0
selected
-
1.
Platelet-rich plasma in alopecia areata and primary cicatricial alopecias: A systematic review
Tejapira K, Yongpisarn T, Sakpuwadol N, Suchonwanit P
Frontiers in medicine. 2022;9:1058431
Abstract
BACKGROUND Immune-mediated alopecias (IMAs), a group of hair disorders associated with immunological reactions, remain a therapeutic challenge since available treatments are generally unfavorable with potential side effects. Platelet-rich plasma (PRP) has been recently proposed as a treatment option based on several limited-quality studies; however, there is no systematic evaluation of PRP efficacy on IMAs in the literature. OBJECTIVE To assess PRP's effects in treating IMAs using a systematic review. METHODS Electronic searches were conducted using PubMed, Embase, Scopus, and Cochrane Library databases. A search strategy was designed to retrieve all studies exploring PRP in treating IMAs, including alopecia areata (AA) and primary cicatricial alopecias (PCAs). In addition, all randomized and non-randomized studies reporting subjective and/or objective outcomes of alopecia treatment with PRP were included. RESULTS Thirty-two studies were included, comprising 621 patients with AA and 19 patients with PCAs. PRP had superior efficacy as monotherapy in five studies, comparable to intralesional corticosteroids in six studies in AA treatment. In addition, in the analysis of PCAs, including lymphocytic and neutrophilic subtypes, PRP was efficacious in alleviating disease progression in nine studies. CONCLUSION PRP is considered a promising treatment for AA and PCAs in patients who experienced unfavorable outcomes from conventional treatment. However, its clinical application remains to be standardized, and its recommendation as a treatment for IMAs could not be ascertained due to a lack of high-quality evidence. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353859], identifier [CRD42022353859].
-
2.
Evaluation of the safety and efficacy of platelet-rich plasma in the treatment of female patients with chronic telogen effluvium: A randomised, controlled, double-blind, pilot clinical trial
El-Dawla RE, Abdelhaleem M, Abdelhamed A
Indian journal of dermatology, venereology and leprology. 2022;:1-9
Abstract
BACKGROUND Chronic telogen effluvium is characterised by diffuse loss of hair of the scalp. One of the emerging lines of treatment is platelet-rich plasma. However, not much of published data exist. AIMS A pilot study was conducted on chronic telogen effluvium patients to evaluate the efficacy and safety of platelet-rich plasma, and to compare two different methods of platelet-rich plasma preparation. METHODS The study included 30 female patients with chronic telogen effluvium. Patients were randomised into three groups: Group (1): Special platelet-rich plasma tubes centrifuged at 3500 rpm; Group (2): Ordinary laboratory tubes centrifuged at 1000 rpm; Group (3): Normal saline as a placebo. Patients' evaluation was done with visual analog scale, hair pull test, trichoscopy, photos, satisfaction questionnaire, and safety. All patients received four monthly sessions. Patients were evaluated one month and three months after the last session. RESULTS The hair pull test,visual analogue scale, and patient satisfaction results showed a statistically significant difference between group 1 vs. group 3 and group 2 vs.group 3 at one and three months after the sessions, while there was no difference between group1 vs. group 2. Trichoscopy results (baseline, one and three months after treatment) showed a significant increase in hair density and thickness in the frontal area, temporal area, and the vertex in groups 1 and 2 only. There was no statistically significant difference between the three groups with regards to side effects. LIMITATIONS The sample size was small with ten patients in each group. Furthermore, the follow-up of patients was for only three months. CONCLUSIONS Platelet-rich plasma could be considered as a promising therapy for patients with chronic telogen effluvium with an excellent safety profile. The ordinary laboratory low-cost tubes might be a reliable alternative to the expensive special platelet-rich plasma kits tubes. The trial registry number is PACTR202006539654415.
-
3.
Use of autologous platelet-rich plasma in androgenetic alopecia in women: a systematic review and meta-analysis
Oliveira AFQ, Arcanjo FPN, Rodrigues MRP, Rosa E Silva AA, Hall PR
The Journal of dermatological treatment. 2022;:1-17
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis to verify the efficacy of using autologous PRP in female pattern alopecia. DATA SOURCES MEDLINE/PubMed, Cochrane Library, ClinicalTrials.gov and EMBASE up to May 2021. STUDY SELECTION AND DATA EXTRACTION We identified all studies evaluating the effect of PRP in female pattern alopecia. A narrative synthesis was performed from data on the efficacy of PRP treatment and adverse effects; quantitative results of PRP use compared to control treatment for female AGA were synthesized. The outcomes analyzed were terminal density and hair thickness. RESULTS Seven articles were selected for this review. Meta-analysis showed that PRP-based interventions were able to increase terminal hair density compared to control (SMD =2.98, 95% CI =1.10, 4.85), with no significant increase in hair thickness (SMD =1.16, 95% CI = -0.96, 3.28). During and after treatment, no major side effects were reported by patients or researchers. CONCLUSION The use of autologous PRP injections in female AGA seems to be promising, with more consistent results on terminal hair density. However, caution is recommended in the interpretation of these results until they can be replicated in larger and more representative samples. PROSPERO registration number CRD42021257154.
-
4.
The effect of placebo in split-scalp and whole-head platelet-rich plasma trials for androgenetic alopecia differs: Findings from a systematic review with quantitative evidence syntheses
Gupta AK, Bamimore MA
Journal of cosmetic dermatology. 2022
Abstract
BACKGROUND Some studies have shown that platelet-rich plasma (PRP) improves androgenetic alopecia (AGA)-while others do not. We determined whether the placebo effect significantly varies between split-scalp and whole-head trials on PRP monotherapy for AGA. Our rationale was based on the plausibility of PRP diffusing to the control (i.e., 'placebo') side of split-scalp trials. This is not possible in whole head studies. METHODS We systematically searched the literature for available data. Our choice of analyses and outcomes were determined by the available data. RESULTS Our endpoint was change in total hair density six months after baseline. Our regression showed that total hair density after six months was significantly (p<0.05) higher in the placebo arm of split-scalp trials, compared to whole-head studies, by 37 hairs/cm(2) . Our one-arm meta-analyses showed that the pooled change in total hair density between the PRP side and placebo side in split scalp studies was -3 hairs/cm(2) (p=0.37), that is, a slight decrease in hair density in the placebo side of the scalp. For whole head stdies the corresponding difference in total hair density between patients receiving PRP and those on placebo was -30 hairs/cm(2) (p=0.000017), that is, a much larger decrease in hair density. Patients in the placebo group in whole-head trials lost significantly more hair than in the placebo side of the split-head trials where hair loss was comparatively reduced-presumably because of PRP diffusing from the treatment side of the scalp. CONCLUSIONS The association between design (i.e., split-scalp vs. whole-head) and outcome, in placebo arms of AGA trials on PRP monotherapy, had never been reported. This 'design effect' could partly reconcile the incongruent conclusions across the PRP literature for AGA; furthermore, clinical guidelines can consider 'design effect' when selecting evidence to base care practices on.
-
5.
Platelet-Rich Plasma Monotherapies for Androgenetic Alopecia: A Network Meta-Analysis and Meta-Regression Study
Gupta A, Bamimore M
Journal of drugs in dermatology : JDD. 2022;21(9):943-952
Abstract
INTRODUCTION Platelet-rich plasma (PRP) is a commonly used therapeutic option for androgenetic alopecia (AGA). Evidence syntheses for the impact of PRP on AGA has been handicapped by non-standardized protocols for its administration. We quantitatively synthesized the evidence base to determine the relative efficacy of PRP regimens with different frequencies of administration. We defined frequency as a vector of the (i) number of sessions and (ii) time interval between the sessions. METHODS We systematically reviewed the peer-reviewed literature to obtain relevant data; we then conducted a multivariable meta-regression and network meta-analyses (NMAs). RESULTS Twenty-five trials met our eligibility criteria; 10 unique PRP regimens were ultimately identified for use in our analyses. Our NMAs produced surface under the cumulative ranking curve (SUCRA) values that corroborated the findings of our multivariable meta-regression. The frequency of PRP sessions, chemical activation, number of centrifugations, the age and sex of the patient, and the design of PRP administration (ie, whole-head vs split-scalp) are correlated with the efficacy of PRP insofar as the mean change in total hair density at 6 months from baseline. CONCLUSIONS For the most part, regimens’ SUCRA rankings and relative effects support that the efficacy of PRP administration increases when: (i) the number of sessions increases and (ii) the time interval between sessions decreases; we found that chemically-activated PRP (vs inactivated), double centrifugation (vs single), younger (vs older) age of treated patients, female (vs male) sex, and whole-head (vs split-scalp) administration is associated with improved PRP efficacy. Our approach rules out much confounding as the analysis of our outcome was exclusive to monotherapy at a singular timepoint. Our results may reconcile discrepant findings among previous studies and may be helpful in updating clinical practice guidelines. J Drugs Dermatol. 2022;21(9):943-952. doi:10.36849/JDD.6948.
-
6.
Comparison of Autologous Platelet-Rich Fibrin Matrix and Transplantation of Autologous Noncultured Epidermal Cell Suspension in the Treatment of Chronic Non Healing Ulcer: Randomized Comparative Study
Singh SK, Rupa S
Indian journal of dermatology. 2022;67(4):334-342
Abstract
CONTEXT Chronic non-healing ulcer causes significant morbidity, high cost and reduced quality of life. AIMS To compare autologous platelet-rich fibrin matrix and transplantation of autologous non-cultured epidermal cell suspension in the treatment of chronic non-healing ulcers. METHODS The study was single-centre, prospective, randomised comparative study conducted in a tertiary care center in North India. Patients with chronic non-healing ulcer were included and randomly divided into two treatment groups- Group 1: Platelet-rich fibrin matrix (PRFM) procedure was done every 2 weeks with maximum three sittings and in Group 2: Transplantation of autologous noncultured epidermal cell suspension (NCES) procedure was done once. Follow-up was done every 2 weeks for 8 weeks then monthly for up to 5 months to evaluate the healing of the ulcer. The data were analysed by statistical package for social science (SPSS) trial version 22. To find out a significant difference in mean value between groups, the Chi-square test, student's t-test, and Mann-Whitney U test were used. RESULTS A total of 41 patients were included in the study. Complete healing of ulcers occurred in 89.5% of the patients in the PRFM group and 93.8% of the patients in the NCES group at the end of 5 months (P = 0.33). The mean duration of complete healing in PRFM was 1.7 months and in NCES was 2.13 months (P = 0.20). CONCLUSIONS Both procedures were effective, and there was no significant difference between the two procedures.
-
7.
Comparative Study Between Intralesional Injection Of Platelet Rich Plasma And Intra Lesional Triamcinolone For The Treatment Of Alopecia Areata
Khan, F. A., Hussain, M., Khan, B. M., Afsar, S., Shafique, M., Haq, S. U., Akbar, N., Siddique, A.
Journal of Ayub Medical College, Abbottabad : Jamc. 2022;34(4):762-765
Abstract
BACKGROUND Alopecia areata is an autoimmune disorder of patchy non scarring hair loss. Steroids, either Intralesional, e.g, triamcinolone or potent topical, e.g, clobetasol are the first line treatment. Platelet rich plasma is an autologous concentrated plasma with growth factors which enhances regeneration of hair follicles. It is simple and effective treatment with no major side effects. Objective was to compare the efficacy of intralesional injection of platelet rich plasma and triamcinolone in patients of alopecia areata. It was a randomized controlled trial (open-labelled), conducted at the Dermatology Department, Combined Military Hospital Abbottabad from 1st May to 31st December 2021. METHODS Sixty clinically diagnosed patients of alopecia areata of the scalp were enrolled in the study. They were divided into two groups, A and B. Random numbers table was used to allocate 30 patients into each group. Group A patients were given an intralesional injection of triamcinolone while intralesional platelet rich plasma was given to Group B. Both treatments were repeated at one-month intervals for four months. In the study, Chi-square tests were used to compare effectiveness. It was considered significant when the p-value turned out to be <0.05.. RESULTS There was significant difference in complete response rate between intralesional injection of steroid and intralesional injection of platelet rich plasma. Platelet rich plasma was less effective (p =0.05). Local corticosteroid injection was significantly more effective than platelet rich plasma (p<0.05). CONCLUSIONS Intralesional injection of steroid is an effective and considerable treatment for alopecia areata. This study also proposes intralesional injection of platelet rich plasma as an alternative therapy for alopecia areata as it is not associated with serious local side effects.
-
8.
Transepidermal Delivery of Triamcinolone Acetonide or Platelet Rich Plasma Using Either Fractional Carbon Dioxide Laser or Micro-needling in Treatment of Alopecia Areata
El Mulla KF, Elmorsy EH, Halwag DI, Hassan EM
Dermatology practical & conceptual. 2022;12(4):e2022196
Abstract
INTRODUCTION Trans-epidermal drug delivery, using "laser-assisted drug delivery", or micro-needling, are new treatment modalities, that can improve drug penetration into skin in treatment of alopecia areata patients. OBJECTIVES To evaluate the use of fractional carbon dioxide laser versus micro-needling in trans-epidermal delivery of triamcinolone acetonide and platelet rich plasma in alopecia areata treatment. METHODS Interventional comparative study carried out on 60 patients, randomly divided into four equal groups. Group I: Fractional Carbon dioxide laser and triamcinolone acetonide. Group II: micro-needling with Dermapen and triamcinolone acetonide. Group III: fractional carbon dioxide laser and platelet-rich plasma. Group IV: micro-needling with Dermapen and platelet-rich plasma. Patients were evaluated clinically, using Severity of Alopecia Tool score and hair regrowth scale, and dermoscopically. RESULTS In all treatment groups, there was improvement in the Regrowth scale, with statistical significance between the different groups at fourth (P = 0.001) and last (P = 0.008) visits, with highest, most significant changes in Pen-Steroid group. Comparing Regrowth scale at last visit, results were in favor of Dermapen, compared to Carbon dioxide laser for trans-epidermal drug delivery (P = 0.023); and in favor of triamcinolone acetonide, compared to platelet-rich plasma as topical medication (P = 0.015). Dermoscopic signs of improvement included decrease in black dots, and appearance of Upright regrowing hairs (P < 0.001). CONCLUSIONS Micro-needling and fractional carbon dioxide laser are effective tools for trans-epidermal drug delivery for Alopecia areata treatment. Micro-needling for delivery of Triamcinolone acetonide showed best treatment outcomes. Dermoscopy is highly beneficial in evaluating treatment response in alopecia areata.
-
9.
A Randomized Trial of Oral Tranexamic Acid With Fluocinolone-Based Triple Cream Versus Fluocinolone Based Triple Cream Alone for the Treatment of Melasma
Perveen, S., Rubin, A., Berger, L., Xiong, W., Waqas, N., Sharif, S., Rao, B.
Journal of Drugs in Dermatology : Jdd. 2022;21(3):321-322
Abstract
Oral tranexamic acid (TXA) is a relatively new treatment option for melasma. It is thought to reduce hyperpigmentation through inhibition of the plasminogen/plasmin pathway with resulting decreases in epidermal melanocyte tyrosinase activity, inflammatory mediators, dermal neovascularization, and mast cell numbers.
-
10.
Meta-analysis of the efficacy of adding platelet-rich plasma to 308-nm excimer laser for patients with vitiligo
Chen, J., Yu, N., Li, H., Tang, Y., Zhu, H.
The Journal of International Medical Research. 2022;50(9):3000605221119646
Abstract
OBJECTIVE Platelet-rich plasma (PRP) is a novel treatment option for vitiligo. PRP has been reported to be effective in combination with 308-nm excimer laser therapy, but there is no consensus on their combination use. Therefore, this meta-analysis assessed the efficacy and safety of the combination regimen in patients with vitiligo compared with laser therapy alone. METHODS The meta-analysis was performed by searching PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and WanFang to identify relevant publications published through 1 February 2022. RESULTS Six studies involving 302 patients were included. Compared with phototherapy alone, combination treatment with PRP and 308-nm excimer laser therapy significantly improved the total response rate and reduced the no response rate. Additionally, the proportions of patients with repigmentation rates of ≥75%, ≥50%, and ≥25% were significantly higher in the combination group than in the monotherapy group. In addition, the rates of adverse events for combination therapy were comparable to those for laser therapy alone, and the recurrence rates were low. CONCLUSIONS This meta-analysis provided evidence supporting the combined use of PRP and 308-nm excimer laser therapy as a valuable treatment modality for patients with vitiligo based on its superiority to monotherapy.