Abstract
Background and Objectives
Platelet-rich plasma (PRP) has received growing attention as a valuable therapeutic tool in androgenetic alopecia (AGA). However, knowledge regarding specific effectiveness and satisfaction of PRP for different grades of AGA in male pattern hair loss (MPHL) and female pattern hair loss (FPHL) is missing. This study aims to ascertain and compare the efficacy and safety of PRP treatment for different grades of AGA in males and females over 6 months.
Methods
In this study, 51 MPHL patients with Norwood-Hamilton stage II-V and 42 FPHL patients with Ludwig stage I to III were enrolled for 6 monthly sessions of PRP injections. A longitudinal analysis was used to compare the hair density, thickness, and hair pull test over 6 months for MPHL and FPHL through generalized estimating equation (GEE) models. Phototrichograms of scalp inflammation and oil secretion, global photographs and overall patient satisfaction were also assessed.
Results
Consequently, improvement of hair density, hair thickness, hair pull test, the level of scalp inflammation and oil secretion were observed with statistical significance in all stages for both MPHL and FPHL at 6 months. Noteworthy, lower level of alopecia (Grade II, III in MPHL and Grade I in FPHL) had better response to PRP, and also had a better tendency of increment of hair growth than that of high-grade patients with prolonged treatment.
Conclusions
PRP injections, as an efficacious and reliable therapy, can be recommended for Grade II and Grade III in MPHL and Grade I in FPHL.
Similar content being viewed by others
References
Varothai S, Bergfeld WF. Androgenetic alopecia: an evidence-based treatment update. Am J Clin Dermatol. 2014;15(3):217–30.
Hamilton JB. Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci. 1951;53(3):708–28.
Whiting DA. Possible mechanisms of miniaturization during androgenetic alopecia or pattern hair loss. J Am Acad Dermatol. 2001;45(3):S81–6.
Heilmann S, Kiefer AK, Fricker N, Drichel D, Hillmer AM, Herold C, et al. Androgenetic alopecia: identification of four genetic risk loci and evidence for the contribution of WNT signaling to its etiology. J Invest Dermatol. 2013;133(6):1489–96.
Prodi DA, Pirastu N, Maninchedda G, Sassu A, Picciau A, Palmas MA, et al. EDA2R is associated with androgenetic alopecia. J Invest Dermatol. 2008;128(9):2268–70.
Miao Y, Qu Q, Jiang W, Liu XM, Shi PL, Fan ZX, et al. Identification of functional patterns of androgenetic alopecia using transcriptome profiling in distinct locations of hair follicles. J Invest Dermatol 2017.
Tabolli S, Sampogna F, di Pietro C, Mannooranparampil TJ, Ribuffo M, Abeni D. Health status, coping strategies, and alexithymia in subjects with androgenetic alopecia: a questionnaire study. Am J Clin Dermatol. 2013;14(2):139–45.
Bater KL, Ishii M, Joseph A, Su P, Nellis J, Ishii LE. Perception of hair transplant for androgenetic alopecia. JAMA Facial Plast Surg. 2016;18(6):413–8.
Friedman ES, Friedman PM, Cohen DE, Washenik K. Allergic contact dermatitis to topical minoxidil solution: etiology and treatment. J Am Acad Dermatol. 2002;46(2):309–12.
Traish AM, Mulgaonkar A, Giordano N. The dark side of 5alpha-reductase inhibitors’ therapy: sexual dysfunction, high Gleason grade prostate cancer and depression. Korean J Urol. 2014;55(6):367–79.
Li ZJ, Choi H, Choi D, Sohn K, Im M, Seo Y, et al. Autologous platelet-rich plasma a potential therapeutic tool for promoting hair growth. Dermatol Surg. 2012;38(71):1040–6.
Badran KW, Sand JP. Platelet-rich plasma for hair loss: review of methods and results. Facial Plast Surg Clin North Am. 2018;26(4):469–85.
Uebel CO, Da SJ, Cantarelli D, Martins P. The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg. 2006;118(6):1458–66.
Tomita Y, Akiyama M, Shimizu H. PDGF isoforms induce and maintain anagen phase of murine hair follicles. J Dermatol Sci. 2006;43(2):105–15.
Takakura N, Yoshida H, Kunisada T, Nishikawa S, Nishikawa SI. Involvement of platelet-derived growth factor receptor-alpha in hair canal formation. J Invest Dermatol. 1996;107(5):770–7.
Li J, Yang Z, Li Z, Gu L, Wang Y, Sung C. Exogenous IGF-1 promotes hair growth by stimulating cell proliferation and down regulating TGF-beta1 in C57BL/6 mice in vivo. Growth Horm IGF Res. 2014;24(2–3):89–94.
Panchaprateep R, Asawanonda P. Insulin-like growth factor-1 roles in androgenetic alopecia. Exp Dermatol. 2014;23(3):216–8.
Su HY, Hickford JG, The PH, Hill AM, Frampton CM, Bickerstaffe R. Increased vibrissa growth in transgenic mice expressing insulin-like growth factor 1. J Invest Dermatol. 1999;112(2):245–8.
Chew EG, Tan JH, Bahta AW, Ho BS, Liu X, Lim TC, et al. Differential expression between human dermal papilla cells from balding and non-balding scalps reveals new candidate genes for androgenetic alopecia. J Invest Dermatol. 2016 2016-04-06.
Gupta AK, Carviel J. A Mechanistic model of platelet-rich plasma treatment for androgenetic alopecia. Dermatol Surg. 2016;42(12):1335–9.
Cervelli V, Garcovich S, Bielli A, Cervelli G, Curcio BC, Scioli MG, et al. The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss clinical and histomorphometric evaluation. Biomed Res Int. 2014;760:709.
El-Sharkawy H, Kantarci A, Deady J, Hasturk H, Liu H, Alshahat M, et al. Platelet-rich plasma: growth factors and pro- and anti-inflammatory properties. J Periodontol. 2007;78(4):661–9.
Michel L, Reygagne P, Benech P, Jean-Louis F, Scalvino S, Ly KSS, et al. Study of gene expression alteration in male androgenetic alopecia: evidence of predominant molecular signaling pathways. Br J Dermatol. 2017 2017-04-12.
Anitua E, Pino A, Martinez N, Orive G, Berridi D. The effect of plasma rich in growth factors on pattern hair loss: a pilot study. Dermatol Surg. 2017;43(5):658–70.
Kang JS, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34 + cell-containing autologous platelet-rich plasma injection on pattern hair loss a preliminary study. J Eur Acad Dermatol Venereol. 2014;28(1):72–9.
Kure K, Isago T, Hirayama T. Changes in the sebaceous gland in patients with male pattern hair loss (androgenic alopecia). J Cosmet Dermatol. 2015;14(3):178–84.
Lattanand A, Johnson WC. Male pattern alopecia a histopathologic and histochemical study. J Cutan Pathol. 1975;2(2):58–70.
Leiros GJ, Attorresi AI, Balana ME. Hair follicle stem cell differentiation is inhibited through cross-talk between Wnt/beta-catenin and androgen signalling in dermal papilla cells from patients with androgenetic alopecia. Br J Dermatol. 2012;166(5):1035–42.
Kretzschmar K, Cottle DL, Schweiger PJ, Watt FM. The androgen receptor antagonizes wnt/beta-catenin signaling in epidermal stem cells. J Invest Dermatol. 2015;135(11):2753–63.
Gentile P, Garcovich S, Scioli MG, Bielli A, Orlandi A, Cervelli V. Mechanical and controlled prp injections in patients affected by androgenetic alopecia. J Vis Exp. 2018.
Gkini MA, Kouskoukis AE, Tripsianis G, Rigopoulos D, Kouskoukis K. Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through a 1-year period. J Cutan Aesthet Surg. 2014;7(4):213–9.
Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014;40(9):1010–9.
Mapar MA, Shahriari S, Haghighizadeh MH. Efficacy of platelet-rich plasma in the treatment of androgenetic (male-patterned) alopecia: a pilot randomized controlled trial. J Cosmet Laser Ther. 2016;18(8):452–5.
Puig CJ, Reese R, Peters M. Double-Blind, placebo-controlled pilot study on the use of platelet-rich plasma in women with female androgenetic alopecia. Dermatol Surg. 2016;42(11):1243–7.
Ince B, Yildirim M, Dadaci M, Avunduk MC, Savaci N (2017) Comparison of the efficacy of homologous and autologous platelet-rich plasma (PRP) for treating androgenic alopecia. Aesthetic Plast Surg.
Starace M, Alessandrini A, D’Acunto C, Melandri D, Bruni F, Patrizi A, et al. Platelet-rich plasma on female androgenetic alopecia: tested on 10 patients. J Cosmet Dermatol 2018.
Hausauer AK, Jones DH. Evaluating the efficacy of different platelet-rich plasma regimens for management of androgenetic alopecia: a single-center, blinded, randomized clinical trial. Dermatol Surg. 2018;44(9):1191–200.
Gkini MA, Kouskoukis AE, Tripsianis G, Rigopoulos D, Kouskoukis K. Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period. J Cutan Aesthet Surg. 2014;7(4):213–9.
Schiavone G, Paradisi A, Ricci F, Abeni D. Injectable platelet-, leukocyte-, and fibrin-rich plasma (iL-PRF) in the management of androgenetic alopecia. Dermatol Surg. 2018;44(9):1183–90.
Torkamani N, Rufaut NW, Jones L, Sinclair R. Destruction of the arrector pili muscle and fat infiltration in androgenic alopecia. Br J Dermatol. 2014;170(6):1291–8.
Sinclair R, Torkamani N, Jones L. Androgenetic alopecia: new insights into the pathogenesis and mechanism of hair loss. F1000Res. 2015;1000:585.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Funding
This study was funded by the followings: Natural Science Foundation of China (Grant no. 81471900, no. 81772104, no. 81701929), the Natural Science Foundation of Guangdong Province (Grant no. 2015A030311001, no. 2017A030310120), Science and Technology Program of Guangzhou (Grant no. 201508020262).
Conflict of interest
The authors declare that they have no competing interests.
Ethical approval
All contents in this study were adhered to the tenets of the Declaration of Helsinki. The protocol and informed consent documentation were reviewed and approved by Southern Medical University Ethical Committee (Guangzhou, China).
Informed consent
Informed consents were obtained from all participants included in the trial.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Qu, Q., Shi, P., Yi, Y. et al. Efficacy of Platelet-rich Plasma for Treating Androgenic Alopecia of Varying Grades. Clin Drug Investig 39, 865–872 (2019). https://doi.org/10.1007/s40261-019-00806-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40261-019-00806-4