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Efficacy of platelet poor plasma gel in combination with fractional CO(2) laser in striae distensae: a clinical, histological and immunohistochemical study
Gad SE, Neinaa YME, Rizk OK, Ghaly NER
Journal of cosmetic dermatology. 2021
Abstract
BACKGROUND Platelet-poor plasma gel is a semi-solid plasma formulation that recently recommended as autologous bio-filler for treatment of atrophic dermal scars. OBJECTIVE To compare the therapeutic efficacy and safety of intradermal injection of plasma gel in combination with fractional CO(2) laser versus fractional CO(2) laser alone in striae distensae (SD). PATIENTS AND METHODS This study included 36 SD patients treated by 3 sessions (one session/1.5 months) of fractional CO(2) laser on all SD lesions following intradermal injection of plasma gel on one side, and saline (as placebo) on the other side. RESULTS Significant clinical improvements associated with remarkable narrowing of SD lesions and prominent enhancement of skin texture were observed on both treatment sides. Obviously, higher degrees of clinical improvements of SD lesions were reported following combined therapy with fractional CO(2) laser and plasma gel rather than fractional CO(2) laser monotherapy. However, post-inflammatory hyperpigmentation (PIH) was reported more frequently with fractional CO(2) laser monotherapy. Histopathological and immunohistochemical examinations revealed significant epidermal improvement, and homogenization, and orientation of dermal collagen bundles as a result of both therapeutic procedures. CONCLUSION Plasma gel in combination with fractional CO(2) laser could be considered a promising novel treatment modality for SD. Plasma gel not only improves the efficacy of fractional CO(2) laser, but also decreases the frequency of PIH.
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2.
Efficacy and Safety of Platelet-Rich Plasma in Melasma: A Systematic Review and Meta-Analysis
Zhao L, Hu M, Xiao Q, Zhou R, Li Y, Xiong L, Li L
Dermatology and therapy. 2021
Abstract
INTRODUCTION Melasma is a chronic and recurrent skin problem for which an effective therapy is currently lacking. Platelet-rich plasma (PRP) has recently emerged as a novel treatment for melasma, but to date there has been no systematic evaluation of its efficacy and safety. METHODS The Web of Science, PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and the Cochrane Library databases were searched for relevant articles using the search items "melasma," "chloasma" and "platelet-rich plasma." STATA version 15.1 software was used to analyze data. Study outcomes were calculated using standardized mean differences with 95% confidence intervals (CIs). RESULTS The database search identified ten studies involving 395 adult patients that met the inclusion criteria and were included in the meta-analysis. Analysis of pre- and post-treatment data from these studies revealed that the post-treatment modified Melasma Area and Severity Index (mMASI) score decreased by 1.18 (95% CI 0.89-1.47; p = 0.02). Subjective satisfaction evaluation of PRP treatment showed that melasma treated with the combination therapy of PRP + microneedling may have been the most efficacious treatment compared to PRP alone or in combination with intradermal injection. Adverse reactions were minor, with only a few patients reporting local congestion, temporary erythema, hyperpigmentation and discoloration. CONCLUSION These results support the efficacy and safety of PRP used in combination or alone as treatment for melasma.
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3.
The Effects of Lower Versus Higher Cell Number of Platelet-Rich Plasma (PRP) in Hair Density and Diameter in Androgenetic Alopecia (AGA): A Randomized, Double-Blinded, Placebo, Paralleled Group Half-Scalp IRB Study
Sasaki GH
Aesthetic surgery journal. 2021
Abstract
BACKGROUND Androgenetic alopecia (AGA) is a common disorder in male and female patients that may benefit from the use of platelet-rich plasma. OBJECTIVES To compare the safety, efficacy, and satisfaction of a lower or higher number of platelets over 6 months. METHODS A prospective randomized, double-blinded, placebo, paralleled group, half-scalp IRB study among eight subjects with moderate AGA. Participants received intradermal PRP injections (baseline and month 3), according to two treatment protocols (high vs low platelet numbers) to the frontal and crown portions of the hemi-scalp and normal saline to control sites. Phototrichoscans were measured at baseline and six months, while global photography and subject and investigator satisfaction questionnaires were obtained at baseline, 3, and 6 months. RESULTS At the end of 6-month evaluation period, both groups demonstrated numerical increases in total hair densities, follicle diameters and terminal hair densities, as well as absolute and percent changes at the frontal and crown targeted sites compared to baseline. These improvements tended to occur more often in areas treated with higher platelet numbers than with lower numbers. Vellus hair densities did not exhibit any significant changes to either PRP dosages. Treatments were assessed by investigator and subjects as "satisfied" at month-3 and were associated with no adverse reactions. CONCLUSIONS Intradermal injections with two therapeutic quantities of platelets were equally safe and efficacious among men and women with androgenetic alopecia. Findings suggest that higher numbers of platelets may have a greater effect than lower number of platelets in regard to hair densities, follicle diameters and terminal hair densities but exhibited minimal effects on vellus hair densities at the month-6 evaluation period. Further studies are required to determine whether any significant advantages occur when delivering either lower or higher numbers of platelets in AGA treatments as long as therapeutic levels are administered.
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4.
Comparing novel versus conventional technique of platelet rich plasma therapy in periorbital hyperpigmentation: A randomized prospective split face study
Budania A, Mandal S, Pathania YS, Lahoria U, Khan A, Puri I, Mishra R
Journal of cosmetic dermatology. 2021
Abstract
BACKGROUND Platelet rich plasma (PRP) has been found to be effective in treating periorbital hyperpigmentation (POH). PRP prepared by double spin (DS) method and activated by calcium has been used conventionally. PRP can be prepared by single spin (SS) and activated at low temperature (novel method), but the evidence is limited. OBJECTIVE To compare the novel and conventional PRP in the treatment of periorbital hyperpigmentation. METHODS We selected 21 patients of POH and randomly divided the face in two halves. One half of the face (group A) was treated with novel PRP (SS and low temperature activation). The other half (group B) was treated with conventional PRP (DS and calcium activation). Total of 3 PRP injections were given at 4 weekly interval. Patients were observed and assessed on 12(th) week by photography, dermoscopy, visual analogue scale (VAS) score, Dermatology life quality index (DLQI). Platelets counts and growth factors were assessed in PRP. RESULTS Mean platelet count in novel and conventional PRP was 7.41± 1.76 lacs and 8.17±2.23 lacs (p= 0.348). Mean photographic and dermoscopic assessment at the end of study in group A and group B was 52.33 ± 6.468 and 53.14 ± 6.99 (p= 0.151). Change in VAS in groups A and B was 3.85 ± 1.27 and 3.90 ± 1.04 (p 0.895). Levels of various growth factors assessed by ELISA did not differ significantly. There was significant decline in DLQI. CONCLUSION The novel method is not inferior to conventional method of PRP in the treatment of periorbital hyperpigmentation.
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5.
Platelet-rich plasma versus carboxytherapy for the treatment of periocular hyperpigmentation; which approach is superior?
Asilian A, Amiri A, Mokhtari F, Faghihi G, Iraji F, Mozafarpoor S
Dermatologic therapy. 2021;:e14980
Abstract
Periorbital hyperpigmentation (POH) is a common aesthetic condition causing people referring to dermatology clinics. Although the therapeutic approach is steeply dependent to the etiology of POH, the gold standard approach of treatment is still a question. The current study is designed to compare the use of carboxytherapy vs platelet-rich plasma (PRP) for the treatment of POH. In the current clinical trial, number of 21 patients with POH underwent carboxytherapy in one side of the face and PRP therapy on the other side. SPSS software version 22 was used with independent T-test, Chi-square, and ANOVA for analytics. Carboxytherapy was performed by intradermal injection of 5 cc carbon-dioxide gas once weekly for six weeks. The PRP treatment was performed by intradermal injection of PRP in periorbital space using an insulin syringe every two weeks for three times. The periorbital darkness was assessed using visual analogue scale (VAS) preoperatively and within 8 weeks postoperatively by the patients and the dermatologists. Automatic assessments of skin vascularity and pigmentation were assessed using a digital camera. The patients represented significant darkness improvement postoperatively for both of the approaches (P-value: 0.84, P-value: 0.87), while the comparison of the two groups revealed insignificant postoperative changes by dermatologists assessments (P-value = 0.59, P-value: 0.61), the patients' assessments (P-value = 0.85), the digital camera skin vascularity and pigmentation assessments (P-value>0.05). Conclusion: Although insignificant changes following both of the approaches were found, it may have occurred due to the technique, quality of material, or inadequate treatment sessions due to the type of Iranian skin; therefore, more evaluations considering particular entities such as vascularity for longer duration of follow-up and new design are strongly recommended. This article is protected by copyright. All rights reserved.
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6.
Efficacy of topical versus intradermal injection of Tranexamic Acid In Egyptian melasma Patients: A randomised clinical trial
Badran AY, Ali AU, Gomaa AS
The Australasian journal of dermatology. 2021
Abstract
BACKGROUND Melasma is one of the common pigmentary problems affecting females in our community, owing to the frequent use of hormonal contraceptives as well as our sunny climate. A lot of treatment options are available but none of them is completely satisfactory. Many patients prefer the use of topical preparations and minimally invasive methods. Tranexamic acid (TA) is a potential treatment option for hyperpigmentation with different delivery routes. AIM: We designed the study in order to evaluate the efficacy of TA in melasma using 2 different routes of delivery. PATIENTS AND METHODS A randomised clinical trial was performed on 60 female patients with melasma, they randomly divided into three groups; A, B and C. Group (A) patients received TA (4 mg/mL) intradermal injections every 2 weeks with, group B received TA (10 mg/mL) intradermal injections every 2 weeks, group C received TA cream (10% concentration) twice daily, treatment continued for 12 weeks in all groups. Melasma Area and Severity Index (MASI) scores were measured for each patient before and after completion of treatment. RESULTS The percentage of MASI score reduction was highest in group B (62.7%) versus (39.1%) in group A, while the percentage of MASI reduction was the lowest in group C (4.2%). CONCLUSION Tranexamic acid is a safe effective and well-tolerated treatment option for melasma patients. Intradermal injection of TA leads to better results than the topical application. Topical TA cream (even in a high concentration) produce fair improvement of melasma.
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7.
Fractional Carbon Dioxide Laser versus Fractional Carbon Dioxide Laser with Autologous Intralesional Platelet-rich Plasma in the Treatment of Stable, Non-segmental Vitiligo: A Randomized Comparative Study
Raizada A, Panda M, Singh BS, Kar BR
Journal of cutaneous and aesthetic surgery. 2021;14(1):55-63
Abstract
BACKGROUND The treatment of vitiligo is often challenging and requires a multi-modality approach. Fractional carbon dioxide (FCO(2)) laser has been studied as an adjuvant therapy in cases of vitiligo. Autologous platelet-rich plasma (PRP) is rich in growth factors, which may contribute to the growth of melanocytes, and thus help in the repigmentation of vitiligo patches. We aimed to study the combination of these two modalities for the treatment of vitiligo. AIMS AND OBJECTIVE The aim of this study was to compare the efficacy and safety of FCO(2) laser with PRP and FCO(2) laser alone as an adjuvant therapy in stable non-segmental vitiligo (NSV) patients. SETTINGS AND DESIGN A prospective, randomized, comparative, open-label interventional study was carried out for a period of 18 months from December 2017 to June 2019, at a tertiary care hospital. MATERIALS AND METHODS Seventy patients with stable, NSV were assessed for eligibility; 66 patients were randomized equally into two groups. Group A received treatment with FCO(2) laser with intralesional PRP, whereas Group B was treated with FCO(2) laser alone. Patients in both the groups were treated with one therapy session and were followed up monthly for a period of 3 months. All the patients received topical psoralen with ultraviolet A (UVA) PUVA-sol treatment. Baseline and monthly assessments were done by VITILIGO AREA SEVERITY INDEX and standardized photographs. RESULTS VASI score reduction was significantly more in the Group A with (mean ± standard deviation [SD]) 9.5 ± 0.22, 5.8 ± 1.12, and 3.6 ± 1.81 as compared to Group B 11.9 ± 2.83, 9.9 ± 3.11, and 8.9 ± 3.46 at each subsequent follow-up visits, respectively. Side effects such as burning sensation, erythema, and crusting were seen less frequently and lasted for a short period in Group A in comparison to those in Group B. CONCLUSION Combination of FCO(2) laser and autologous intralesional PRP has a synergetic effect in treating patients with vitiligo as an adjuvant therapy with minimal adverse effects.
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8.
Platelet rich plasma is a promising therapy for melasma
Tuknayat A, Bhalla M, Pal Thami G
Journal of cosmetic dermatology. 2021
Abstract
Platelet rich plasma (PRP) is an autologous blood product which has recently been used in multiple spheres of dermatology including facial rejuvenation, androgenetic alopecia, acne scars and wound healing. Its use in melasma is comparatively an understudied topic. PRP contains about 30 growth factors, transforming growth factor beta (TGF-β) being one of the growth factors having a predominant role in treatment of melasma. TGF-β decreases signal transduction of microphthalmia induced transcription factor and thus decreases tyrosinase and tyrosinase related proteins. In addition to this, PRP also has an additional benefit of inducing collagen synthesis thus improving the quality and texture of the skin. An extensive systematic literature search of the PubMed electronic database and Cochrane central register of controlled trials was done using the keywords 'platelet rich plasma' and 'melasma' in the title. Relevant studies were selected and data was analysed by two different authors. These studies showed that PRP has been used effectively not only as an adjuvant therapy but also as a standalone treatment for melasma. But there is a scarcity of data and large randomized controlled trials. The relevant references of the included articles were also traced and included. This review is an effort to highlight and upscale the use of this excellent blood product for melasma which is quite a treatment refractory disorder.
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9.
A Systematic Review of Fibrin Glue as an Ideal Treatment for the Pilonidal Disease
Win M, Went TR, Ruo SW, Kannan A, Dominic JL, Sultan W, Kantamaneni K, Yanamala VL, Tara A, Elshaikh AO
Cureus. 2021;13(8):e16831
Abstract
Pilonidal sinus is an acquired condition caused by irritation to the hair follicles at the natal cleft, presenting with an abscess or chronic infection. It is prevalent in young adults affecting their productive lifestyle with morbidities. There are varieties of treatment options; however, there is no consensus yet for the ideal procedure. Less invasive procedures have evolved to replace the traditional surgical techniques, which cannot significantly reduce the risks of recurrence and wound complications despite extensive surgeries. We aimed to assess the effect of fibrin glue as a primary treatment after cleaning the sinus in pilonidal sinus disease. We searched for articles from PubMed®, Ovid MEDLINE®, Ovid EMBASE®, and Cochrane CENTRAL. Six studies that included 336 patients in total were analyzed. Fibrin glue treatment in these studies reported a quicker return to normal activities postoperatively, a low rate of infection, and an acceptable rate of recurrence. Thus, fibrin glue seems beneficial in the management of pilonidal disease. However, further high-quality studies are essential to support and confirm this evidence. Future research should also evaluate its cost and implications in the ambulatory service.
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10.
Comparison of the Efficacy of Fractional Radiofrequency Microneedling alone and in combination with platelet rich plasma in neck rejuvenation a clinical and optical coherence tomography study
Gawdat H, Allam Rshm, Hegazy R, Sameh B, Ragab N
Journal of cosmetic dermatology. 2021
Abstract
BACKGROUND Aesthetic improvement of the neck and cervicomental angle remains one of the most challenging aspects of rejuvenation. Fractional radiofrequency microneedling demonstrated significant skin tightening and lifting of lower third of the face. AIM OF WORK To evaluate and compare fractional radiofrequency microneedling alone and in combination with autologous platelet rich plasma (PRP) in neck rejuvenation. METHODS 20 patients with mild to moderate neck laxity were randomized to receive 3 sessions of either fractional radiofrequency microneedling + PRP (group A) or fractional radiofrequency microneedling monotherapy (group B). Evaluation was done using optical coherence tomographgy to detect dermis thickness, measurement of cervicomental angle, a score done by two investigators blinded to used modality (GAIS) and patient satisfaction score. RESULTS Both Groups showed a statistically significant improvement in all parameters. Comparing the two groups the mean dermal thickness after treatment was higher in group A compared to B but was found statistically insignificant. More favorable results were reported in group A according to GAIS. Other parameters showed comparable results. CONCLUSION Fractional micro-needle radiofrequency with insulated microneedles offers a safe and effective modality for mild to moderate neck laxity when used alone or in combination with PRP. It remains questionable whether combining fr-RF microneedling with PRP provides more favorable results in terms of efficacy and side effects.
