Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation

Alopecia areata is a common cause of nonscarring alopecia that occurs in a patchy, confluent, or diffuse pattern. Dermoscopy is a noninvasive technique for the clinical diagnosis of many skin diseases. Topical minoxidil solution 5% and platelet rich plasma are important modalities used in treatment of alopecia areata. We aimed to evaluate the efficacy of PRP versus topical minoxidil 5% in the treatment of AA by clinical evaluation and trichoscopic examination. Ninety patients were allocated into three groups; the first was treated with topical minoxidil 5% solution, the second with platelets rich plasma injections, and the third with placebo. Diagnosis and follow up were done by serial digital camera photography of lesions and dermoscopic scan before and every 1 month after treatment for 3 months. Patients treated with minoxidil 5% and platelets rich plasma both have significant hair growth than placebo (p < .05). Patients treated with platelets rich plasma had an earlier response in the form of hair regrowth, reduction in short vellus hair and dystrophic hair unlike patients treated with minoxidil and control (p < .05). In conclusion, platelets rich plasma is more effective in the treatment of alopecia areata than topical minoxidil 5% as evaluated by clinical and trichoscopic examination.     

The effect of platelet rich plasma on hair regrowth in patients with alopecia areata totalis: A clinical pilot study

Autologous rich plasma (PRP) is blood plasma with enhanced concentration of platelets and is enriched with several growth factors which stimulate tissue regeneration. The current study aimed to investigate the effect of PRP on hair regrowth in patients with alopecia areata (AA) totalis. Ten subjects (28.9 ± 6.28 years; five males and five females) with clinically diagnosed AA totalis for at least 3 years who had not received any treatment within 3 months prior to the study were recruited. Blood sample was collected in thrombocyte harvesting tubes. The PRP was separated via centrifugation. The patients' scalp was divided sagittally into two approximately equal parts. In each patient, 4 mL of PRP was injected intradermally into the left or right side of the scalp; in each point, 0.1 mL of PRP was injected. Each patient was followed up monthly for 4 months. No hair regrowth was seen in eight patients and in two patients only <10% hair regrowth was observed. Totally, no significant effect was found for PRP on hair regrowth (p > .05). There was no side effect during treatment. Single dermal PRP injection did not prove to have any effect on hair regrowth in these patients.     

Platelet rich plasma for the management of hair loss: Better alone or in combination?

Platelet‐rich plasma (PRP) and autologous protein‐based treatments have recently emerged as a potential therapeutic approach for hair loss‐related disorders including androgenetic alopecia and alopecia areata. The safety and efficacy of repeated intradermal injections of PRP has proved to promote hair growth in a number of randomized clinical trials. Biologically active proteins and cytokines released upon platelet activation have shown to induce folliculogenesis and activate the anagen growing phase of dormant bulbs. Interestingly, further studies have revealed that combining PRP with other hair loss‐related products may enhance the final performance of the treatment. These synergistic approaches include Food and Drug Administration (FDA) approved drugs such as finasteride or minoxidil, bioactive macromolecules and cell‐based therapies. Here, recent research involving alone or combined therapy with platelet‐rich plasma for the management of hair loss‐related disorders are outlined and future prospects are discussed.     

Autologous Platelet-Rich Plasma for the Treatment of Pattern Hair Loss

Platelet-rich plasma (PRP) is a solution derived from whole blood that is enriched in the platelet fraction. Platelets serve as a reservoir of growth factors and cytokines. When platelets are activated in vivo, signaling molecules are released into the immediate microenvironment and activate receptors for various pathways. Historically, PRP has been applied to wound beds to promote healing of complex wounds. Over the last decade, it has served as a valuable therapeutic tool in various specialties such as maxillofacial surgery, plastic surgery, orthopedics and sports medicine. Only recently has PRP been utilized for dermatologic purposes, more specifically, for the treatment of male and female pattern hair loss. In this review, we discuss molecular and cellular pathways upregulated by PRP important in hair folliculogenesis, and examine clinical evidence from all previously published studies involving the use of PRP for pattern hair loss.     

富血小板血浆治疗斑秃的研究进展

目前有文献报道富血小板血浆治疗斑秃安全有效，血小板血浆可通过释放大量的细胞因子促进毛囊干细胞的增殖、分化并改善毛囊周围环境，从而促进毛发生长，本文对富血小板血浆治疗斑秃的研究进展进行了综述。     

富血小板血浆在损容性皮肤病中的应用

血小板富集血浆（PRP）是自体高度浓缩的血小板血浆，浓度为正常成年人外周血中血小板浓度基线值的4～7倍。PRP富含生长因子，有助于促进上皮、血管、胶原再生。本文主要围绕PRP在损容性皮肤病，包括雄激素性脱发、斑秃、瘢痕、白癜风、萎缩纹及面部年轻化等进行综述。     

富血小板血浆在雄激素型脱发治疗中的应用

 富血小板血浆（PRP）富含生长因子、细胞因子等多种生物活性物质，具有促进细胞增殖、分化、基质合成、组织再生与修复等作用。其制作过程虽不复杂，但全球仍没有一个统一的制作标准。 近年来已有多个实验及临床研究证明PRP治疗雄激素型脱发（AGA）有效且安全。治疗方法除了单纯头皮下注射PRP，还衍生出PRP联合微针、药物、脂肪移植、低能量激光疗法、非剥脱性Er:YAG等。本文整理分析近年来相关文献及实验，综述PRP在治疗AGA的作用机制、制备方法、治疗方法等方面的研究进展，为临床医生提供更多理论及实践依据。     

Inhibitory autocrine factors produced by the mesenchyme-derived hair follicle dermal papilla may be a key to male pattern baldness

BACKGROUND: Androgenetic alopecia, or male pattern baldness, is a common, progressive disorder where large, terminal scalp hairs are gradually replaced by smaller hairs in precise patterns until only tiny vellus hairs remain. This balding can cause a marked reduction in the quality of life. Although these changes are driven by androgens, most molecular mechanisms are unknown, limiting available treatments. The mesenchyme-derived dermal papilla at the base of the mainly epithelial hair follicle controls the type of hair produced and is probably the site through which androgens act on follicle cells by altering the regulatory paracrine factors produced by dermal papilla cells. During changes in hair size the relationship between the hair and dermal papilla size remains constant, with alterations in both dermal papilla volume and cell number. This suggests that alterations within the dermal papilla itself play a key role in altering hair size in response to androgens. Cultured dermal papilla cells offer a useful model system to investigate this as they promote new hair growth in vivo, retain characteristics in vitro which reflect their parent follicle's response to androgens in vivo and secrete mitogenic factors for dermal papilla cells and keratinocytes. OBJECTIVES: To investigate whether cultured dermal papilla cells from balding follicles secrete altered amounts/types of mitogenic factors for dermal papilla cells than those from larger, normal follicles. We also aimed to determine whether rodent cells would recognize mitogenic signals from human cells in vitro and whether factors produced by balding dermal papilla cells could alter the start of a new mouse hair cycle in vivo. METHODS: Dermal papilla cells were cultured from normal, balding and almost clinically normal areas of balding scalps and their ability to produce mitogenic factors compared using both human and rat whisker dermal papilla cells as in vitro targets and mouse hair growth in vivo. RESULTS: Normal scalp cells produced soluble factors which stimulated the growth of both human scalp and rat whisker dermal papilla cells in vitro, demonstrating dose-responsive mitogenic capability across species. Although balding cells stimulated some growth, this was much reduced and they also secreted inhibitory factor(s). Balding cell media also delayed new hair growth when injected into mice. CONCLUSIONS: Human balding dermal papilla cells secrete inhibitory factors which affect the growth of both human and rodent dermal papilla cells and factors which delay the onset of anagen in mice in vivo. These inhibitory factor(s) probably cause the formation of smaller dermal papillae and smaller hairs in male pattern baldness. Identification of such factor(s) could lead to novel therapeutic approaches.     

Platelet rich plasma in androgenetic alopecia: A systematic review

In recent years, dozens of manufacturers and clinics have been promoting the use of platelet rich plasma (PRP) procedures for skin and hair regeneration. Well‐designed randomized controlled studies for these procedures are lacking. In this communication, we review the efficacy and safety of PRP procedures for androgenetic alopecia from multiple published peer‐reviewed studies. The conclusion of our analysis is that until the present moment there is not enough evidence for the use of PRP procedures in the treatment of androgenetic alopecia. We hope that this review will help practitioners and patients to make better‐informed treatment decisions.     

应激和脱发

应激是引起脱发的原因之一,应激可能是静止期脱发的主要诱因;可能使以内分泌、感染、遗传或免疫因素为主要病因的脱发(雄激素性脱发、斑秃等)症状加重;脱发引起的情绪低落可能会进一步加重脱发,进而形成恶性循环。除了药物,现在更需要临床医生用全面而谨慎的方法来减轻脱发患者伴随的心理障碍,这将有助于缓解应激,阻断恶性循环并提高患者的生活质量。     

Lichen‐planopilaris‐like scarring pattern in a patient with alopecia and pityriasis rubra pilaris

Pityriasis rubra pilaris (PRP) is an erythematous‐desquamative dermatitis that is sometimes associated with non‐scarring alopecia. Despite the fact that the disease can be disfiguring, scarring alopecia has rarely been described in this disease. Here, we present a 69‐year‐old woman who developed an erythrodermic episode of PRP associated with telogen effluvium that left an area of persistent alopecia of the scalp and resulted in hair loss in the eyebrows. The biopsy of that area of the scalp demonstrated a scarring alopecia with lichen‐planopilaris‐like features. Despite this histopathology, the alopecia responded well to treatment. This finding expands the context in which lichen planopilaris features can be found and demonstrates their good prognosis under early treatment.     

The effect of CD34+ cell‐containing autologous platelet‐rich plasma injection on pattern hair loss: a preliminary study

Background Mobilized CD34+ cells in peripheral blood have angiogenic potential, which is an important factor in active hair growth. In addition, activated autologous platelet‐rich plasma (PRP) has been reported to induce the proliferation of dermal papilla cells. Objectives To investigate the clinical efficacy of interfollicular injection of CD34+ cell‐containing PRP preparation for pattern hair loss. Patients and methods CD34+ cell‐containing PRP preparation was injected on the scalps of 13 patients with pattern hair loss, and 13 patients were treated with interfollicular placental extract injection as a control. The numbers of platelets in PRP were microscopically counted and CD34+ cells were evaluated with flow cytometry. Results Three months after the first treatment, the patients presented clinical improvement in the mean number of hairs, 20.5 ± 17.0% (P < 0.0001), mean hair thickness, 31.3 ± 30.1% (P < 0.0001), and mean two‐point score, 84.4 ± 51.7% (P < 0.0001) compared with baseline values. At 6 months, the patients presented clinical improvement in mean hair count, 29.2 ± 17.8% (P < 0.0001), mean hair thickness, 46.4 ± 37.5% (P < 0.0001), and mean two‐point score, 121.3 ± 66.8% (P < 0.0001) compared with baseline. The MIXED procedure revealed that CD34+ cell‐containing PRP treatment presented a higher degree of improvement than placental extract treatment in hair thickness (P = 0.027) and overall clinical improvement (P = 0.023). Conclusion Our data suggest that the interfollicular injection of autologous CD34+ cell‐containing PRP preparation has a positive therapeutic effect on male and female pattern hair loss without remarkable major side‐effects.     

Identification of clustered cells in human hair follicle responsible for MMP-9 gelatinolytic activity: consequences for the regulation of hair growth

BACKGROUND: The control of human hair follicle growth and differentiation is dependent upon several well-identified factors, including androgens, cytokines, and growth factors. In humans, alopecia androgenetica is a common aging process thought to be regulated through complex genetic imbalances, which also involve several of these crucial identified factors (and probably others not yet characterized), alone or in combination. Among these factors, epidermal growth factor (EGF), as well as pro-inflammatory cytokines, play a pivotal role, as evidenced by their direct inhibitory effects on hair growth both in vitro and in vivo. Following such treatments, the in vitro growth of hair follicles was rapidly arrested and deleterious modifications of hair morphology were also observed. AIM: Because these cytokines act, at least partly, through the induction of matrix metalloproteinases (MMP), and because tissue remodeling occurs during the hair cycle, we attempted to identify and localize MMP in the human pilosebaceous unit. METHOD: We used zymography to observe human hair follicles in culture in vitro. RESULTS: We observed that human hair follicles in culture in vitro mainly and almost exclusively produce MMP-2 and MMP-9 gelatinolytic activities. Furthermore, after stimulation with EGF, tumor necrosis factor-alpha (TNF-alpha), or interleukin-1alpha (IL-1alpha), MMP-9 production was strongly increased. Using immunohistochemistry, we then precisely localized MMP-9 in the lower part of the inner root sheath (Henle's layer) of control human anagen hair follicles. CONCLUSIONS: Cytokine- and EGF-induced upregulation of MMP-9 in the lower epithelial compartment of the human hair bulb is a major mechanism through which hair follicle involution, observed in alopecia, may occur.     

Fractional non-ablative laser-assisted drug delivery leads to improvement in male and female pattern hair loss

Androgenetic alopecia, also known as male and female pattern hair loss, is a very prevalent condition; however, approved therapeutic options are limited. Fractionated laser has been proposed to assist in penetration of topical medications to the cutaneous tissue. We present four cases of androgenetic alopecia that underwent treatment with a non-ablative erbium glass fractional laser followed by the application of topical finasteride 0,05% and growth factors including basic fibroblast growth factor, insulin-like growth factor, vascular endothelial growth factor, and copper peptide 1%. During all laser treatment sessions, eight passes were performed, at 7 mJ, 3–9% of coverage and density of 120 mzt/cm². A positive response was observed in all of the four patients. Photographs taken 2 weeks after the last session showed improvement in hair regrowth and density. No significant side effects were observed.     

Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot randomized controlled trial

BACKGROUND: In addition to the well-known hormonal influences of testosterone and dihydrotestosterone on the hair cycle, melatonin has been reported to have a beneficial effect on hair growth in animals. The effect of melatonin on hair growth in humans has not been investigated so far. OBJECTIVES: To examine whether topically applied melatonin influences anagen and telogen hair rate in women with androgenetic or diffuse hair loss. METHODS: A double-blind, randomized, placebo-controlled study was conducted in 40 women suffering from diffuse alopecia or androgenetic alopecia. A 0.1% melatonin or a placebo solution was applied on the scalp once daily for 6 months and trichograms were performed to assess anagen and telogen hair rate. To monitor effects of treatment on physiological melatonin levels, blood samples were taken over the whole study period. RESULTS: Melatonin led to a significantly increased anagen hair rate in occipital hair in women with androgenetic hair loss compared with placebo (n=12; P=0.012). For frontal hair, melatonin gave a significant increase in the group with diffuse alopecia (n=28; P=0.046). The occipital hair samples of patients with diffuse alopecia and the frontal hair counts of those with androgenetic alopecia also showed an increase of anagen hair, but differences were not significant. Plasma melatonin levels increased under treatment with melatonin, but did not exceed the physiological night peak. CONCLUSIONS: To the authors' knowledge, this pilot study is the first to show that topically applied melatonin might influence hair growth in humans in vivo. The mode of action is not known, but the effect might result from an induction of anagen phase.     

Synergistic effect of platelet-rich plasma injections and scalp lifting in androgenetic alopecia

Androgenetic alopecia (AGA) is a common hair loss disorder, especially in men and the elderly. In this study, we analyzed the therapeutic effects of platelet-rich plasma (PRP) injections and embedded sutures in patients with AGA. In each participant, we administered different treatments in one area of hair loss that was divided into four sections. Each section received one of the following treatments: No treatment, PRP injection, suture embedding, and combined PRP injection/suture-embedded areas. The thickness of the scalp, and scalp perfusion were measured using an ultrasound imaging system and Moor FLPI full-field laser perfusion imaging system, respectively. The diameters of the hair were measured using optical microscopy. Our results show that PRP injection treatments increased the diameter of the hair (P = 0.034), and the combined PRP injection/suture-embedded treatments had a significant effect on the thickness of the scalp (P = 0.002), the blood flow (P = 0.014) through the scalp, and the diameter of the hair (P = 0.013). This study has demonstrated that there is a synergistic effect between PRP injections and suture embedding for increasing the thickness and blood flow of the scalp, and diameter of the hair. Combined PRP injection/suture-embedded PRP injections might have therapeutic benefit for patients with AGA.     

Utility of platelet-rich plasma in aesthetics

Platelet-rich plasma (PRP) has expanded its therapeutic applications into the field of aesthetic medicine. PRP is an autologous blood-derived product with an increased concentration of platelets to plasma relative to that of whole blood, which supports its therapeutic effects. Frequently promoted and marketed directly to consumers and patients, clinicians are often questioned on the efficacy and safety of PRP as a therapeutic modality. Given the rise in popularity of PRP, multiple clinical trials have been conducted to assess its application within the field of aesthetic medicine, particularly for hair loss conditions, skin rejuvenation, scarring, and conditions of dyspigmentation. We have reviewed the relevant research about the utility of PRP and associated evidence-based practices and discuss the direction for future research.