- Platelet Rich Plasma (PRP) is a newer modality of treatment for Androgenetic Alopecia (AGA)
- An autologous concentration of platelets in a fraction of plasma prepared from the patient’s own blood.
- Platelet concentration obtained is 4-7 times (1,000,000/μL) above baseline (2,00,000 cells/μL)
- Simple, safe office-based procedure.
- AGA is a patterned hair loss in either sex with only minoxidil and finasteride as the FDA-approved medication.
- Both medications have limitations due to slower results, and side effects profiles leading to less compliance.
- PRP can be an adjuvant/alternate treatment in AGA.
Materials & Methods
- 60 patients diagnosed with AGA selected (48 males and 12 females).
- Patients who did not respond to topical Minoxidil and oral Finasteride were included.
- Observational study from August 2015 to October 2017.
- Exclusion criteria- H/o bleeding disorders, Uncontrolled diabetes, Unrealistic expectations, anti-coagulant therapy, Keloidal tendency.
- Proper informed consent was taken.
- Photographs were taken at each session.
- Icing and Vibration during therapy was given for all patients.
- Anesthesia was given for apprehensive patients-
- Ring block on scalp
- Topical EMLA
- After cleaning the area to be treated, microneedling was done over the scalp followed by application of PRP.
- Patient was sent home and asked to apply minoxidil at home.
- The sessions were repeated at interval of 4 weeks.
Results
- Patient satisfaction scores (PSS) and Objective assessment score (OAS) were graded based on visual analog score(TABLE 1) ( Fig 1)
- According to subjective scores 48 patients had good to excellent results. According to objective scoring, 49 patients had good to very good results. (Fig 2)
- An attempt was also made to analyse the number of sessions required since there are no standard protocols (Fig 3)
- 50/60 patients underwent 4 sessions. 40 patients had very good results with 4 sessions (p value <0.05) as in Table 2.
Conclusions
- PRP is a simple, safe and good treatment modality for AGA. Our study shows that PRP is an effective treatment modality for AGA.
- Alternate for those who failed to / are apprehensive about medical therapy like finasteride and minoxidil.
- DIFFERNTIAL CENTRIFUGATION is the basic principle in PRP, wherein cells are separated based on their specific gravities.
- GFs particularly PDGF and VEGF, along with many other GFs, cytokines and proteins released from PRP stimulate dermal papilla cells through mitogenesis and angiogenesis.
- Micro-needling done prior to PRP application has the following advantages.
- Reduces need of multiple injections of PRP.
- Facilitates uniform absorption of PRP.
- Induces inflammatory response recruits GFs and increases blood supply.
- PRP can be used an adjunct to hair transplantation also.
- Our study also provides evidence that at least 4 sessions are needed to get good results in AGA (p<0.05), further randomized clinical trials are required to establish this as a standard protocol.
- Further limitations of this study are there is no control/comparison group for the study.
- Larger population-based trials have to be carried out to validate use of PRP as monotherapy modality and to establish standard protocols like centrifugation, activators, number of sessions required, etc.
