Platelet-rich plasma (PRP) has emerged as a new treatment modality in regenerative plastic surgery, and preliminary evidence suggests that it might have a beneficial role in hair regrowth. Here, we report the results of a randomized, evaluator-blinded, placebo-controlled, half-head group study to compare, with the aid of computerized trichograms, hair regrowth with PRP versus placebo. The safety and clinical efficacy of autologous PRP injections for pattern hair loss were investigated. PRP, prepared from a small volume of blood, was injected on half of the selected patients’ scalps with pattern hair loss. The other half was treated with placebo. Three treatments were administered to each patient at 30-day intervals. The endpoints were hair regrowth, hair dystrophy as measured by dermoscopy, burning or itching sensation, and cell proliferation as measured by Ki67 evaluation. Patients were followed for 2 years. Of the 23 patients enrolled, 3 were excluded. At the end of the 3 treatment cycles, the patients presented clinical improvement in the mean number of hairs, with a mean increase of 33.6 hairs in the target area, and a mean increase in total hair density of 45.9 hairs per cm2 compared with baseline values. No side effects were noted during treatment. Microscopic evaluation showed the increase of epidermis thickness and of the number of hair follicles 2 weeks after the last PRP treatment compared with baseline value (p < .05). We also observed an increase of Ki67+ keratinocytes in the epidermis and of hair follicular bulge cells, and a slight increase of small blood vessels around hair follicles in the treated skin compared with baseline (p < .05). Relapse of androgenic alopecia was not evaluated in all patients until 12 months after the last treatment. After 12 months, 4 patients reported progressive hair loss; this was more evident 16 months after the last treatment. Those four patients were re-treated. Our data clearly highlight the positive effects of PRP injections on male pattern hair loss and absence of major side effects. PRP may serve as a safe and effective treatment option against hair loss; more extensive controlled studies are needed.

https://stemcellsjournals.onlinelibrary.wiley.com/doi/pdf/10.5966/sctm.2015-0107

The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial

Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80% Caucasian men and 42% of women. Patients afflicted with androgenetic alopecia may undergo significant impairment of quality of life. The European Dermatology Forum (EDF) initiated a project to develop evidence-based guidelines for the treatment of androgenetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.

https://www.onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.14624

Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men - short version.

BACKGROUNDPlatelet-rich plasma (PRP) was identified as having a beneficial effect in alopecia and has been postulated as a new therapy for androgenetic alopecia (AGA).OBJECTIVETo assess the efficacy of PRP for the treatment of AGA.MATERIALS AND METHODSThis was a randomized, placebo-controlled, doubl

Randomized Placebo-Controlled, Double-Blind, Half-Head Study to Assess the Efficacy of Platelet-Rich Plasma on the Treatment of Androgenetic Alopecia.

The use of stem cells has been reported to improve hair regrowth in several therapeutic strategies, including reversing the pathological mechanisms, that contribute to hair loss, regeneration of hair follicles, or creating hair using the tissue-engineering approach. Although various promising stem cell approaches are progressing via pre-clinical models to clinical trials, intraoperative stem cell treatments with a one-step procedure offer a quicker result by incorporating an autologous cell source without manipulation, which may be injected by surgeons through a well-established clinical practice. Many authors have concentrated on adipose-derived stromal vascular cells due to their ability to separate into numerous cell genealogies, platelet-rich plasma for its ability to enhance cell multiplication and neo-angiogenesis, as well as human follicle mesenchymal stem cells. In this paper, the significant improvements in intraoperative stem cell approaches, from in vivo models to clinical investigations, are reviewed. The potential regenerative instruments and functions of various cell populaces in the hair regrowth process are discussed. The addition of Wnt signaling in dermal papilla cells is considered a key factor in stimulating hair growth. Mesenchymal stem cell-derived signaling and growth factors obtained by platelets influence hair growth through cellular proliferation to prolong the anagen phase (FGF-7), induce cell growth (ERK activation), stimulate hair follicle development (β-catenin), and suppress apoptotic cues (Bcl-2 release and Akt activation).

Advances in Regenerative Stem Cell Therapy in Androgenic Alopecia and Hair Loss: Wnt pathway, Growth-Factor, and Mesenchymal Stem Cell Signaling Impact Analysis on Cell Growth and Hair Follicle Development.

Platelet rich plasma (PRP) was tested as a potential therapy for androgenetic alopecia (AGA) through two different clinical protocols in which one population (18 participants) received half-head treatment with autologous non-activated PRP (A-PRP) produced by CPunT Preparation System (Biomed Device, Modena, Italy) and the other half-head with placebo, and a second separated population in which all participants (n = 6, 3 participants per group) received treatment with calcium-activated PRP (AA-PRP) produced from one of two different PRP collection devices (Regen Blood Cell Therapy or Arthrex Angel System). For the A-PRP study, three treatments were administered over 30-day intervals. Trichoscan analysis of patients, three months post-treatment, showed a clinical improvement in the number of hairs in the target area (36 ± 3 hairs) and in total hair density (65± 5 hair cm2), whereas negligible improvements in hair count (1.1± 1.4 hairs) and density (1.9 ± 10.2 hair cm2) were seen in the region of the scalp that received placebo. Microscopic evaluation conducted two weeks after treatment showed also an increase in epidermal thickness, Ki67+ keratinocytes, and in the number of follicles. The AA-PRP treatment groups received a singular set of injections, and six months after the treatments were administered, notable differences in clinical outcomes were obtained from the two PRP collection devices (+90 ± 6 hair cm2 versus -73 ± 30 hair cm2 hair densities, Regen versus Arthrex). Growth factor concentrations in AA-PRP prepared from the two collection devices did not differ significantly upon calcium activation.

Evaluation of Not-Activated and Activated PRP in Hair Loss Treatment: Role of Growth Factor and Cytokine Concentrations Obtained by Different Collection Systems.

Background: Platelet-rich plasma (PRP) is defined as an autologous concentration of plasma with a greater count of platelets than that of whole blood. Its action depends on the released growth factors from platelets. It has been investigated and used in numerous fields of medicine. Recently, PRP has received growing attention as a potential therapeutic tool for hair loss. Aims: To evaluate the efficacy and safety of PRP injections in the scalp of patients with androgenetic alopecia. Settings and Design: Prospective cohort study. Materials and Methods: 20 patients, 18 males and 2 females, with androgenetic alopecia were enrolled in the study. PRP was prepared using a single spin method (Regenlab SA). Upon activation, it was injected in the androgen-related areas of scalp. Three treatment sessions were performed with an interval of 21 days and a booster session at 6 months following the onset of therapy. Statistical Analysis: Statistical analysis of the data was performed using the Statistical Package for the Social Sciences (SPSS), version 19.0 (IBM, NY, USA). Results: Hair loss reduced and at 3 months it reached normal levels. Hair density reached a peak at 3 months (170.70 ± 37.81, P < 0.001). At 6 months and at 1 year, it was significantly increased, 156.25 ± 37.75 (P < 0.001) and 153.70 ± 39.92 (P < 0.001) respectively, comparing to baseline. Patients were satisfied with a mean result rating of 7.1 on a scale of 1-10. No remarkable adverse effects were noted. Conclusions: Our data suggest that PRP injections may have a positive therapeutic effect on male and female pattern hair loss without remarkable major side effects. Further studies are needed to confirm its efficacy.

Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period

Variation in management of porocarcinoma: a 10-year retrospective review of 75 cases across three UK tertiary centres.


 Alopecia areata (AA) is an autoimmune condition that targets the hair follicles, causing nonscarring hair loss. It can manifest with different patterns, ranging from discrete bald patches on the scalp to complete loss of body hairs. Despite being considered a disease of purely aesthetic concern, recent data support its systemic nature. In June 2022, baricitinib, an oral selective inhibitor of Janus kinases 1 and 2, was the first US Food and Drug Administration-approved systemic treatment for adult patients with severe AA. Our objective was to present the efficacy and safety of baricitinib in the management of adult patients with severe AA in real practice at 24 weeks. All consecutive adult patients diagnosed with severe AA, who were started on baricitinib in our specialist hair clinic, and completed 24 weeks of treatment were eligible. Access to baricitinib was granted after approval by the national organization for the provision of health services on a case-by-case basis. Demographic data, disease history, previous treatments for AA and comorbidities were documented. Severity of Alopecia Tool (SALT) score, loss of eyebrows/eyelashes, hair loss in other parts of the body and nail involvement were also assessed. Patients completed the Dermatology Life Quality Index (DLQI), Patient Health Questionnaire (PHQ)-9 and Generalised Anxiety Disorder Assessment (GAD-7) at each visit. Safety profile was also assessed. Visits were performed at T1 (4 weeks), T2 (8 weeks), T3 (12 weeks) and T4 (24 weeks). Ten patients were included in the analysis. The male-to-female ratio was 3 : 2. Mean patient age was 34.8 years. All were White. Sixty per cent of patients had alopecia universalis/totalis, 30% had ophiasis and 10% had patchy alopecia. Mean disease duration was 6.1 years. The most common comorbidities were depression and anxiety. Baseline mean SALT score was 82, which decreased significantly at weeks 8, 12 and 24. Ninety per cent had eyebrow/eyelash regrowth. Patients with more recent disease onset responded quicker than those with a more chronic disease course. Nail involvement was noted in 30% of patients, which improved in all of them at week 24. There was a significant decrease in PHQ-9, GAD-7 and DLQI scores at weeks 8, 12 and 24. Forty per cent of patients developed an acneiform rash, 30% an upper respiratory infection, 10% a vaginal infection, 40% transient raised creatine kinase, 20% dyslipidaemia and 20% transient neutropenia and anaemia. Our real-world data showed a quick onset of action for baricitinib and encouraging results in terms of efficacy at week 24. Safety profile was acceptable, with many of the adverse events being transient and not requiring treatment. No severe adverse events were noted. Studies with a larger number of patients and longer duration of treatment are needed to assess the long-term efficacy and safety of baricitinib in everyday clinical practice. Finally, national registries for patients with AA could play a crucial role.

/pdf/bh15-efficacy-and-safety-of-baricitinib-in-the-management-of-sebw2b1m.pdf

Maria-Angeliki Gkini

Papers

Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period

Variation in management of porocarcinoma: a 10-year retrospective review of 75 cases across three UK tertiary centres.

BH15 Efficacy and safety of baricitinib in the management of severe alopecia areata over a 6-month period: a real-world experience