Alopecia Areata Treatment Birmingham and Solihull
Alopecia areata (AA) is a common chronic hair loss disorder, predisposed by inflammation and stress that causes non-cicatricial hair loss of scalp or body. Alopecia areata varies in severity from small patches of hair loss, to complete alopecia where chances of regrowth are poor. small patches, tend to spontaneously recover whereas larger patches have more difficulty. It is an autoimmune condition whereby T-cells tigger environmental factors. Alopecia areata is also associated with autoimmune diseases such as thyroid disease, diabetes, lupus erythematosus, vitiligo, and psoriasis, and also has no sex differentiation.
A definitive cure or preventive treatment is yet to be established. In some cases treatment can be challenging as none of the available therapies ’cure’. Most immunosuppressive therapies are generally not recommended for a first port of call. injections of steroids are commonly used in the treatment of adults. Finding new options for this condition is of utmost importance as it severely impacts the quality of life, especially in young individuals. Autologous platelet-rich plasma (PRP) has emerged as a new modality of treatment, and it has been shown on numerous cases to have a beneficial role in hair regrowth. PRP is a high platelet concentrate into a small volume of plasma. It has growth-promoting, immunomodulatory, and anti-inflammatory effects and can be a simple yet effective modality for the treatment of AA. Furthermore, steroid carrie unwanted side effects that PRP simply does not.
PRP has been explored in the treatment of hair disorders and is a potential therapeutic tool for AA. It is an effective high concentration of bio-active protein growth factors by virtue of platelets. These growth factors stimulate proliferation and differentiation of stem cells in hair follicle. Furthermore, growth factors from PRP has an important role in anagen-associated angiogenesis, which is the stimulation of new blood vessels. In addition, Li et al., that observed that PRP-treated dermal papilla cells had increased levels of protein kinase B and phosphorylated extracellular signal regulated kinase (ERK). ERK pathway promotes cell growth, whereas protein kinase B pathway increases cell survival and decreases cell death. PRP is also associated with prolongation of the anagen phase of cell cycle. Another study found significantly higher levels of Ki 67, a marker of cellular proliferation in hair treated with PRP. Anti-inflammatory effects of PRP suppress the release of cytokines and reduce tissue inflammation. It is probable that the anti-inflammatory effects may be beneficial in AA.
Kauret al., in their study on patients of AA observed more than 50% regrowth in 67.5% of patients treated with intralesional steroid at the end of 12 weeks. Amirniaet al., administered intralesional steroid in 120 patients of AA. Patients were treated with intralesional triamcinolone acetonide for four sessions with an interval of 3 weeks. It was noted that there was 60%–90% regrowth in 26.7% of patients at the end of 12 weeks. Singh., in their prospective study on 20 patients of biopsy-proven AA also reported successful treatment with PRP. All the patients received six sessions of PRP at 4-week intervals. Kumaret al., in their study on the role of PRP in AA observed a significant difference in mean score after intralesional PRP treatment. A statistically significant difference in the distribution of scores at each visit with respect to baseline in patients treated with intralesional injection of PRP was observed. Trinket al., evaluated the use of PRP for AA by a double-blind, split-scalp study and noted that PRP increased hair regrowth significantly and decreased hair death and burning or itching sensation compared with steroid or placebo.
Shumezet al., allocated 74 patients of AA into two groups, 48 patients were treated with triamcinolone injections and 26 patients were treated with PRP injections at 3-week intervals each with a follow-up at 3 months. At the end of 3 weeks, the comparison of overall improvement between the two groups was not significant. A higher percentage of complete resolution was observed in the PRP group at the 6th week. Also, all their patients achieved complete regrowth of hair at the end of 9th week and 3 months in both the groups. Skin thinning was noted in patients treated with steroid at the end of 12 weeks. None of the patients in the PRP group developed this side effect.
Both steroid and PRP are safe and efficacious in AA but response with PRP holds less side-effects and his better long-term. PRP is a relatively new modality in the treatment of alopecia, with scientific evidence that he is continuing to grow. Furthermore, research can be improved with better quality of PRP via improve preparation and standardisation.
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