An umbrella review of the use of platelet-rich plasma in the treatment of androgenetic alopecia
Li C, Pan L, Yang L, Kong J, Zhang L
Journal of cosmetic dermatology. 2023
OBJECTIVE To evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of androgenetic alopecia, as well as establish an effective treatment protocol and optimal PRP preparation procedure. METHODS We searched the PubMed, Scopus, Embase, Cochrane, CNKI, and Wanfang databases from inception to October 29, 2021, using PROSPERO's International Prospective Register of Systematic Reviews (registration ID: CRD42022295921). RESULTS The original literature search revealed 215 reviews; after duplication removal, 89 papers were eliminated, 95 were eliminated after reading the titles and abstracts, and eventually, 28 articles were included after reading the complete text. CONCLUSIONS PRP treatment for androgenetic alopecia is effective, and we recommend the following: (1) a PRP volume of at least 0.05 ml/cm(2) , preferably 0.1 ml/cm(2) ; (2) at least three consecutive treatments at an interval of 1 month; (3) intensive therapy is beneficial and can be provided from 3 to 6 months after continuous treatment; (4) objective indicators such as hair diameter, hair count; (5) long-term follow-up.
Systematic review: Platelet-rich plasma (PRP) use in facial rejuvenation
Gentile P, Garcovich S
Plastic and reconstructive surgery. 2023
BACKGROUND An increasing interest in maintaining a youthful appearance has led to the development of innovative and non-invasive aesthetic procedures for the treatment of facial aging as the recent use of Autologous Platelet-Rich Plasma (PRP). OBJECTIVES This article aims to review the literature and critically appraise the available evidence regarding the efficacy of autologous activated PRP (AA-PRP) and/or not-activated PRP (ANA-PRP) injection used for facial rejuvenation. METHODS A systematic review regarding the clinical use of AA-PRP and ANA-PRP injection in facial rejuvenation against signs of aging was performed using PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus, and Cochrane databases. The protocol was developed following the Preferred Reporting for Items for Systematic Reviews-Protocols (PRISMA-P) guidelines. The included studies had to match predetermined criteria according to the PICOS approach. RESULTS Eleven of the twelve studies identified, including three randomized split-face trials, showed improved results despite differences in study design and outcome measures, many of which were subjective. CONCLUSIONS Further randomized controlled trials and related systematic reviews, as evidence-based medicine (EBM) studies of level 1 are required to confirm PRP injection efficacy in facial rejuvenation, to consolidate the promising results of the studies identified in this systematic review.
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
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.
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
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.
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
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.
Platelet-Rich Plasma in Alopecia Areata-A Steroid-Free Treatment Modality: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Meznerics FA, Illés K, Dembrovszky F, Fehérvári P, Kemény LV, Kovács KD, Wikonkál NM, Csupor D, Hegyi P, Bánvölgyi A
BACKGROUND Alopecia areata (AA) is a chronic autoimmune condition that can lead to a serious deterioration in patients' quality of life. The first line of treatment in patchy AA is triamcinolone acetonide (TrA); however, the efficacy of the treatment varies greatly. Our aim was to investigate the therapeutic effects of platelet-rich plasma (PRP) in the treatment of AA. METHOD We performed a systematic literature search in four databases. Randomized clinical trials (RCT) reporting on patients with AA treated with PRP were included, comparing PRP with TrA or a placebo. The primary outcome was the Severity of Alopecia Tool (SALT) score. RESULTS Our systematic search provided a total of 2747 articles. We identified four studies eligible for quantitative analysis. The pooled mean differences from the four studies did not exhibit a significant difference in the mean change in the SALT score when PRP and TrA groups were compared (MD =-2.04, CI: -4.72-0.65; I(2) = 80.4%, p = 0.14). CONCLUSIONS PRP is a promising topical, steroid-free treatment modality in the therapy of AA. No significant difference was found between PRP and TrA treatment; however, further high-quality RCTs are needed to further assess the efficacy of PRP treatment and strengthen the quality of evidence.
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
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].
Autologous Platelet-Rich Plasma Treatment for Androgenic Alopecia: A Systematic Review and Meta-analysis of Clinical Trials on Patient Safety, Efficacy and Outcomes
Papakonstantinou M, Siotos C, Gasteratos KC, Spyropoulou GA, Gentile P
Plastic and reconstructive surgery. 2022
BACKGROUND Androgenic alopecia (AGA) is a common condition associated with hair loss both in men and women (female pattern hair loss, FPHL), causing considerable psychological distress. Ongoing research focuses on novel safe, cost-effective and efficient treatments with the best patient outcomes. Autologous platelet-rich plasma (PRP) has become increasingly popular in the treatment of AGA compared to hair transplantation techniques. The present study aims to evaluate the outcomes of PRP as a treatment for AGA/FPHL. METHODS A computerized literature search was conducted on PubMed, clinicaltrials.gov and Cochrane Library for articles published until November 2020. The online screening process was performed by two independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported using PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses), and it was registered at the International Prospective Register of Systematic Reviews (PROSPERO) of the National Institute for Health Research (NIHR). Meta-analyses were performed by employing the Random Effects Model using the RevMan software. RESULTS The initial search yielded 49 randomized controlled clinical trials (RCTs). Eleven RCTs were included in the study based on a priori criteria. PRP injections significantly increased the number of hair follicles, hair thickness and density compared to placebo interventions. Also, the patients reported high overall satisfaction with the PRP treatment. Only temporary minor side effects were noted, including localized pain, bleeding and itching. CONCLUSION Autologous PRP significantly improves alopecia in select patients. Future research should focus on optimizing PRP treatment protocols and minimizing possible adverse reactions.
Meta-analysis of platelet-rich plasma therapy for anal fistula
Luo Q, Zhou P, Chang S
Journal of cosmetic dermatology. 2022
OBJECTIVE To systematically evaluate the efficacy of platelet-rich plasma (PRP) in treating anal fistula. METHODS PubMed, EMBASE, and Cochrane Library databases were systematically searched for randomized controlled studies (RCTs) and case-control studies published before June 2021 on evaluating the efficacy of platelet-rich plasma (PRP) in treating anal fistula. References of the journals were manually searched for relevant studies. Literature search, screening, data extraction, and bias assessment were carried out by two researcher independently. Stata13.0 and RevMan 5.3 software were used for statistical analysis of the cure rate and recurrence rate of anal fistula. RESULTS A total of 6 case-control studies and 3 RCTs involving 289 patients were included. Meta-analysis showed that the pooled cure rate of all studies was 65% (95% CI 0.53-0.77), p = 0.000, and the pooled recurrence rate of all studies was 12% (95% CI 0.08-0.17). CONCLUSION Platelet-rich plasma is safe and effective in treating anal fistula and should be promoted and further studied in clinical practice.
Ablative Fractional Carbon Dioxide Laser Combined with Autologous Platelet-Rich Plasma in the Treatment of Atrophic Acne Scars: A Systematic Review and Meta-Analysis
Aljefri YE, Ghaddaf AA, Alahmadi RA, Alkhamisi TA, Alkhunani TA, Samarkandy S, Alamri A
Dermatologic therapy. 2022;:e15888
BACKGROUND Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80-90% of all acne scars. Ablative fractional carbon dioxide (FCO2) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars. METHODS Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review saught to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD). RESULTS 11 RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR=2.56, 95% CI 1.37 to 4.78 and OR=3.38, 95% CI 1.80 to 6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD = -0.40, 95% CI -0.65 to -0.14). CONCLUSION The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars. This article is protected by copyright. All rights reserved.