|Year : 2019 | Volume
| Issue : 3 | Page : 137-140
Platelet-Rich plasma in androgenic alopecia: Myth or an effective tool
Yeshwant Lamture1, Aditya Mundada1, Varsha Gajbhiye2
1 Department of General Surgery, JNMC, Wardha, Maharashtra, India
2 Department of Pharmacolgy, JNMC, Wardha, Maharashtra, India
|Date of Submission||25-Feb-2019|
|Date of Decision||30-Apr-2019|
|Date of Acceptance||15-Jul-2019|
|Date of Web Publication||2-May-2020|
Dr. Varsha Gajbhiye
Doctors Quarter, F.9, AVBRH Campus, Sawangi (Meghe), Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Androgenic alopecia (AGA) is the most common form of alopecia, affecting up to 80% of men. Platelet-rich plasma (PRP) is an autologous preparation of plasma with concentrated platelets. PRP contains various growth factors and cytokines that enhance the body's inherent capacity to repair and regenerate. Materials and Methods: A study involves 20 patients suffering from AGA. The hair pull test was performed before the treatment session. The volume of 10 cc PRP was injected. The treatment was repeated every month for six times. The outcome was assessed after 6 months by clinical examination, global photos, hair pull test, and patient's overall satisfaction. Results: A significant improvement in hair loss was observed between the first and sixth injection of PRP. Hair count increased from the average number of 60 hair follicular units to 84 hair follicular units. The average mean gain in hair follicles is 24 units/cm2. After the 6th session, the pull test was negative in 17 patients. The average improvement before and after the procedure ranged from −2 to + 4 according to the 15-point Jaeschke scale. AGA is a disorder that is marked by the reduction in the diameter, length, and pigmentation of the hair. Growth factors in PRP are known to activate the proliferative phase and transdifferentiation of hair and stem cells and produce new follicular units. Conclusion: PRP injection is a simple, cost-effective, and feasible treatment option for AGA.
Keywords: Androgenic alopecia, hair pull test, platelet-rich plasma
|How to cite this article:|
Lamture Y, Mundada A, Gajbhiye V. Platelet-Rich plasma in androgenic alopecia: Myth or an effective tool. J Datta Meghe Inst Med Sci Univ 2019;14:137-40
| Introduction|| |
Androgenic alopecia (AGA) is the most common form of alopecia, affecting up to 80% of men. It is a chronic, nonscarring, age-related disorder marked by a progressive reduction in the diameter, length, and pigmentation of the hair.
Platelet-rich plasma (PRP) is an autologous preparation of plasma with concentrated platelets. PRP contains various growth factors and cytokines that enhance the body's inherent capacity to repair and regenerate. Growth factors in PRP are known to activate the proliferative phase and transdifferentiation of hair and stem cells and produce new follicular units.
With more hair restoration clinics choosing to offer PRP therapy, data on treatment efficacy have begun to accumulate. We undertake this study to verify whether PRP could be an alternative to traditional therapies in AGA.
The aim of this study is to prove the efficacy of PRP in the treatment of AGA.
The objectives of this study are as follows:
- To study the efficacy and feasibility of PRP in AGA in males
- To study the safety of PRP in AGA
- To demonstrate a new method of preparing PRP with the use of a syringe and melting gum.
| Materials and Methods|| |
- Study setup: Acharya Vinoba Bhave Rural Hospital (AVBRH)
- Study design: Prospective, interventional study
- Sample size: Twenty patients
- Inclusion criteria: Patients suffering from AGA
- Exclusion criteria: Patients with hematological disorders, thyroid dysfunction, malnutrition, and other dermatological disorders.
Approval from the Institutional Ethical Committee was obtained. All patients were advised to avoid washing hair 2 days before the treatment. Before each session, the hair pull test was performed three times by the same clinician. A bundle of approximately 50–60 hairs was grasped between the thumb, index, and middle finger from the base close to the scalp. The hair was firmly tugged away from the scalp, and the extracted hair was counted in every session. To evaluate overall hair growth, hair volume, hair quality, and fullness, global pictures were taken in every session from the vertex view.
PRP was prepared by collecting 12 cc of fresh blood in heparin-containing syringe under proper aseptic precaution [Figure 1]. The finger holder of the syringe was cut by scissors, and the piston was fixed with the help of melting gum [Figure 2] and [Figure 3]. The syringe was then rotated in a centrifugation machine at 1500 revolutions/min for 6 min [Figure 4]. The first centrifugation is called “soft spin,” which allows blood separation into three layers, namely bottom red blood cell layer (55% of total volume), top-most acellular plasma layer called plasma (40% of total volume), and an intermediate layer (5% of total volume) called the “buffy coat” which comprises white blood cells. The syringe was then taken out from the centrifuge and was connected to another 5 cc syringe with the help of a scalp vein set, of which one end is attached to the syringe containing a buffy coat and the other end to the empty syringe [Figure 5]. After connecting both the syringes, the separated buffy coat with plasma was transferred to the empty syringe by pressing the piston. This syringe containing the buffy coat with plasma underwent a second centrifugation, which was longer and faster than the first, called “hard spin,” comprising at 2500 revolution/min for 15 min. This allows the PRP to settle at the bottom of the tube. The upper 2/3rd layer containing platelet-poor plasma was discarded by pressing the piston and ultimately the lower layer of PRP was obtained and was transferred to another syringe containing calcium chloride as an activator for use with the help of scalp vein set.
|Figure 5: Transfer of buffy coat with plasma into an empty syringe for second centrifugation|
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One hour before the administration of PRP, anesthetic cream was applied over the bald area. The area of the scalp to be treated was cleaned with cetavlon, spirit, and povidone-iodine. With the help of syringe, PRP was injected over affected area by Nappage technique (multiple small injections in a linear pattern 1 cm apart) under proper aseptic precaution in the minor operation theater. A total volume of 2–3 cc was injected. The treatment was repeated every 4 weeks for six sessions. The outcome was assessed after 6 months by clinical examination, global photos, hair pull test, and patient's overall satisfaction with the use of Jaeschke scale which is as follows:
- −7: A very great deal worse
- −6: A great deal worse
- −5: A good deal worse
- −4: Moderately worse
- −3: Somewhat worse
- −2: A little worse
- −1: A little worse, hardly any worse at all
- 0: About the same
- +1: A little better, hardly any better at all
- +2: A little better
- +3: Somewhat better
- +4: Moderately better
- +5: A good deal better
- +6: A great deal better
- +7: A very great deal better.
| Results|| |
Before treatment, all our patients (100%) had a positive hair pull test, with a mean number of 15 hairs. After the sixth session, the pull test was negative in 17 patients (85%), with an average number of three hairs. A significant reduction in hair loss was observed between the first and sixth therapy as noticed by patients. Global pictures also revealed a moderate improvement in hair volume and coverage [Figure 6], [Figure 7], [Figure 8]. Hair count depicted the average number of 60 hair follicles over marked area before starting the treatment, and after 6 sessions of PRP, the average number of follicular units was 84 follicles. Therefore, the average mean gain is 24 follicles/cm2. The average clinical change before and after the procedure ranged from −2 to + 4 according to the 15-point Jaeschke scale. The side effects after PRP injections include minimal pain, redness at the time of injections, and pinpoint bleeding.
|Figure 7: Global photo of the scalp after 3 months of platelet-rich plasma therapy|
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|Figure 8: Global photo of the scalp after 6 months of platelet-rich plasma therapy|
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| Discussion|| |
Hair loss can cause significant psychological distress and is associated with low self-esteem and depression. Treatment options for AGA are very limited. The current standard of the treatment for AGA includes oral finasteride and topical minoxidil solution or foam. Additional therapies, including dutasteride, ketoconazole, prostaglandin analogs, and hormonal therapy, have also been used in treating AGA. On the one hand, medication is required for an indefinite period of time, and effectiveness is limited by patient adherence. In addition, they may cause side effects such as hypertrichosis close to the area of minoxidil application, possible birth defects, decreased libido, and prolonged impotence with finasteride use in males. On the other hand, because of its invasive nature and high price, surgeries such as hair transplantation and scalp reduction are generally reserved for patients who do not achieve success with medical therapy. Surgical options are dependent on each patient's supply of donor hair, and possible scarring in donor sites is a shortcoming.
PRP, new biotechnology, is the product of an augmented interest in cell-based therapy and tissue engineering. PRP contains high concentrations of over 20 growth factors that are actively secreted from the α-granules of platelets. Among those thought to stimulate hair regrowth include platelet-derived growth factor, transforming growth factor, vascular endothelial growth factor, epidermal growth factor, fibroblast growth factor, connective tissue growth factor, and insulin-like growth factor IGF-1. These essential proteins regulate cell migration, attachment, proliferation, and differentiation and promote extracellular matrix accumulation. Growth factors in PRP promote hair regrowth by binding to their respective receptors expressed by stem cells of the hair follicle bulge region and associated tissues. Upon ligand binding, stem cells induce the proliferative phase of the hair follicle, producing the anagen follicular unit, and facilitating hair regrowth.
In our study, the hair pull test became negative after six sessions of PRP. This study also observed a significant improvement in hair volume and coverage in global pictures, but according to our study, only moderate improvement in hair volume and coverage was observed. Similar study was done by Anitua et al. evaluated the use of plasma rich in growth factors in 19 participants with AGA. Participants were given 5 injections, compared to baseline, all outcome measures showed positive results after 1 year of follow-up. Mean hair density, hair diameter, and terminal/vellus hair ratio were among the measures showing statistically significant improvement (P < 0.05). Overall, patients were satisfied with their clinical improvement. A study done by Verma K et al. suggested that PRP therapy can be a valuable adjuvant to topical minoxidil therapy in treatment of AGA. Another study with the result comparable to our study was done by Khatu et al. to investigate PRP efficacy in 11 participants. After 4 sessions of PRP, nine participants reverted to having a negative hair pull test. Hair volume, coverage, and follicular hair unit count were improved. Hair counts were noted to be increased from 71 to 93.09 on average. Our study has some limitations. A sample size is very small. The mean follow-up of patients is also short to draw the conclusion regarding the long-term effectiveness of treatment. Thus, further studies are needed with longer follow-up and with larger sample size.
| Conclusion|| |
PRP injection for AGA is a simple, cost-effective, and feasible treatment option for hair loss and can be regarded as a valuable adjuvant treatment modality for AGA. Although PRP has a sufficient theoretical scientific basis to support its use in hair restoration, hair restoration using PRP is still at its infancy. Clinical evidence is still weak. Considering its excellent safety profile and relatively low cost, PRP hair treatment is a promising treatment option for patients with thinning hair. The new method of PRP preparation was useful, easy to use, and gained good results as shown by the study.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Khatu SS, More YE, Gokhale NR, Chavhan DC, Bendsure N. Platelet-rich plasma in androgenic alopecia: Myth or an effective tool. J Cutan Aesthet Surg 2014;7:107-10.
] [Full text]
Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: A pilot study. Dermatol Surg 2014;40:1010-9.
Cervantes J, Perper M, Wong LL, Eber AE, Villasante Fricke AC, Wikramanayake TC, et al
. Effectiveness of platelet-rich plasma for androgenetic alopecia: A review of the literature. Skin Appendage Disord 2018;4:1-11.
Anitua E, Pino A, Martinez N, Orive G, Berridi D. The effect of plasma rich in growth factors on pattern hair loss: A pilot study. Dermatol Surg 2017;43:658-70.
Verma K, Tegta GR, Verma G, Gupta M, Negi A, Sharma R. A study to compare the efficacy of platelet-rich plasma and minoxidil therapy for the treatment of androgenetic alopecia. Int J Trichol 2019;11:68-79.
] [Full text]
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]