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CORRESPONDENCE |
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| Year : 2019 | Volume
: 64
| Issue : 5 | Page : 417-419 |
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| Platelet-rich plasma therapy for androgenetic alopecia |
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Vinod K Sharma, Neetu Bhari, Suman Patra, Anita Singh Parihar
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| Date of Web Publication | 5-Sep-2019 |
Correspondence Address:
Vinod K Sharma
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.IJD_363_17
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How to cite this article:
Sharma VK, Bhari N, Patra S, Parihar AS. Platelet-rich plasma therapy for androgenetic alopecia. Indian J Dermatol 2019;64:417-9 |
Indian J Dermatol 2019:64(5):417-9
Sir,
Platelet-rich plasma (PRP) means “abundant platelets that are concentrated into a small volume of plasma.” The role of PRP has been demonstrated recently for the treatment of patterned hair loss. The proposed mechanism of action includes proliferation of dermal papilla cells by upregulation of growth factors and by stimulation of anagen-associated angiogenesis.[1],[2] In this prospective case series, we planned to study the effect of PRP in chronic nonresponsive cases of patterned hair loss.
Chronic nonresponsive cases of patterned hair loss, who have used minoxidil for more than 1 year, were recruited over a period of 1 year (May 2015 to June 2016). Patients with a propensity for keloid or blood coagulopathies were excluded from the study. After a baseline evaluation and photographic and dermoscopic analyses, patients were treated with PRP therapy. Global pictures were taken in every session from the lateral, front, vertex, and back views with standard camera settings. Dermoscopic analysis (Medicam, 200X USB Video Dermatoscope Camera) was repeated before each session after marking a 1 cm2 area, 10 cm proximal to the midpupillary line of the right eyebrow. Three sessions of PRP injections were done at 6-week interval. Follow-up analysis was done at monthly intervals for 6 months. Adjuvant treatment comprised of topical minoxidil 5% lotion 1 ml twice daily in male patients and 2% lotion 1 ml twice daily in female patients.
We prepared PRP in an automated centrifuge machine (REMI PRP centrifuge) which worked based on the double-spin technique. To prepare PRP, whole blood (20 ml) was taken from the antecubital vein using blood collection tubes containing citrate solution as anticoagulant (Vacutainer W). The first step was “light-spin” centrifugation, which separated red blood cells from the rest of the plasma (REMI PRP centrifugation tube). After the second “heavy-spin” centrifugation, platelets spun down and were separated as a pellet at the bottom of the tube from platelet-poor plasma above. Approximately 3/4th of the supernatant was discarded, and the platelet-rich pellet was resuspended in the remaining plasma. PRP was activated by adding CaCl2(250 μl per 1 ml of plasma), just before its injection. The resulting platelet concentration was standardized to 0.4–0.5 million/μl.
After surgical cleansing, block anesthesia with lignocaine 2% solution without adrenaline was given in supraorbital and supratemporal nerves. PRP solution of 0.2–0.3 ml per site was injected into multiple sites by Nappage technique over the affected areas of the scalp with the help of 1-ml insulin syringe. An approximate distance of 1 cm was kept between the two injections. The remaining solution was sprinkled over the scalp followed by microneedling for better penetration of the solution. Analysis of therapeutic response was done by an independent dermatologist by comparing pre- and post-treatment photographs, and improvement was graded from 0% to 100%.
A total of 54 patients of androgenetic alopecia with chronic nonresponsive disease were recruited [Table 1]. The mean age at presentation was 28 years (range: 18–44 years), and the mean duration of illness was 4.5 years (range: 1.5–8 years). A male predominance was seen with a male-to-female ratio of 49:5. According to the Norwood Classification of male pattern baldness, there were 7 patients with Type II alopecia, 17 patients with Type IV, 15 patients with Type V and VI, and 10 patients with Type VII alopecia. According to the Ludwig Classification, among women, there were three patients with Grade I alopecia and two patients with Grade II alopecia. | Table 1: Therapeutic response with platelet-rich plasma therapy as assessed by independent dermatologist
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A mean improvement of 45.74%±13.11% was seen at the end of three sessions (range: 0%–80%) [Figure 1]. This improvement was further classified as mild <40%, moderate 40%–80%, and excellent as more than 80% improvement. Based on this photographic analysis, mild improvement was noted in 30 (55.5%) cases and moderate in 24 (44.4%). Improvement in female patients was comparatively less, 24% (0%–60%), though the number was small to draw a conclusion. Advanced grade of alopecia (Norwood–Hamilton scale VI–VII) was associated with milder improvement compared to early disease (Norwood–Hamilton Grade II–V), though, the difference was not significant (38% vs. 52.2%, P = 0.073). The improvement was not related to the duration of disease, age of presentation, and baseline hemoglobin levels. The improvement in hair density was attributed to increase in the thickness of hair shaft as well as increased number of hair follicles as seen on dermoscopic evaluation [Figure 2]. A 6-month follow-up was available in 30 patients. Maximum therapeutic response was seen after 1 month of the third injection, and reversal of response was noted in 12 (40%) patients. | Figure 1: Baseline (a, c, e, and g) and follow-up (b, d, f, and h) clinical photographs of patients showing response to three injections of platelet-rich plasma therapy
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 | Figure 2: Corresponding baseline (a, c, e, and g) and follow-up (b, d, f, and h) dermoscopic images showing increase in thickness and number of hair follicles
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No major complications were seen during the procedure. Mild pain during the procedure and transient swelling postprocedure were seen in majority of the patients.
Although improvement in our study was similar to the recent published studies and meta-analysis, limitation of our study included the absence of control cases and relatively small sample size.[3],[4],[5] We conclude that the injection of PRP has shown positive response in our case series; however, better-designed, larger, and long-term trials with placebo control are needed to confirm its effectiveness in the management of patterned hair loss.
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.
Acknowledgments
We thank Ms. Anshu Rawat, Department of Dermatology, All India Institute of Medical Sciences, New Delhi, for her help in the preparation of PRP. We also thank Dr. Subuhi Kaul, Senior Resident, Department of Dermatology, All India Institute of Medical Sciences, New Delhi, for the evaluation of therapeutic response as an independent observer.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Li ZJ, Choi HI, Choi DK, Sohn KC, Im M, Seo YJ, et al. Autologous platelet-rich plasma: A potential therapeutic tool for promoting hair growth. Dermatol Surg 2012;38:1040-6.  |
| 2. | Li W, Enomoto M, Ukegawa M, Hirai T, Sotome S, Wakabayashi Y, et al. Subcutaneous injections of platelet-rich plasma into skin flaps modulate proangiogenic gene expression and improve survival rates. Plast Reconstr Surg 2012;129:858-66. |
| 3. | Gupta AK, Carviel JL. Meta-analysis of efficacy of platelet-rich plasma therapy for androgenetic alopecia. J Dermatolog Treat 2017;28:55-8. |
| 4. | Giordano S, Romeo M, Lankinen P. Platelet-rich plasma for androgenetic alopecia: Does it work? Evidence from meta analysis. J Cosmet Dermatol 2017;16:374-81. |
| 5. | Betsi EE, Germain E, Kalbermatten DF, Tremp M, Emmenegger V. Platelet-rich plasma injection is effective and safe for the treatment of alopecia. Eur J Plast Surg 2013;36:407-12. |
[Figure 1], [Figure 2]
[Table 1] |
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