristics, recurrence rate and postoperative AFS reduction score except for previous intrauterine operation (P < 0.05). Conclusion Thus, after TCRA, intrauterine injections of APG provides better efficacy and safety compared with intrauterine injections of medical chitosan in preventing recurrence of intrauterine adhesions.

Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs

Article

Full-text available

May 2023

Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Traditionally, topical minoxidil and oral finasteride have been the standard of care yielding mixed results. New treatments such as Low-Level Laser Therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others have been extensively studied in the literature, and the purpose of this review is to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating AGA. Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients. In this review, we present data from recent studies on the clinical efficacy of these treatments. Furthermore, as new treatments have emerged, clinicians have tested combination therapies to assess whether there may be a synergistic relationship between multiple modalities. While there has been a great increase in the treatments available for AGA, the quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments. While PRP and LLLT have demonstrated encouraging results, standardized treatment protocols are needed to adequately inform clinicians on how to use such therapies. Given the abundance of new therapeutic options, clinicians and patients must weigh the benefits and risks of each treatment option for AGA.

Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia

Article

Full-text available

Apr 2023

Shadi Zari

Abstract Introduction This study assessed the levels of compliance to topical minoxidil (TM) among male and female patients with androgenetic alopecia (AGA) and analyzed the factors associated with minoxidil discontinuation. Method A retrospective study was conducted among 400 consecutive patients with AGA who presented to a dermatology clinic and who were prescribed minoxidil 2% or 5% in the past 5 years. Demographic factors, other previous treatments, and minoxidil parameters including the dose (2% or 5%), total duration of use, treatment results, and side effects were collected. Result The mean age of the patients was 32.41 years [standard deviation (SD) 8.18], and 66.5% were female. The majority of patients (82.5%) did not receive any previous treatment for AGA. Of the total patients, 345 (86.3%) have discontinued minoxidil. Discontinuation rate showed no association with sex (p = 0.271), age category (p = 0.069), or previous treatment (p = 0.530). Furthermore, the likelihood of minoxidil discontinuation decreased with the increase in treatment duration (p

Current Status of PRP Manufacturing Requirements & European Regulatory Frameworks: Practical Tools for the Appropriate Implementation of PRP Therapies in Musculoskeletal Regenerative Medicine

Article

Full-text available

Feb 2023

Providing accurate and up-to-date practical tools enabling oversight of platelet-rich plasma (PRP) legislation and of the appropriate standards to be implemented for its manufacture and use in Europe is a demanding task. This is due to rapid medico-technological advancements, slowness and disparity in legislation updates and enforcement between member states, and many reported gray-zone practices, notably for autologous PRP use. The levels of risk associated with blood manipulation processes generally dictate the manufacturing requirements for PRP preparations, which have gradually shifted toward good manufacturing practices (GMP) for standardization and overall quality enhancement. This work firstly outlines Western European and Swiss legislation for PRP products/preparations, providing key simplified information and recommendations for medical doctors seeking to implement this biological-based therapy for safe use in hospital settings, clinics, or private offices. This work secondly shows the importance of PRP-based product manufacturing standardization, which subsequently enables sound clinical evaluation of therapeutic interventions. Although the applicable legal bases provide guidelines for GMP manufacturing infrastructure and basic process design, paramount importance is set on the definition of workflows, technical specifications, and key parameters for PRP preparation and delivery. Overall, the development of simple and robust technologies and processes for PRP preparation is critical for guaranteeing the high therapeutic quality of the intervention, in collaboration with qualified GMP manufacturing platforms. Importantly, this work aims to serve as a practical tool for clinicians based in Western Europe who are willing to appropriately (i.e., administratively and technically) implement autologous PRP treatments in musculoskeletal regenerative medicine workflows, to ensure they make informed and optimal regulatory or process-based decisions.

Innowacje w medycynie - przegląd wybranych technologii XXI w. Tom 10

Book

Full-text available

May 2023

Efficacy of platelet-rich plasma for sacroiliac joint dysfunction: a qualitative systematic review with pooled analysis

Article

May 2023
REGEN MED

Aim: We aimed to expound upon previous research examining the effect of platelet rich plasma in the treatment of sacroiliac joint (SIJ) dysfunction and pain. Materials & methods: A systematic review was employed in conjunction with a pooled analysis of the efficacy of platelet-rich plasma (PRP) in SIJ dysfunction and pain. Results: A total of 259 articles were retrieved following database systematic review. As a result, four clinical trials and two case studies were subjected to full text appraisal. The dates of publication ranged from 2015 to 2022. Conclusion: Although a unique modality, there is not enough evidence to support the employment of PRP injections over current steroid standard of care. Further double-blinded, randomized control trials are required to elucidate PRP role in SIJ dysfunction.

Postsurgical Transient Hypertrichosis Around Healing Wound After Total Knee Arthroplasty: A Case Report

Article

Jan 2022

Hypertrichosis is a condition characterized by the presence of an abnormal increase in the number of hairs and either occurs in a localized pattern or a generalized pattern. Localized hypertrichosis around a healing wound is an infrequent postsurgical complication. A 60-year-old Asian man came for a consultation because of an increase in the amount of hair around his 2-month postsurgical wound of right knee arthroplasty. Neither history of topical medications nor systemic medications, which can cause hypertrichosis, were presented. A diagnosis of postsurgical hypertrichosis was made clinically without any laboratory investigations. The patient was reassured that the medication was not necessary and he was appointed for follow-ups. Within the next 4 months, the hypertrichosis resolved spontaneously without any treatment. The case demonstrates the correlation between wound healing and hair morphogenesis, especially as both processes involve some similar growth factors and signaling molecules. Further studies might lead to discovery and better management of hair disorders.

Evolution and Trends of Facial Plastic Surgery and Facial Aesthetic Procedures in India: From Awakening to Revival

Article

Full-text available

Feb 2023

Facial aesthetic surgery is an emerging branch worldwide. India, a torchbearer country in facial plastic surgery, has seen tremendous growth in medical technology, resources, and clientele over the past century. This study aims to study past practices and current trends in facial plastic surgery and aesthetic procedures in India by individually addressing commonly performed nonsurgical procedures (Botox, Kybella [Allergan, Irvine, CA], fillers, threads, micro-focused ultrasound, and nonsurgical hair restoration), and surgical procedures (rhinoplasty, blepharoplasty, hair transplant, and facelift). It also aims to further elaborate on the scope of facial aesthetics and make recommendations on prospects in the field. A structured scoping review and a subsequent evidence-based synthesis were done following an extensive literature search on various databases such as PubMed (National Institutes of Health, Bethesda, MD), LILACS (Latin American and Caribbean Center on Health Sciences Information, São Paulo, Brazil), MEDLINE (National Library of Medicine, Bethesda, MD), EMBASE (Elsevier, Amsterdam, the Netherlands), and Cochrane (Wiley, Hoboken, NJ). The initial search yielded 703 articles, out of which 20 were found to be relevant to the present study and discussed. It was found that there is an upward trend in the growth of facial plastic surgery in India, and a gradual shift in patient attitude toward nonsurgical aesthetic procedures was seen. This article affirms the growth of facial aesthetic surgery in India by highlighting the recent development and trends in the practices of surgeons. It also addresses the shortcomings in the current administration and makes recommendations to fill the existing loopholes in plastic surgery. Level of Evidence: 5

Introducing Platelet-Rich Stroma: Platelet-Rich Plasma (PRP) and Stromal Vascular Fraction (SVF) Combined for the Treatment of Androgenetic Alopecia

Article

Full-text available

Mar 2018

Background Androgenetic alopecia (AGA) is characterized by miniaturization of the hair follicles gradually causing conversion of terminal hairs into vellus hairs, leading to progressive reduction of the density of hair on the scalp. Approved therapeutic options are limited and show side effects. Objectives To evaluate injections of stromal vascular fraction (SVF), which is rich in adipose-derived stromal cells (ASCs) in combination with platelet-rich plasma (PRP) in the upper scalp as a new autologous treatment option for AGA. Methods Ten male patients (age range, 25-72 years), suffering from AGA at stage II to III according to the Norwood-Hamilton scale, have been treated with a single injection of autologous PRS (ACPSVF: combination of PRP and SVF) in the upper scalp. Preinjection and 6 and 12 weeks postinjection changes in hair density were assessed using ultra high-resolution photography (Fotofinder). Results Hair density was significantly increased after 6 weeks and 12 weeks postinjection (P = 0.013 and P < 0.001). In hair-to-hair matching analyses, new hair grew from active follicles. Furhtermore nonfunctioning hair follicles filled with hyperkeartotic plugs, up to today assumed incapable of forming new hair, proved to grow new hair. No side effects were noted after treatment. Conclusions A single treatment of platelet-rich stroma injected in the scalp of patients with AGA significantly increased hair density within 6 to 12 weeks. Further research is required to determine the optimal treatment regimen. Preferred options to our opinion include the repetition of PRS or additional treatments with PRP. Level of Evidence: 4

Platelet-rich Plasma by Single Spin Process in Male Pattern Androgenetic Alopecia: Is it an Effective Treatment?

Article

Full-text available

Nov 2017

Introduction and Objective Platelet-rich plasma (PRP) is an autologous preparation of platelets in concentrated plasma. The platelet is a natural source of different growth factors and cytokines. These growth factors act on stem cells in the bulge area of the follicles and stimulate the development of new follicles, and promote neovascularization. The aim of this study was to investigate the efficacy and safety of PRP injections in androgenetic alopecia (AGA) in men. Patients and Methods Fifteen male patients (mean age: 39 ± 9.7 years) with AGA grades III–VI were enrolled in the study. Five injections of 2–4 ml PRP (Regenlab PRP Kit-RegenACR®, Le Mont-sur-Lausanne Switzerland) by single spin process were administered every 2 weeks. Standard photographs, trichogram, and measurement of hair density and diameter in an area marked with a tattoo (with digital photographic hair analyzer) were done at baseline and 3 months after the last injection. In addition, patients completed a patient satisfaction questionnaire at each visit on a −2 to +2 score (−2: much worse, −1: slightly worse, 0: without change, +1: slightly better, +2: much better). Results Thirteen patients completed the study. The number of hairs increased slightly from 149.62 ± 49.56 to 168.46 ± 43.703/cm², however, this increase was not statistically significant (P = 0.24). On the other hand, the thickness of hairs decreased from 0.051 ± 0.105 to 0.045 ± 0.011 mm, which was also not significant (P = 0.37). There was a significant decrease in anagen hairs and increase in telogen hairs, and anagen/telogen ratio decreased significantly from 6.38 ± 4.57 to 2.67 ± 1.87 (P = 0.003). Conclusion Our study could not show any benefit from PRP injections in the treatment of male AGA. There is a strong need for well-designed, randomized controlled trials with large sample size, proper control group, standard treatment protocols (concerning the amount, number and interval of PRP injections, method of preparation and activation, etc.), and long follow-up periods to evaluate the safety and efficacy of PRP in the treatment of male AGA.

Alopecia and platelet-derived therapies

Article

Full-text available

Nov 2017

Background: Platelet rich plasma (PRP) injections have emerged as a promising regenerative therapy for androgenetic alopecia. To date, injections of both autologous native and activated PRP have been administered to hair loss patients, and positive results have been observed. However, little to no work has yet to be seen wherein PRP treatments are combined with hair restoration surgeries. Furthermore, the PRP activation protocol in the hair restoration setting employs compounds with potentially deleterious side effects, namely thrombin or calcium gluconate. Therefore, the objectives of this work are to evaluate the effectiveness of platelet and platelet-derived products as augmented graft therapies in hair restoration surgeries and to compare the follicular regeneration rate of follicles transplanted in the presence of platelet lysate (PL) versus activated PRP (AA–PRP). Methods: PL was administered to the frontal scalp of three male AGA patients. Three treatment zones measuring 4 cm-2 were mapped in the midline scalp region of each patient and equal number of follicular grafts were placed in each box along with PL, AA–PRP, or normal saline. The transplanted follicular grafts of a fourth patient were placed solely with PL. Hair checks in which the surface area of hair coverage was quantified were performed at follow-up appointments ranging from 3.5 months to 7 months post-surgery. In these appointments, the number of follicular units with hairs measuring 50 mm or more were counted to determine the percentage of graft hair regeneration. Growth factor concentrations (VEGF, TGF-1, PDGF-BB, IGF-1) in PL and AA–PRP were also measured for an independent subject set. Results: Follicular regeneration in transplanted grafts was found to be superior for those placed with PL rather than AA–PRP or saline at all follow-up dates. Specifically, at 3.5 moths post-op, 89±9%, 74±7%, and 57±10% of follicular units had regenerated hair in the PL, AA–PRP, and saline treatment zones, respectively. At 4 months post-op, 99%, 75%, and 71% of follicle regeneration had occurred in the PL, AA–PRP, and saline treatment areas, respectively. Impressively, when PLwas injected alone , the patient experienced a 50% increase in follicular unit density and a 122% increase in hair density 7 months post-injection. When growth factor concentrations were measured, PL generated from a 30 min sonication of PRP was found to have significantly higher levels of VEGF, PDGF-BB, and TGF-1 than AA–PRP. Conclusions: PRP remains a promising hair loss therapy and should be evaluated further for use not only as an independent therapeutic tool, but also as a treatment to augment surgical procedures. PL in particular affords an effective and efficacious therapeutic product given that the lysate may be obtained by mechanical rather than chemical means. Ultrasonic waves provide sufficient energy to rupture platelet cell walls, and centrifugation may be used to separate the lysate from cell fragments prior to delivery.

A Proposal of an Effective Platelet-rich Plasma Protocol for the Treatment of Androgenetic Alopecia

Article

Full-text available

Oct 2017

Background Platelet-rich plasma (PRP) has emerged as a promising treatment for androgenetic alopecia (AGA). In spite of the several studies previously reported, to date, a standardized protocol for PRP preparation and application, as well as a standard method for evaluating results has not been established. Aims The aim of this study is to propose a standardized method for preparation and application of PRP for male AGA (MAGA) and female AGA (FAGA) and assess its safety and efficacy as a co-adjuvant therapy. Materials and Methods Seventy-eight patients, 19 men and 59 women with AGA Grades II–IV in Ebling's scale, currently on treatment with topical minoxidil and/or oral finasteride for more than a year without improvement, were included in this study. PRP was prepared using a single spin method, and injected in affected areas for 3 monthly sessions, followed by 3 bimonthly sessions. A decrease of at least one grade in Ebling's scale was considered a successful result. Results After the 6° session, 71.4% of MAGA and 73.4% of FAGA patients reached a successful outcome while 21.4% and 16.3%, respectively, remained without changes. Only 7.1% of MAGA and 10.2% of FAGA presented worsening of their condition. Conclusions PRP together with a periodical application protocol can be considered effective as a coadjuvant therapy in patients who no longer respond to pharmacological treatments. Ebling's scale was a practical and reliable parameter to allow a better evaluation in both MAGA and FAGA.

Platelet-rich plasma-an 'Elixir' for treatment of alopecia: Personal experience on 117 patients with review of literature

Article

Full-text available

Jul 2017

Platelet-rich plasma (PRP) has emerged as a new treatment modality in regenerative plastic surgery and dermatology. PRP is a simple, cost-effective and feasible treatment option with high patient satisfaction for hair loss and can be regarded as a valuable adjuvant treatment modality for androgenic alopecia and other types of non-scarring alopecias. Authors have proposed a hair model termed "Golden anchorage with 'molecular locking' of ectodermal and mesenchymal components for survival and integrity of hair follicle (HF)" in this article. Golden anchorage comprises of bulge stem cells, ectodermal basement membrane and bulge portion of APM. PRP with its autologous supply of millions of growth factors works on 'Golden anchorage' along with keratinocytes (PDGF), dermal papilla (IGF and fibroblast growth factor), vasculature (VEGF and PDGF) and neural cells (Nerve Growth Factor) in a multipronged manner serving as an 'elixir' for hair growth and improving overall environment.

Mechanical and Controlled PRP Injections in Patients Affected by Androgenetic Alopecia

Article

Jan 2018
JoVE

Evaluating the Efficacy of Different Platelet-Rich Plasma Regimens for Management of Androgenetic Alopecia: A Single-Center, Blinded, Randomized Clinical Trial

Article

May 2018

Background: Studies suggest platelet-rich plasma (PRP) may mitigate androgenetic alopecia (AGA), but each varies in the frequency of and interval between treatments. Objective: To compare the efficacy, satisfaction, tolerability, and safety of 2 initial PRP injection protocols over 6 months. Methods: Prospective, randomized, single-blinded trial among 40 patients with moderate AGA. Participants received subdermal PRP injections according to 1 of 2 treatment protocols: 3 monthly sessions with booster 3 months later (Group 1) or 2 sessions every 3 months (Group 2). Folliscope hair count and shaft caliber, global photography, and patient satisfaction questionnaires were obtained at baseline, 3 months, and 6 months. Results: At 6 months, both groups demonstrated statistically significant increases in hair count (p < .001). These improvements occurred more rapidly and more profoundly for Group 1 (mean percent change: Group 1, 29.6 ± 13.6 vs Group 2, 7.2 ± 10.4; p < .001). Shaft caliber also increased significantly with no difference between groups. Treatments produced high satisfaction (82% "satisfied" or "highly satisfied") and were safe and well tolerated (mean pain score 2.1). Conclusion: Subdermal PRP injections are an efficacious and tolerable therapy among men and women with AGA. The benefits may be greater if first administered monthly. Clinicians should consider these findings when designing treatment plans.

Platelet-rich plasma on female androgenetic alopecia: Tested on 10 patients

Article

Apr 2018

Background Recently, platelet‐rich plasma (PRP) injection has been proposed as a potential adjuvant therapy to treat androgenetic alopecia. Aims Investigate the efficacy, tolerability, and clinical improvement of PRP for the treatment of female AGA. Patients/Methods A total of 10 female patients affected by AGA and not responding to treatment with minoxidil and/or oral antiandrogens were enrolled. The clinical improvement was evaluated by pull test, global photographs, and Trichoscan at weeks 9, 12, and 24, and hair measurements were performed at baseline and 12 and 24 weeks after the first session. Results After 24 weeks, the median relative percentage change (%RC) for all the parameters of hair density was mostly positive. After 12 weeks, the medium hair diameter in frontal area showed a significant increase (%RD = 12.5, with P‐value < .05), and after 24 weeks (%RD = 14.6, P‐value < .05), the vellus relative change instead showed a decrease, especially in the front and the central area, while for the vertex, the decrease was mainly visible at the end (−6.6%). No adverse events were reported. Conclusion Platelet‐rich plasma injections have a positive therapeutic effect on hair density and hair diameter improvement.

Mechanical and Controlled PRP Injections in Patients Affected by Androgenetic Alopecia

Article

Jan 2018
JoVE

23 patients (18 male and 5 female) aged 21-70 years who displayed male pattern hair loss (MPHL) in Stage 1 to Stage 5 as determined by the Norwood-Hamilton classification scale, and female pattern hair loss (FPHL) in Stage 1 to Stage 2 as determined by the Ludwig classification scale, were treated with non-activated autologous platelet-rich plasma (A-PRP). Autologous blood (55 mL) was harvested using sodium citrate as an anticoagulant. A-PRP (23 mL) was produced for all cases using a closed system according to the transfusion service protocol. Following centrifugation (260 x g for 10 min) the A-PRP was inserted in a laser light selector device, and after the centrifugation, 9 mL of A-PRP was collected. The scalp of the patients affected by androgenetic alopecia (AGA) was divided into four areas (frontal, parietal, vertex, and occipital); local anesthesia was not performed. Interfollicular A-PRP injections (0.2 mL × cm²) were performed by controlled and mechanical injections scheduled at a depth of 5 mm using a medical injector gun. Treatment sessions were performed with a 30-day interval. For each patient, three treatment sessions were performed. PRP was injected in the androgen-related areas of scalp affected by hair loss. Placebo (normal saline solution) was loaded in another syringe (10 mL) and injected on the adjacent side in a similar fashion.

Comparison of the Efficacy of Homologous and Autologous Platelet-Rich Plasma (PRP) for Treating Androgenic Alopecia

Article

Nov 2017

Background: Androgenetic alopecia (AGA), the most common cause of hair loss in both sexes, accounts for 95% of all cases of hair loss. Although the literature has suggested that both nonactivated (n-PRP) and activated autologous (a-PRP) PRP can be used to treat AGA, we did not find any study investigating the use of homologous PRP (h-PRP) for this purpose. Also, to the best of our knowledge, there are no studies comparing the efficacy of h-PRP, a-PRP, or n-PRP on AGA therapy. Objectives: The aim of this study was to compare the increase in hair density, average number of platelets, complications, preparation, and duration of application in the treatment of AGA using a-PRP, n-PRP, and h-PRP. Methods: Between 2014 and 2015, we studied male patients who had experienced increased hair loss in the last year. Patients were divided into three groups: Group 1 received n-PRP, Group 2 received active PRP, and Group 3 received h-PRP. For Group 1, PRP was prepared by a single centrifugation prepared from the patient's own blood. For Group 2, the PRP was prepared from the patient's own blood, but a second centrifugation was applied for platelet activation with calcium chloride. For Group 3, the PRP was prepared from pooled platelets with the same blood group as the patient from the blood center. PRP was injected at 1, 2, and 6 months. The hair density (n/cm(2)) of each patient before and after injection was calculated. Each patient was assigned a fixed evaluation point at the time of application to calculate hair density. Results: At 2, 6, and 12 months after the first treatment, the increase in hair density was calculated as 11.2, 26.1, and 32.4%, respectively, in Group 1; 8.1, 12.5, and 20.8%, respectively, in Group 2; and 16.09, 36.41, and 41.76%, respectively, in Group 3. The increase in hair density was statistically significantly greater in Group 1 than in Group 2 and more so in Group 3 than in both groups among all controls (p < 0.05). Conclusion: The efficacy of both PRPs was determined in AGA treatment in our study. However, it was determined statistically that the increase in hair density with h-PRP was greater than with autologous PRP groups. We believe that h-PRP therapy can be used in patients with AGA presenting with hair loss. Level of evidence ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .