Platelet rich plasma in dermatology and cosmetology

Abstract

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

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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
http://www.ijord.com
Review Article
Platelet rich plasma in dermatology and cosmetology
Shobhit Mohan1, Lalit Mohan2*, Renu Sangal3, Neelu Singh4
INTRODUCTION
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
dermatology.
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
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.
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
*Correspondence:
Dr. Lalit Mohan,
E-mail: lalitmohanbrd54@gmail.com
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.
DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20200616

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
PRP IN ALOPECIA
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
group.15
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-3β 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
PRP IN SKIN REJUVENATION
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
skin.
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 IN SCARS AND CONTOUR DEFECTS
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
rejuvenation.25
PRP IN ACUTE AND CHRONIC ULCERS
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
PRP IN LIPODERMATOSCLEROSIS
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
SAFETY OF PRP
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
CONCLUSION
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.