Platelet Rich Plasma or PRP is a preparation taken from a patient’s own blood, in which the platelets are enriched in concentrated plasma. Most think of platelets as the component of blood that coagulates wounds. However, the function of platelets is far more than just forming clots. When activated, they secrete cytokines and growth factors, acting as an integral part of wound healing.
Recent animal studies show that PRP increases dermal papilla cells, which are decreased in individuals with balding. Potent hair growth stimulators, Fibroblast growth factor-7 and Beta-catenin, are also increased by PRP treatment. In the fall, the Dermatologic Surgery journal showed that mice treated with PRP have quicker transitions into the growing phase of hair than untreated mice. When used as an adjunct to hair transplantation, hair follicles pre-treated with PRP can demonstrate better density and graft survival. The theory is that the platelets are secreting growth factors, leading to stem cell activation from the surrounding hair follicles. Thus, hair specialists have been trialing the therapy in patients who are balding due to androgenetic alopecia.
When I attended the International Society for Hair Restoration Surgery, several of the surgeons around the world provided anecdotal reports of using platelet-rich plasma for not only androgenetic alopecia (or balding), but also to treat alopecia areata. However, there had been no scientific studies performed at the time.
Alopecia areata differs from androgenetic alopecia in its mechanism, as well as its clinical appearance. Alopecia areata is an autoimmune condition, in which the person’s own immune system targets their hair follicles, causing them to fallout. The entity may manifest as small circular patches of hair loss or may occur more diffusely. Diffuse alopecia areata is often not only cosmetically disfiguring, but also can be recalcitrant to standard treatments, such as intralesional steroids.
A recent edition of the British Journal of Dermatology reported a pilot study successfully using platelet-rich plasma to treat alopecia areata. In the study, 45 patients with alopecia areata were given 3 monthly injections of either PRP, intralesional steroids, or placebo and followed for a year. The patients given PRP saw the most significant hair regrowth.
The use of PRP to treat recalcitrant alopecia areata seems promising and a great tool in our armamentarium for hair loss. However, this advancement still has few published, large human clinical trials. In addition, there is no consensus on optimal concentrations and dosing schedules.
Although, PRP seems to be a promising advancement in the field of hair loss, many hair specialists have not adopted its use widely because the amount of benefit is unclear and most importantly, guidelines for use have not been established.
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