How Effective is PRP Treatment for Hair Regrowth? A Review of the Evidence
PRP Treatment in Hair Regrowth
Platelet rich plasma (PRP) was first described in as a small volume of plasma containing a high concentration of platelets than normally found in whole blood. In modern clinical practice, PRP has become a popular treatment for many conditions in musculoskeletal medicine, sport medicine, orthopaedics, regenerative medicine, aesthetic medicine and hair loss treatment as it contains a large number of growth factors and cytokines that can accelerate tissue healing and tissue regeneration. Here at the Dynamic Clinic in Birmingham and Henley in Arden we have been providing this exciting treatment for several years and very keen to promote it success.
Despite its wide application and fantastic results in clinical practice, the mechanism underlying the hair regrowth effects of PRP remains to be fully understood. The recent 2022 review article aims to review the effectiveness of PRP for the treatment of hair loss including definition, classification, mechanism of action, clinical efficacy in hair regrowth, and adverse effects.
Controlled higher concentration of platelets that work too stimulate and facilitate tissue healing and regeneration. The effectiveness of stimulating tissue regeneration depends on the concentration of platelets present in the plasma. Research has shown that concentrations two to six times higher than normal platelet count is required for optimal outcomes.
Mechanism of Action
Many studies demonstrate that platelets have many immunomodulatory effects. Not only do they positively affect hemostatic regulation, but platelets also have positive impacts on modulating inflammation, promoting new blood vessel formation (angiogenesis), stem cell induction, and cell proliferation through the release of bioactive growth factors and cytokines.
Activated platelets in PRP release numerous growth factors and cytokines from alpha granules, including platelet-derived endothelial growth factor (PDGF), transforming growth factor β (TGF-β), fibroblast growth factor-2 (FGF-2), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insulin-like growth factor- 1 (IGF-1), glial cell line–derived neurotrophic factor (GDNF), which play major roles in stimulating hair growth through cell proliferation, differentiation and angiogenesis. GDNF stimulates cell proliferation and protects hair follicle from premature catagen transition. VEGF plays a major role as a potent hair growth stimulator via an angiogenesis which is a huge contributor within regenerative medicine. Furthermore, IGF-1 stimulates proliferation of cycling Ki67+ basal keratinocytes, which induce and prolong the anagen phase of the hair growth cycle.
In addition to the above, PRP induces the proliferation of dermal papilla cells by activating extracellular kinase, fibroblast growth factor, beta-catenin, and Akt signaling (an anti-apoptotic signaling molecule). There is also an increase in expression of Bcl-2 protein (an anti-apoptotic protein) in vitro human dermal papilla cells cultured with PRP. Here, it was clearly identified that PRP can increase the survival of hair follicle cells through anti-apoptotic effects and stimulate hair growth by extending the anagen phase of the hair cycle. This is also further supported by the analysis of microscopic examination demonstrating increases in number of follicular bulge cells, hair follicles, epidermal thickening, vascularisation, and a higher number of Ki67+ basal keratinocytes in PRP-treated scalp tissue compared with placebo.
Although PRP is a safe treatment with minimal side effects, there are some contraindications such as - thrombocytopenia (low platelet), platelet dysfunction, hemodynamic instability, sepsis, local infection. Other indications include - non use of NSAIDs use in 48 hours, glucocorticoid injection at treatment site within one-month, systemic glucocorticoid within 2 weeks, recent illness or fever, cancer. Smoking, recreational drugs, poor diet and poor hydration can also affect success.
PRP Treatment For Hair Loss
Androgenetic alopecia is a non-scarring hair loss condition characterised by a shortened anagen phase and progressive miniaturisation of hairs. In men, thinning hair is started with frontal recession and thinning of hair on vertex area. In women, hair loss is identified by less hair density and smaller hair shaft diameter over the crown without frontal hairline recessions. Approved oral finasteride is available for men and topical minoxidil for the treatment of androgenetic alopecia for both.
A meta-analysis from six studies (four studies were randomised controlled trials) involving 177 patients, showed a significant increase in number of hairs per cm2 after PRP injections compared to control with increased hair count and hair thickness. Similar result was confirmed by another two analysis studies identifying significantly increased hair numbers per following PRP treatment versus the control group.
In comparison to minoxidil, finasteride, and stem cell therapy, 84% of all studies reported a positive effect of PRP. Despite many clinical trials showing great success of PRP therapy for hair regrowth,
PRP preparation and administration it’s fundamentally important. As is for, platelet activation, assessment and required treatment intervals.
The action of dihydrotestosterone (DHT) on dermal papilla cells suppressed signaling, resulting in defective hair growth and hair cycling. PRP promoting hair growth by activating this signalling leads to proliferation and differentiation of hair follicle cells and triggering new hair cycle. Ineffectiveness of PRP in treatment of hair loss, may be caused by low platelet concentration.
Female Pattern Hair Loss
Female pattern hair loss is the most common cause of hair loss in women. This is progressive follicular miniaturisation and conversion of terminal follicles into vellus-like follicles, leading to decreased hair density and thinning. The cause is unknown, but it is related to genetics, hormones, and environmental conditions.
A systemic review study looking at the efficacy of PRP in the treatment female pattern hair loss with 92 patients from 6 randomised clinical trials showed that PRP has a great positive effect by increasing hair thickness and hair density. Recently, two further studies have confirmed this. The first study consisted of 776 female participants covering 16 randomised trials and 26 observational trials, demonstrating PRP having great therapeutic effect in hair density compared to the control groups. The second study from 8 clinical studies and a total of 197 subjects showed a significant increase in hair count and hair diameter in 4 studies after PRP treatment. Furthermore, PRP has been shown to produce high levels of satisfaction and improvement in the quality of life.
Differences in the treatment efficacy for Androgenetic alopecia with PRP between men and women was discovered by a meta-analysis study, which revealed that PRP significantly increased both hair density and hair diameter in men and women.
Alopecia areata is a common autoimmune disorder that causes nonscarring alopecia in males and females at any age. This can occur with just one small patch of hair, to many patches of hair including eyebrows and beard.
As PRP has a potent anti-inflammatory effect, it can reduce local tissue inflammation and improve hair growth. PRP was initially tested in patients with AA by a randomised, double-blinded trials, also in comparison to the treatment of steroid. Results in these comparison studies have indicated that PRP significantly increased hair regrowth and Ki-67 level (marker for cell proliferation) compared with steroid injection treatment or placebo injection. Furthermore, many randomised trials have demonstrated PRP treatment in stimulating hair regrowth to the same extent as intralesional in the treatment of stubborn alopecia areata.
Furthermore, there was a prospective study on the efficacy of PRP treatment in 20 cases of chronic AA who had not responded to conventional therapy for 2 years, demonstrated that all patients with chronic AA were successfully treated with PRP, only one patient had a relapse after one year of follow-up. PRP also been reported to be successful in patients who are resistant to steroid treatment.
Addition, steroid has side-effects that can be detrimental to local tissue health, causing feeling. PRP is reported to be safe and has regenerative properties.
Cicatricial alopecia is a type of scarring alopecia, caused by different inflammatory conditions, trauma, or severe infections that lead to the damage of the hair follicles and scarring. The aim of treatment is to reduce the disease progression, prevent further hair loss and scarring by using different approaches. Actual hair growth is very unlikely.
Frontal fibrosing alopecia (FFA), a variant of lichen planopilaris, is currently the most common type of cicatricial alopecia. Associated with progressive recession of the frontal and temporoparietal hairline and band-shaped scarring alopecia in the frontotemporal area. The satisfactory treatment outcome with a course of PRP injections was reported in a 44-year-old female, unresponsive to conventional steroid treatment. One month after treatment, erythema, scaling, and lichenoid papules on the hairline were improved, and no further hair loss was seen after 5 months.
Lichen planopilaris (LPP) is a chronic inflammatory scarring alopecia characterized by follicular hyperkeratosis, erythema, and loss of follicular orifices. A difficult condition to treat. However, it has been reported that after 3 treatments of PRP and followed up for 6 months, patient can experienced complete regression of scalp itching and hair shedding.
Effective treatment of cicatricial alopecia with PRP is possible due to various cytokines and growth factors, which have anti-inflammatory and tissue regenerative effects.
The use of PRP during and following on from transplant surgery is greatly beneficial. Many studies have shown a positive effect of using PRP in combination with a hair transplant. The experimental study in a group of 20 patients with male pattern baldness demonstrated a 15% greater hair density in areas pretreated. Similar results were found in another two studies, showing growth faster than normal at 4 months after hair transplant, 99% of follicle regeneration had occurred.
Furthermore, PRP can also be used as a combination treatment with the follicular unit extraction (FUE) hair transplant surgery. It is clearly seen that intra-operative PRP therapy is hugely beneficial in giving significantly improved density and quality of hair growth, reducing the catagen loss of transplanted hair, early recovery of the skin and faster appearance of new anagen hair in FUE transplant patients. Thus, PRP is not only an effective hair loss treatment, but it can also be used in conjunction to hair transplant surgery.
Adverse Effects of Platelet Rich Plasma
As PRP treatment use your own cells, there is a very low risk of reaction or rejection. PRP has been reported to be a very safe intervention with minimal adverse effects, including temporary and tolerable discomfort during treatment, mild headache, minimal itching and mild redness. No major side effects such as scarring, infections, panniculitis, hematoma or allergic reaction have been reported following PRP treatment. After treatment, patients can resume normal daily activities, no medications are needed. Most patients can return to work tue same day, it is just advised to keep the area clean and to avoid heavy exercise and sweating for 24/48 hours.
PRP can be used as a greatly beneficial safe therapeutic option for the treatment of hair loss hair loss including androgenetic alopecia and female pattern hair loss. It can be used either by itself or along side conventional therapy like minoxidil or hair transplantation. PRP is also safe, effective, steroid sparing, and effective for the treatment if alopecia areata. Furthermore, there is a evidence identifying that PRP can improve clinical symptoms in some types of cicatricial alopecia. It is important to appreciate how many PRP treatments are required, the PRP preparation and injection in order to achieve the maximum therapeutic efficiency.
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