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Platelet Rich Plasma Combination Therapies for Treatment of Androgenetic Alopecia: A Systematic Review
Kaiser, M. A., Ferrari, L. M., Gaumond, S. I., Issa, N., Jimenez, J. J., Issa, N. T.
Journal of cutaneous and aesthetic surgery. 2023;16(3):169-177
Abstract
Androgenetic alopecia (AGA) is the most common cause of alopecia in males and females. Minoxidil and finasteride are the only FDA-approved treatments for AGA. New treatments including Platelet Rich Plasma (PRP) and microneedling have shown promising results. The purpose of this literature review was to highlight recent studies examining the effects of topical minoxidil combined with PRP to minoxidil or PRP monotherapy. The method used for this paper includes a systematic review of the literature from 2010 to 2022 using the PubMed, EMBASE, and MEDLINE databases examining studies evaluating combination therapies for AGA. Three randomized control trials compared combination PRP + topical 5% minoxidil to either no treatment, 5% minoxidil, or PRP only. Two studies found increased hair growth at five months and at six months following combined therapy. Another study found an increase in hair density and improved patient satisfaction with combination therapy compared to monotherapy. A prospective study revealed that patients treated with combined 5% minoxidil, PRP, and microneedling reported the highest patient and physician satisfaction compared to minoxidil monotherapy. An observational study evaluating topical 5% minoxidil with PRP reported an increase in hair diameter after one year of combination treatment compared to minoxidil monotherapy. PRP therapy combined with minoxidil and microneedling in a retrospective study was shown to increase hair growth compared to PRP with minoxidil as well as PRP or minoxidil monotherapy. In conclusion, a variety of studies demonstrated superior treatment response with a combination of PRP and minoxidil therapy in patients with AGA. Limitations to this study include different PRP preparation protocols, few randomized control studies, and small sample sizes.
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Platelet rich plasma use for treatment of acne scars: an overview of systematic reviews
Cruciani, M., Masiello, F., Pati, I., Pupella, S., De Angelis, V.
Blood transfusion = Trasfusione del sangue. 2023
Abstract
BACKGROUND A reappraisal of the conclusions of systematic reviews (SRs) and meta-analyses validity related to Platelet-rich plasma (PRP), alone or in combination with other treatments, compared to regimens PRP-free for the treatment of acne scars. MATERIALS AND METHODS An overview of SRs. The methodological quality of the reviews was assessed using AMSTAR-2 checklist; quality of the evidence of primary studies was appraised following the GRADE approach. RESULTS Fifteen SRs were included in this overview. Data were from 124 overlapping reports, based on 34 individual primary studies (10 parallel arm randomized trials, 21 split-face studies, and 3 uncontrolled studies). Most of the studies evaluated combination of PRP with microneedling or with laser therapy compared to microneedling or laser therapy without PRP. Clinical improvement (reported as degree of improvement or improvement score) and patient's satisfaction rate were significantly higher in PRP recipients compared to controls. Crusting time and duration of erythema were significantly shorter in PRP recipients compared to controls. Most of the reviews considered in this overview can be considered of low methodological quality due to the fact that several critical methodological requirements of AMSTAR-2 checklist were unmet or partially met; only 6 of the 15 reviews incorporated study quality in their conclusions, and no GRADE assessment was performed for the reported outcomes in any of the SRs. With the GRADE approach, the quality of the evidence for the outcomes analysed ranged from very low to low due to risk of bias in the primary studies, inconsistency between the studies, and imprecision. DISCUSSION The low or very low certainty of evidence does not support clear clinical decision about the PRP use in combination with microneedling or laser therapy for the treatment of acne scars. Further well-designed studies are required to improve the evidence base for PRP combination therapy for acne scars.
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3.
Effect of Platelet-Rich Plasma and other Key Factors on Hair Follicle Preservation
Thuangtong, R., Chaweekulrat, P., Thanomkitti, K., Triwongwaranat, D., Rujitharanawong, C.
International journal of trichology. 2023;15(2):50-55
Abstract
BACKGROUND Hair graft preservation is an important factor that influences graft survival in hair transplantation. OBJECTIVE To investigate the benefits of adding platelet-rich plasma (PRP), and the effect of different storage solutions and temperatures on hair follicle preservation. MATERIALS AND METHODS This randomized-controlled study included 10 androgenetic alopecia patients who underwent hair transplantation. Forty-five hair grafts were collected from each patient and then randomized to 8 different culture conditions for 7 days. Hair grafts were cultured in Williams' Medium E or Ringer's lactate solution (RLS) at either 4°C or 37°C, and with or without 10% PRP supplementation. RESULTS In vitro hair growth in Williams' Medium E was significantly greater than in RLS. The 37°C temperature condition was found to be significantly better than the 4°C condition. The growth of hair grafts cultured with PRP was not significance difference from those without PRP. However, immunofluorescence staining for cytokeratin 15 showed greater expression in hair graft cultured with PRP. CONCLUSION PRP may have a beneficial effect for preserving the viability of hair grafts. Williams' Medium E and 37°C temperature were found to be superior to RLS and 4°C relative to hair follicle growth in organ culture.
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Effect of platelet counts and activator in platelet-rich plasma on the treatment of androgenetic alopecia, split-head comparison: A randomised, double-blind study
Singh SK, Singh S
Indian journal of dermatology, venereology and leprology. 2023;:1-9
Abstract
Background Androgenetic alopecia is a common, chronic, non-scarring alopecia. It is characterised by stepwise miniaturisation of the hair follicles, due to alteration in the hair cycle dynamics, leading to the transformation of terminal hair follicles into a vellus ones. Oral finasteride and topical minoxidil are the only approved drugs for treating this condition. Due to a limited number of effective therapies for androgenetic alopecia, platelet-rich plasma may be an effective alternative treatment. Aims To study the effect of activator in platelet-rich plasma and baseline platelet count in platelet-rich plasma on the treatment of androgenetic alopecia. Methods A randomised, double-blind split-head comparative study. The sample size was calculated and randomisation was done. Patients with androgenetic alopecia were allocated into two groups; in the first group, autologous activated platelet-rich plasma was injected in the right half of the affected scalp and autologous non-activated platelet-rich plasma was injected in the left half of the affected scalp and vice versa in the second group. Patients were also categorised on the basis of platelet counts in their platelet-rich plasma in three groups; group A (6-8 lakh/mm3), group B (8.1-10 lakh/mm3) and group C (>10 lakh/mm3). Interventions were done monthly for three months and followed up for the next three months. Effects of interventions were assessed by hair density, hair thickness, patient self-assessment and clinical photography. Results A total of 80 patients were included in the study. Activated platelet-rich plasma produced significant improvement of hair density after four months and hair thickness at 6 months. An increase in platelet count led to a significant increase in hair density and hair thickness after three and four months respectively and a highly significant increase in both parameters at the end of the study. Limitations Long-term follow-up of cases was not done and no measurement of vellus hair count was done. Conclusion There is a significant effect of activator and platelet count of the platelet-rich plasma on hair density as well as hair thickness.
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Comparing Single-spin Versus Double-spin Platelet-rich Plasma (PRP) Centrifugation Methods on Thrombocyte Count and Clinical Improvement of Androgenetic Alopecia: A Preliminary, Randomized, Double-blind Clinical Trial
Legiawati, L., Yusharyahya, S. N., Bernadette, I., Novianto, E., Priyanto, M. H., Gliselda, K. C., Iriyanty, S., Mutiara, R.
The Journal of clinical and aesthetic dermatology. 2023;16(12):39-44
Abstract
OBJECTIVE Platelet-rich plasma (PRP) is widely known as an alternative therapy for androgenetic alopecia (AGA); however, there is no standardized method for its preparation and application. This study aims to compare the thrombocyte count elevation and clinical AGA improvements between single- and double-spin PRP preparation methods. METHODS This preliminary, double-blind, randomized clinical trial included 30 male subjects with AGA aged 25 to 59 years with Hamilton-Norwood stages III to VI. Subjects were divided into a single-spin group (3,000rpm for 15 minutes) and a double-spin group (first spinning at 1,500rpm for 6 minutes, continuing at 2,500rpm for 15 minutes). The study was conducted for six weeks, with a two-week visit interval. Baseline and PRP thrombocyte counts were assessed on the initial appointment. A total of 1cc of PRP was intradermally injected into a 6×4cm predetermined area, administered at Weeks 0, 2, and 4. At every visit, clinical progress was assessed by overall hair appearance, photography, trichoscopy, and trichoscan. All subjects were instructed to use minoxidil twice daily during the study. This study has been registered at clinicaltrials.gov (ID No. NCT05681897). RESULTS Both groups increased thrombocyte counts by 4 to 5 times from their initial levels; however, the increase in the single-spin group was more significant. Significant improvements were observed in both groups, including hair density, hair rate, and hair count of anagen, telogen, vellus, and terminal hair. LIMITATIONS Limitations include lack of placebo or vehicle control. CONCLUSION Both PRP preparation methods significantly raise thrombocyte counts, substantially improve nearly all hair parameters, and have tremendous therapeutic promise for treating AGA. Clinicians may designate one of the two techniques.
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Systematic review: Impact of stem cells-based therapy, and platelet-rich plasma in hair loss and telogen effluvium related to COVID-19
Gentile, P., Garcovich, S.
Regenerative therapy. 2023;24:267-273
Abstract
BACKGROUND The incidence of hair loss (HL) and telogen effluvium (TE) in COVID-19 patients has been reported in several studies. OBJECTIVES Evaluate both the increased incidence of HL and TE in COVID-19 and the effectiveness of Platelet-Rich Plasma (PRP), Adipose-derived Mesenchymal Stem Cells (AD-MSCs), and Human Follicle Stem Cells (HFSCs) in these patients. METHODS The protocol was developed by the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. A multistep search of PubMed, MEDLINE, Embase, Clinicaltrials. gov, Scopus, and Cochrane databases has been performed to identify papers focusing on HL and TE COVID-19 related, and papers focusing on AD-MSCs, HFSC, and PRP use. RESULTS Of the 404 articles initially identified focusing on HL and TE, 44 were related to COVID-19, and finally, only 6 were analyzed. On the other way, 331 articles focusing on AD-MSCs, HFSC, and PRP were initially identified. Of these, only 6 articles PRP (n = 3), AD-MSCs, and HFSCs (n = 3) have been analyzed. CONCLUSION Collected data confirmed both an increased incidence of HL and TE in COVID-19 patients, preliminarily, the related effectiveness of AD-MSCs, HFSCs, and PRP without major side effects.
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Healing effects of autologous platelet gel and growth factors on cutaneous leishmaniasis wounds in addition to antimony; a self-controlled clinical trial with randomized lesion assignment
Shadmand, E., Solhjoo, K., Taghipour, A., Tayer, A. H., Sadeghi, F., Meshkin, A.
BMC research notes. 2023;16(1):200
Abstract
OBJECTIVE Autologous platelet gel (APG) is used in most surgeries to treat a variety of tissue defects because of its healing factors composition. This randomized parallel clinical trial was conducted to investigate the healing effects of APG on cutaneous leishmaniasis (CL) wounds. Eighteen male patients with CL wounds were recruited and followed for two months. The patients had more than one cutaneous wound, one of which was examined as the control and the other one as the intervention wound. APG was applied to the intervention wounds once a week, up to eight times. The primary endpoint was wound healing which defined as complete epithelialization and tissue granulation. Other clinical evaluation criteria were assessment of the wound size, and histopathology analyses. RESULTS Of 18 patients, 15 patients completed the trial (83.3%, mean age 28 years). The use of APG on the wounds was associated with complete and faster healing in 66% of the wounds and partial healing in 34% of the wounds. During the study, none of the control wounds were completely healed. The wound area in the intervention cases showed a statistically significant decrease throughout the study (P < 0.01) compared with controls. Following treatment of CL lesions with APG, the inflammatory process in the epidermis and dermis were decreased significantly (P < 0.01) compared with controls. CONCLUSION Our preliminary results confirm the clinical healing improvement described in the literature for APG-GF treatment of chronic non-leishmania wounds via immunomodulation. TRIAL REGISTRATION IRCT, IRCT20190212042694N1. Registered 20 February 2019, https://en.irct.ir/trial/37522.
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8.
Injections of platelet-rich plasma prepared by automatic blood cell separator combined with topical 5% minoxidil in the treatment of male androgenetic alopecia
Wei, W., Zhang, Y., Long, B., Zhang, Y., Zhang, C., Zhang, S.
Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI). 2023;29(7):e13315
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Abstract
BACKGROUND Platelet-rich plasma (PRP) has been increasingly accepted as a potential therapy in the treatment of androgenetic alopecia (AGA), However, there remains a dearth of data on the effectiveness of PRP prepared by automatic blood cell separator with a combination of topical minoxidil for the treatment of AGA. OBJECTIVE To evaluate the efficacy and safety of PRP prepared by automatic blood cell separator combined with topical 5% minoxidil therapy in male AGA. METHODS Thirty male patients with mild/moderate AGA were enrolled in a randomized double-blind controlled study. Patients were randomly divided into two treatment arms: (group A) PRP prepared by automatic blood cell separator combined with topical 5% minoxidil group; (group B) PRP prepared by automatic blood cell separator combined with a topical placebo group. Trichoscopic assessments regarding hair density/quantity and mean hair diameter were performed at baseline and follow-up. Clinical efficacy of global photography and patient satisfaction were conducted to verify the therapeutic efficacy of the treatment, and the occurrence of adverse reactions was recorded. RESULTS We detected a significant increase in all patients in hair density and quantity after PRP treatment (p < 0.05), and there was no significant difference in mean hair diameter. Although hair density/quantity was more pronounced in group A than in group B, the difference between groups was not statistically significant (p > 0.05). In terms of clinical efficacy and patient satisfaction, group A was superior to group B, and no serious adverse reactions occurred. CONCLUSION We hereby conclude that the injections of PRP prepared by an automated method are effective and safe in the treatment of mild-to-moderate male AGA patients, and its combination with topical 5% minoxidil therapy was superior to PRP monotherapy with better clinical efficacy and higher patient satisfaction.
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The use of platelet-rich plasma in wound healing and vitiligo: A systematic review and meta-analysis
Wang, Z., Feng, C., Chang, G., Liu, H., Li, S.
Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI). 2023;29(9):e13444
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Abstract
OBJECTIVE To critically assess the effect and safety of platelet-rich plasma (PRP) in chronic wounds and vitiligo. METHODS A systematic literature searching was performed. Results were expressed as weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. RESULTS A total of 27 studies were included in this meta-analysis. In patients with chronic diabetic ulcers, PRP significantly increased proportion of complete wound healing, percentage of wound area healed, and shortened the complete wound healing. In venous ulcers, PRP improved the epithelialized area and percentage of wound area healed. In vitiligo, PRP had better results in degree of improvement and mean repigmentation than controls. Regarding the safety profile, PRP did not increase the risk of infection in patients with chronic diabetic ulcers. Meta-regression revealed that source of PRP and preparation method of PRP significantly affected the proportion of complete wound healing, whereas age, gender, country, duration of wound, and wound size had no impact on this outcome. CONCLUSION PRP is effective and safe, and can be used as a potential therapeutic adjunct or alternative treatment in chronic wounds of multiple etiologies and vitiligo.
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Platelet-Rich Plasma for the Treatment of Plaque Psoriasis: A Systematic Review
Bunjaj, A., Brandao, L., Siracuse, K., Soti, V.
Cureus. 2023;15(12):e50356
Abstract
Psoriasis is a chronic and recurring condition characterized by scaly red plaques. The most common variant, plaque-type psoriasis, presents distinct clinical features. It profoundly impacts psychological and mental well-being, resulting in depression, anxiety, and suicidal thoughts. Psoriasis occurs due to disruptions in the skin's innate and adaptive immune response triggered by trauma, infection, or medications. Treatment options include topical therapies such as corticosteroids and vitamin D analogs, phototherapy, conventional systemic agents such as methotrexate (MTX), and biologics that target pro-inflammatory cytokines. There has been growing interest in platelet-rich plasma (PRP) as a potential treatment option for plaque psoriasis, given its lower toxicity compared to existing approaches. However, its use is not yet widespread in clinical practice due to the limited awareness of its effectiveness. This review aims to investigate the efficacy of PRP therapy for plaque psoriasis. To conduct a comprehensive analysis, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, thoroughly searching PubMed, Elton Bryson Stephens Company (EBSCO), and ClinicalTrials.gov between February and July 2023. Our focus was on patients diagnosed with plaque psoriasis, and we found multiple studies that demonstrated promising results of PRP either as monotherapy or in combination with current treatments such as MTX. The clinical evidence strongly supports the effectiveness of PRP in treating plaque psoriasis. PRP significantly improves dermatological symptoms and enhances patient and physician satisfaction. Research suggests that PRP reduces the expression of interleukin (IL) 17, a pro-inflammatory mediator, explaining its mechanism of action in treating plaque psoriasis. However, additional clinical trials with larger sample sizes, including PRP as a separate treatment group and comparisons with positive and control groups, are necessary to reinforce its efficacy in plaque psoriasis patients and elucidate other potential mechanisms underlying its beneficial effects.