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Platelet rich plasma in dermatology and cosmetology



p class="abstract">Platelet rich plasma (PRP) therapies in medicine has become increasing popular during the last decade. The interest in in the application of PRP in dermatology and cosmetology has increased recently in different applications such as alopecia, skin rejuvenation, wound healing, scar revision, and tissue regeneration. PRP is an autologous blood product obtained from the blood of the patients. The detailed knowledge about PRP should help clinicians better understand this therapy. In this view, the current review was done for a better understanding of what pathologies can be corrected with PRP.</p
International Journal of Research in Dermatology | March-April 2020 | Vol 6 | Issue 2 Page 288
International Journal of Research in Dermatology
Mohan S et al. Int J Res Dermatol. 2020 Mar;6(2):288-291
Review Article
Platelet rich plasma in dermatology and cosmetology
Shobhit Mohan1, Lalit Mohan2*, Renu Sangal3, Neelu Singh4
Platelet rich plasma (PRP) is also known as platelet
concentrated plasma, autologous platelet gel or plasma-
rich growth factors.1 It is prepared by concentrating
abundant platelets into a small volume of plasma. The
successful utilization of PRP in dentistry is well
documented by Marx et al.2 This development has fueled
research on its role in other specialties like aesthetics and
PRP is a concentrate of multiple fundamental growth
factors (GFs) by virtue of platelets alone and plasma
proteins such as fibrin, fibronectin and vitronectin.3 This
combination is important for tissue repair, regeneration,
structural development of the bone and connective tissue
and helps in epithelial migration.4
Du to this mechanism, PRP has been used extensively in
the musculoskeletal field in sports injuries.5 Other
medical fields that are using PRP are gynecology,
urology, cardiac surgery, plastic surgery and
opthalomology.6 Recently PRP has gained interest in
dermatology for its properties in conditions such as tissue
regeneration, wound healing, scar revision, skin
rejuvenating effects and alopecia.7-12
PRP plays an important role in stimulating human dermal
fibroblast proliferation and increased type 1 collagen
synthesis.13 This made its utilization in cosmetic
dermatology such as improvement of burn scares,
postsurgical scars and acne scars. PRP alone or in
combination with other techniques improve the quality of
the skin by increasing the production of elastic and
collagen fibres.14
Preparation of activated PRP is done either manually or
by the use of automated devices under strict aseptic
conditions and at optimum temperature regulations.
Anticoagulant (citrate dextrose solution A or sodium
citrate) is used to inhibit platelet aggregation.3
Platelet rich plasma (PRP) therapies in medicine has become increasing popular during the last decade. The interest in
in the application of PRP in dermatology and cosmetology has increased recently in different applications such as
alopecia, skin rejuvenation, wound healing, scar revision, and tissue regeneration. PRP is an autologous blood product
obtained from the blood of the patients. The detailed knowledge about PRP should help clinicians better understand
this therapy. In this view, the current review was done for a better understanding of what pathologies can be corrected
with PRP.
Keywords: PRP, Dermatology, Cosmetology, Alopecia, Skin pathologies
1Department of Dermatology, 1,3Medical College, Basti, Uttar Pradesh, India
2Department of Dermatology, 2Medical College, Gorakhpur, Uttar Pradesh, India
4Cosmetologists, Medical College Campus, Gorakhpur, UP, India
Received: 02 December 2019
Accepted: 13 February 2020
Dr. Lalit Mohan,
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
Mohan S et al. Int J Res Dermatol. 2020 Mar;6(2):288-291
International Journal of Research in Dermatology | March-April 2020 | Vol 6 | Issue 2 Page 289
The angiogenic role of PRP gained attention of
dermatologists and plastic surgeons to explore its use in
hair growth modality. Activated PRP stimulates
proliferation and differentiation of stem cells in the hair
follicle bulge area via multiple molecular mechanisms
such as upregulation of transcriptional activity of beta-
catenin, increase bcl-2 levels by anti-apopotic action,
activation of Akt and ERK signaling pathways,
expression of FGF-7 in dermal papilla cells and by
proangiogenesis by increasing VEGF and PDGF.15
The efficacy of PRP in alopecia treatment is documented
by few studies. According to the study performed by
Akiyama et al, epidermal growth factor and transforming
growth factor are involved in controlling the growth and
differentiation of bulge cells, and platelet-derived growth
factor may have associated functions in the interactions
between the bulge and the related tissues, starting with
follicle morphogenesis.16,17 Beside this mechanism, the
anagen phase is also activated by Wnt/β-catenin/T-cell
factor lymphoid enhancer.18 In the dermal papilla cells,
activation of Wnt will lead to accumulation of β-catenin,
in combination with T-cell factor lymphoid enhancer
which promotes survival, proliferation and angiogenesis.
Then the dermal papilla cells inturn initiate the
differentiation from the telogen to anagen phase.19
Another mechanism in the dermal papilla (DP) cell
involved is the activation of extracellular signal-regulated
kinase (ERK) and protein kinase B (Akt) signaling that
promotes cell survival and prevents apoptosis.15 Exact
role of PRP in promoting hair growth is not fully
understood. Li et al explained the mechanism by
evaluating the effects of PRP on hair growth using in
vitro and in vivo models. In the in vitro model, activated
PRP was applied to isolated human DP cells. The results
proved that PRP increased the proliferation of DP cells
by activating ERK and Akt signaling, leading to
antiapoptotic effects. It also increased the beta-catenin
activity and FGF-7 expression in DP cells. In the in vivo
model, mice injected with activated PRP exhibited a
faster telogen-anagen transition in comparison to control
Another mechanism was proposed for the action of PRP
on human follicles by Gupta et al. They found elicitation
of the Wnt/β-catenin, ERK, and Akt signaling pathways
are responsible for promoting cell survival, proliferation,
and differentiation.19 After binding of growth factors with
its respective GF receptor, the signalling for the
responsible expression begins. The GF-GF receptor
activates both Akt and ERK signalling. This activation of
signals will inhibit 2 pathways through phosphorylation.
Firstly, glycogen synthase kinase- that promotes
degradation of β-catenin and secondly, Bcl-2-associated
death promoter, which is responsible for inducing
apoptosis. By these mechanisms PRP might increase
vascularization, prevent apoptosis and prolong the
duration of anagen phase.17
It has been reported that use of PRP increases dermal
elasticity by stimulating the elimination of photodamaged
extracellular matrix components and by inducing the
synthesis of new collagen by dermal fibroblasts via
various molecular mechanisms that include increased
proliferation of human dermal fibroblasts, increased
expression of matrix metalloproteinase (MMP)-1 and
MMP-3 (removal of photodamaged ECM), increased
production of procollagen type 1 peptide and expression
of collagen type-1, alpha-1 which synthesis new collagen,
and increased expression of G1 cell cycle regulators
which accelerates wound healing.20,21
The use of PRP in skin rejuvenation is evidenced by the
reports of Shin et al.22 He used a combination of topical
PRP with fractional non-ablative (erbium glass) laser
therapy, resulted in improvement in skin elasticity and
increase in collagen density. Histological examination
showed an increase in length of dermoepidermal junction,
and number of fibroblasts and collagen in the treated
In another study, treatment of deep wrinkles and severe
photodamaging skin with PRP in combination with
fractional ablative lasers (carbon dioxide) reduced
transient adverse effects and decreased the downtime.23
PRP has become a promising modality among soft tissue
augmentation techniques. Activated PRP has been used
as a filler to correct deep nasolabial folds without any
adverse effects. It can used as an adjuvant in autologous
fat transfer procedures. In an in vitro pilot study, the
findings revealed that fat grafts in combination with PRP
increased vascularity, less fibrosis, fewer cysts and
vacuoles and overall improved quality and life time of fat
grafts compared to saline.24 Other findings suggests that
fat grafts can be admixed with PRP in treating traumatic
scars followed by fractional laser resurfacing to give
good results. PRP injections in combination with
fractional carbon dioxide resurfacing have shown good
results in acne scar resurfacing also, apart from skin
PRP showed promising results in the treatment of
diabetic neuropathy and other chronic wound ulcers as
similar to recombinant PDGF-ββ (becaplermin) gel.
Activated PRP is rich in growth factors, and has shown
promising results when applied topically to the non-
healing ulcers, to enhance re-epithelization.26
Mohan S et al. Int J Res Dermatol. 2020 Mar;6(2):288-291
International Journal of Research in Dermatology | March-April 2020 | Vol 6 | Issue 2 Page 290
In a study by Kim et al, topical application of PRP
significantly accelerated the re-epithelialisation process
in the case of stasis ulcers, diabetic ulcers, livedoid
vasculitis, claw foot and traumatic ulcers by upregulation
of cell cycle regulatory proteins like cyclin A and
CDK4.27 Even dermatomyositis associated elbow ulcers
have been successfully treated with PRP.28
Subcutaneous PRP injections in five sessions fortnightly
showed complete re-epithelization of venous ulcer and
marked improvement in hyperpigmentation and
induration at the treated site.29
PRP is an autologous preparation and is devoid of any
serious adverse effects. Pain or secondary infection at the
site of infection can be avoided with proper precautions.
PRP is safe and has no issues regarding transmission of
infections such as hepatitis-B, C or HIV. Still, some
safety concerns with bovine thrombin have been raised
about the potential transmission of Cruetzfeld-Jacob
disease (mad-cow disease) but some authors refuted the
statement affirming that prion vector has been found only
in the neural tissues of cattle, whereas thrombin is
exclusively isolated from the blood and is also further
processed by heating.30 Some reports stated that post-
operative bleeding due to bovine thrombin-induced
factor-V deficiency, have made it an unpopular choice
but use of CaCl2 as an activator, automatically eliminates
the above risks.31,32
PRP can be considered as new therapeutic option for
different pathologies in dermatology and cosmetology.
Understanding the biology and mechanism of action of
PRP therapy will help clinicians in selecting specific
system to meet the needs of a given indication. In
addition, characterizing the type of PRP will helps in
standardization of PRP, making it easier to sort and
interpret the available data.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
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Cite this article as: Mohan S, Mohan L, Sangal R,
Singh N. Platelet rich plasma in dermatology and
cosmetology. Int J Res Dermatol 2020;6:288-91.
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Platelet-rich plasma (PRP) is currently used in different medical fields. The interest in the application of PRP in dermatology has recently increased. It is being used in several different applications as in tissue regeneration, wound healing, scar revision, skin rejuvenating effects, and alopecia. PRP is a biological product defined as a portion of the plasma fraction of autologous blood with a platelet concentration above the baseline. It is obtained from the blood of patients collected before centrifugation. The knowledge of the biology, mechanism of action, and classification of the PRP should help clinicians better understand this new therapy and to easily sort and interpret the data available in the literature regarding PRP. In this review, we try to provide useful information for a better understanding of what should and should not be treated with PRP.
Full-text available
“There is a growing body of evidence suggesting that wound healing in chronic diabetic foot ulcers is growth factor dependent, and that the therapeutic delivery of these growth factors to wounds topically, has the potential ability to accelerate wound healing in conjunction with conventional wound care”. There is, however, confusion about the utility of platelet rich plasma because the studies that have evaluated them use a wide range of products (different platelet and leukocyte concentrations, different techniques and frequencies of application, very heterogeneous simple, and different endpoints) making almost impossible to compare data and draw conclusions. In this study, we have analyzed the different platelet rich plasma products from a new perspective: cost-efficiency. According to our data, we observe that platelet rich plasma is a cost-effective option that allows faster healing of ulcers, and that should be taken into account in patients with long evolution ulcers.
Full-text available
There has been a recent spurt in application of platelet-rich plasma (PRP) in dermatology and aesthetic medicine. However, the details regarding use of PRP in various dermatological indications ranging from hair restoration to chronic ulcers are dispersed in literature, herein we have tried to focus all under one heading. Overall, PRP seems to be a promising therapeutic modality but the level of evidence as of now, from the available published data is low. This review will also stimulate readers to carry out well designed, larger population based trials, so as to validate its use in dermatology practice.
Full-text available
Platelet-rich plasma (PRP) is used as an adjuvant in the treatment of chronic ulcers of the lower extremity and has shown particularly promising results in the case of neuropathic ulcers. There has been less research, however, into its use in venous and hypertensive ulcers. Our aim was to assess the safety and feasibility of using PRP in the treatment of chronic ulcers of the lower extremity and to evaluate its potential benefits in directed healing. We prospectively selected 11 patients with nonischemic ulcers of the lower extremity that had been present for at least 6 weeks. PRP was injected subcutaneously into the perilesional tissue and applied topically in 4 sessions held at 1-week intervals. We assessed quality of life (SF-12 questionnaire), pain (visual analog scale), and the circumference of the ulcer before and after treatment. There was a predominance of women (8/11, 73%), and venous ulcers (7/11, 64%) were more common than hypertensive ulcers (4/11, 36%). The median age of the patients was 79 years and the median time since onset of the ulcer was 17 months (range, 6-108 months). We observed a significant reduction in pain (P<.05) and a significant improvement in the physical and mental components of the SF-12 (P<.05). The mean reduction in ulcer size was 60%, and complete healing was achieved in 5 cases. No adverse effects were observed. The local application of PRP is a valuable and practical procedure that promotes the healing of chronic ulcers of the lower extremity; it can improve patient quality of life and is particularly effective in local pain relief.
Background: Platelet-rich plasma (PRP) therapy is a novel procedure used to treat androgenetic alopecia (AGA). Objective: Propose a mechanism of action of PRP therapy for AGA. Methods and materials: A thorough literature search including PRP research for AGA therapy as well as PRP research in other areas of medicine was conducted. Results: A mechanistic model for the action of PRP on the hair follicle was created. Conclusion: Platelet-rich plasma therapy stimulates hair growth through the promotion of vascularization and angiogenesis, as well as encourages hair follicles to enter and extend the duration of the anagen phase of the growth cycle. The process is accomplished through growth factor-mediated increased activation of wingless (Wnt)/β-catenin, extracellular signaling regulated kinase (ERK), and protein kinase B (Akt) signaling pathways, which leads to the necessary cellular proliferation and differentiation.
Platelet-rich plasma (PRP) is an autologous blood-derived product enriched in platelets, growth factors, chemokines and cytokines. Initial applications were predominantly in musculoskeletal and maxillofacial fields, however in recent years, it has been used for a range of dermatological indications including wound healing, fat grafting, alopecia, scar revision and dermal volume augmentation. Here, we critically appraise the literature relating to the usage of PRP within Dermatology. We have evaluated in vitro data, preclinical animal studies and human trials. We conclude that, whilst the literature may be consistent with a modest benefit for specific indications, there is not sufficient evidence supporting the efficacy of PRP to justify a role in routine dermatological practice at the present time. However, since PRP is generally well tolerated with few reported complications, further study may be justified in the context of organized trials.
Unlabelled: In facial plastic surgery, the potential for direct delivery of growth factors from platelet preparations has been of particular interest for use in facial rejuvenation, recovery after facial surgery, and wound healing. A literature search was conducted through PubMed for the terms PRP, PRFM, platelet-rich plasma, platelet-rich fibrin matrix, platelet preparations, platelet therapy, growth factors, platelet facial, platelet facial rejuvenation, platelet wound healing, platelet plastic surgery. Articles pertaining to the use of platelet preparations in facial surgery and wound healing in plastic surgery after 2001 were included. Thirteen in vitro studies showed use of platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) had a significant effect on cellular activity. Twenty-four out of 28 animal studies exhibited favorable results with use of a platelet preparation, including five of six studies that showed enhanced fat graft survival with addition of a platelet preparation. Twenty-three case series and clinical trials were identified, only two of which showed no differences. Twenty-one reported favorable results with use of various platelet preparations. A total of 47 studies used PRP, four studies evaluated Leukocyte-rich PRP, and fourteen studies used PRFM. The vast majority of studies examined show a significant and measurable effect on cellular changes, wound healing, and facial esthetic outcomes with use of platelet preparations, both topical and injectable. One must also consider possible publication bias against null results that may have had an influence on the data that were available for review. However, the preponderance of studies suggests that platelet preparations might represent an as-of-yet untapped adjunct in facial plastic surgery. Level of evidence v: 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 .