• Adam Whatley

Use of Platelet-rich Plasma (PRP) in Aesthetic and Medical Dermatology


Here at Dynamic Regenerative Medicine in BIrmingham we have been treating in the field of hair restoration and skin rejuvenation for many years. We now want to outline and create awareness of regenerative medicine, specific into the natural and highly effective treatment of platelet rich plasma (PRP).



Platelet-rich plasma (PRP), is a popular biological treatment, which is a portion of the own plasma with platelet concentration well above baseline. Platelets are very specialised cells that are highly enriched with key several growth factors, chemokines, cytokines, and other many other plasma proteins, crucial in tissue repair.



There are more than 20 bioactive growth factors in PRP. These various types of growth factors bind to cell surface receptors and activate cell signaling pathways, resulting in the expression of genes and the synthesis of various proteins required for mitogenesis, for increasing cell numbers, and angiogenesis, for stimulating vascular growth.



This article aims to highlight the potential efficacy and benefits of PRP in skin rejuvenation, androgenic alopecia (AGA), alopecia areata (AA), chronic vitiligo, melasma, inflammatory nail disorders, and psoriasis.



SKIN REJUVENATION


Skin ageing inevitably results in wrinkles, reduced smoothness, pigmentation changes, and a reduction of skin elasticity. The beauty of PRP is that it can induce remodelling of the extracellular matrix. Intern, this removes photodamaged cellular components and stimulates the production and synthesis of collagen. To verify the efficacy of PRP rejuvenation on skin, Abuaf et al., performed punch biopsies in the infra-auricular eye area at three time points: before injection, 28 days after PRP injection, and 28 days after saline injection. Collagen fiber bundles in the dermis skin layer and the number and thickness of elastic fibres were significantly increased relative to baseline in groups treated with PRP and saline. Furthermore, the density of collagen fibers was significantly higher in the PRP-treated group than in the saline-treated group. The authors concluded that PRP increased dermal skin collagen levels not only through growth factors but also via skin microneedling treatment. Moreover, it was suggested that PRP treatment is a safe and effective procedure, even after a single application, for facial skin rejuvenation.



Objective assessments of PRP have also demonstrated efficacy for skin rejuvenation. Although PRP has been used clinically for skin rejuvenation for several years, the first randomised controlled clinical trial was conducted in 2018 by Alam et al., Here, PRP and saline were injected in the same subjects on one cheek and the contralateral cheek. At 6 months’ follow-up, masked participants rated the conditions and found that the PRP-treated cheek showed significant improvement in skin texture and wrinkles in comparison. Elnehrawy et al., reported that, after a single PRP injection, nasolabial folds responded most favourably to treatment, followed by crow’s feet and the transverse forehead lines. There was also a significant improvement in fine wrinkles and texture, with notable improvement in the 4th week and the greatest improvement observed in the 8th week after injection. Lee et al., also administered a single PRP injection on the cheeks and reported that patients were significantly satisfied with the overall facial and cheek appearance based on FACE-Q appearance appraisal scale evaluation. On the FACE-Q postcare scales, the majority of patients reported being pleased with the result (74.2%) and agreed that “it was/is worth the time and effort” (80.0%).

In a split-face, double-blind study, PRP and ready-made growth factors were used for skin rejuvenation every 2 weeks for 3 months. At 6 months following the last administration, the PRP group showed sustained improvement, whereas the group given ready-made GFs showed a decrease in both epidermal and dermal thickness.



Sclafani et al., used platelet-rich fibrin (PRF) to treat deep nasolabial folds. Following this, the average wrinkle assessment scale score was reduced. The authors suggested that PRF could provide long-term improvements of the deep nasolabial folds without causing excessive scar tissue, which can result by using foreign materials. In addition, PRF showed a significantly greater ability to promote collage synthesis, relative to PRP. Based on the evidence in the literature, PRP appears to be effective and safe for skin rejuvenation. The adverse effects of PRP, such as mildness swelling or redness tends to settle very fast.


PRP FOR HAIR LOSS (ALOPECIA)




it is now well established that PRP treatment has very good impacts on hair folliculogenesis (hair follicle stimulation) and hair cycling. Growth factors bind to receptors on dermal papilla cells of hair follicles to activate the various biological pathways. 19 growth factors such as VEGF, EGF, hepatocyte growth factor, fibroblast growth factor, and IGF-1, have angiogenic (new blood vessel) potential and can increase vascular structures around hair follicles, ultimately providing more life nutrition. 19 articles published in 2019, with that majority concluding that PRP is beneficial for hair regrowth.



The effect of PRP on the follicular units in male baldness surgery was also observe by 2006. It was reported that it had a significant improvement over conventional techniques. 6 randomised control trials were also reviewed six on the efficacy of PRP injection for androgenetic alopecia (AGA) treatment. PRP treatment showed a significantly higher degree of improvement in hair thickness and overall clinical improvement than many other treatments.



Hair-to-hair matching analyses has showed that new hair gas grown from active follicles. Nonfunctioning hair follicles filled with hyperkeratotic plugs also showed new hair growth. PRP stimulates follicle regrowth and modulation of the hair cycle, as well as the production and secretion of growth factors. The expression of these allows stem cells to have an angiogenic capacity and the ability to induce tissue neovascularization and a microenvironment with an abundant blood supply for hair cells to regenerate hair follicles. Stem cells also exert immunomodulatory and/or immunosuppressive effects via direct cell-to-cell interaction or secreted cytokines. Thus, irrespective of whether PRP is administered alone or in combination with other agents, it is very promising for the treatment of hair loss.



Alopecia areata (AA)


It is revealed that PRP administered either alone or in combination with steroid has been a very successful treatment for AA. AA is considered an organ-specific autoimmune disease that results results in the loss of the immune privilege of hair follicles. Conventional therapies are

mostly immunosuppressive in nature and have significant relapse rates and side effects. For instance, relapse rates of 30% and 70% have been reported for corticosteroids injection treatment in limited AA. These relapse rates are increased with topical steroids, oral steroids, methotrexate, and cyclosporine, respectively. The improvement in chronic AA showed no significant difference between PRP and steroid in two studies, but PRP showed significantly better result in one study.

The mechanism of PRP in AA treatment is thought to be a combination of cell proliferation, anti-inflammatory effects, and immunomodulatory mechanisms induced by growth factors. Apart from mild discomfort, no other side effects of PRP were reported in AA treatment.




Cicatricial alopecia


Two biopsy-proven cases of primary scarring alopecia caused by cicatricial alopecia and lichen planopilaris have been reported. Both cases have shown that they responded well after three injections of PRP administered at four-week intervals. Six months after treatment, maintenance treatments are recommended in frequently. For cicatricial alopecia, anti-inflammatory effects of growth factors from PRP as well as their ability to remodel collagen, may be a contributing factor to the success.





SKIN PIGMENTATION DISORDERS




Vitiligo

PRP treatment can improve vitiligo by several possible mechanisms:


1. Growth factors:

The stimulation and regeneration of melanin-producing cells is very important for vitiligo treatment. Basic cell stimulation in PRP has been shown to significantly enhance the migration of melanin cells. Parambath et al., identified that TGF-β present in PRP leads to better response for stable vitiligo. Moreover, PRP stimulates the undifferentiated stem cells.


2. Anti-inflammatory:

PRP produces anti-inflammatory effects that can suppress the release of inflammatory cytokines, such as interleukin-1 and tumor necrosis factor-α. This, in turn, benefits the interaction between melanocytes and keratin cells.


3. Matrix proteins:

PRP containing fibrin and various of a proteins enhances cell adhesions between keratin cells, fibrin and melanin cells. In a double-blind randomised controlled trial, stable vitiligo was treated with autologous transplantation of noncultured epidermal cell suspension (NECS). The results indicated that NECS in PRP resulted in significantly greater mean repigmentation and patient satisfaction. Mahajan et al., identified that treatment with PRP injections, consisting of six injections at two-week intervals, was an effective treatment for chronic vitiligo patients who did

not respond to traditional therapies. As for the treatment of stable nonsegmental vitiligo lesions, the combination of fractional CO2 laser with PRP injection treatment resulted in superior repigmentation. NB-UVB is also a good combination treatment to use. Because the cause and development of vitiligo involves autoimmune-mediated destruction of melanin cells, the inhibition of autoimmunity could be considered as a vitiligo treatment, and P-PRP or L-PRP can be used by professionals for its treatment.




Melasma


Previous studies have found significant melasma reductions upon PRP injection. TGF-β1 and PDGF present in PRP could have led to melasma reduction. TGF-β1 released from PRP inhibits melanin synthesis in a concentration-dependent manner. PDGF released from PRP leads to a more favourable microenvironment in the dermis skin layer.




Psoriasis


Nuclear factor kappa B (NF-κB), which plays a regulatory role in inflammation, could also be a crucial mediator in the cause and development of psoriasis. PRP exerts inhibitory effect on NF-κB through enhanced cell expression, which results in the retention. PRP reduces chemotaxis by inhibiting chemokine transactivation and CXCR4 receptor expression, possibly controlling local inflammation. Patients with chronic plaque psoriasis treated with PRP and methotrexate showed a significant improvement in each visit compared to patients treated with methotrexate alone. 3-6 months, all patients in the combination therapy group achieved very good success.




Inflammatory nail disorder.


Kaur et al., shown that PRP injections to be a safe and effective alternative in refractory nail disorders. Improvements after two PRP injections administered at three-week intervals have been ident. Researchers have proposed that PRP improved inflammatory nail disorders by decreasing the inflammatory factors, thereby normalizing the nail matrix and promoting regeneration through the release of bioactive growth factors.





CONCLUSION


With the unveiling of its mechanisms and clinical efficacy in recent years, PRP is a very promising and exciting therapeutic modality in the field of dermatology and aesthetic medicine, specifically in the field of hair loss treatment and skin rejuvenation. PRP used alone or in combination with other therapies, showed beneficial effects in terms of cosmetic improvements and for various skin diseases, This due to the mechanisms of biological growth factors. Furthermore, PRP has been shown to be very safe with only very mild side-effects associated.



Journal of Clinical Aesthetics and Dermatology. 2020. Progress in the Use of Platelet-rich Plasma in Aesthetic and Medical Dermatology.







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