Platelet-Rich Plasma (PRP) Compared with Minoxidil®, Finasteride® and Stem Cell for Hair Loss
Platelet rich plasma (PRP) is considered standard routine for experts in hair growth.
In particular, the released growth factors from PRP has been suggested as one of the most important factors stimulating hair regrowth via the activation of complex signalling, improving the survival of dermal papilla cells (DPCs) during the hair cycle. Additionally, the up-regulation of fibroblast growth factor signalling pathways with PRP treatment has been suggested to stimulate hair regrowth by inducing hair follicle stem cell differentiation as well as prolonging the anagen phase of the HG cycle.
The total number of articles published on PRP in hair loss treatment is considerable (163 articles were identified in PubMed). The results are very encouraging for the vast majority of the identified articles. The efficacy of PRP in patients who suffer hair loss (androgenic alopecia) is clear and it has also been reported several times by authors.
Regenerative procedures are represented beyond the PRP, also from adult stem cell-based therapy to hair follicles stem cell injections. Most recently, many articles showed the efficacy of autologous micro-grafts, containing unexpanded hair follicle stem cells obtained slow centrifugation of scalp micro fragments (2 mm) according to minimal manipulation rules, with promising results (please see here). In this review, the effectiveness of an autologous regenerative therapy focused exclusively on PRP treatment for hair loss (androgenic alopecia) was evaluated, with the conclusion that PRP was effective in promoting high regrowth in most articles.
PRP with Minoxidil® and Finasteride®
Current drugs indicated for alopecia with approval include Minoxidil® and Finasteride®.
The Minoxidil® lotion was the first drug to receive approval treatment in males (1988) and in females (1991). Minoxidil® lotion 5% received approval in 1997 for males who suffered AGA followed by approval of the 5% foam in 2006. Minoxidil® Is thought to prolong the anagen and increase the hair follicle diameter through increasing blood flow via vasodilation. Finasteride® is a type II 5-alpha-reductase-inhibitor, which decreases dihydrotestosterone (DHT) by about 65% in the serum, prostate, and scalp. It was registered in Europe in 1992 for the treatment of benign prostatic hyperplasia. The drug was registered in the U.S (1993) and Europe (1994) for the therapy of mild to moderate androgenic alopecia in male patients.
Alternative procedures, based on autologous regenerative medicine and a minimally invasive approach, are PRP (A-PRP and AA-PRP), adipose-derived mesenchymal stem cells (AD-MSCs) and hair follicle stem cell (HFSCs). A more invasive surgical approach is represented by hair transplants, which is indicated only for patients affected by aggressive conditions of hair loss.
Essentially the majority of hair loss treatments are based on stimulating blood flow to the scalp. Minoxidil® is known as a vasodilator, which provides increased blood flow intermittently. Whereas PRP promotes a process called angiogenesis, which is the formation of new blood vessels in the area. So PRP has a dual action of releasing all important growth factors at the same time as creating new blood vessels. Finasteride® also presents with unwanted side effects.
Evidence-Based Medicine’s Impact of PRP in AGA Treatment
One of the problems most encountered in the scientific community is the level of consolidated evidence-based medicine offered by PRP in the treatment of AGA and hair loss, compared with FDA-approved treatments like Minoxidil® and Finasteride®.
Many institutional guidelines of several countries are based on the evidence based impact of a procedure/drug. Regarding PRP in hair loss -19 systematic reviews, 9 meta-analyses, and 12 clinical trials are indexed currently. The number is theoretically more than sufficient to demonstrate a consolidated evidence and related effectiveness of PRP’s use in hair loss.
Most recently, a systemic review was published by Hausauer and Humphrey on the PRP effects in several hair loss kinds, analysing the impact, limits, and advantages. Within this, they also described the beneficial role ion PRP in soft-tissue remodelling and rejuvenation.
This review suggests five crucial points: 1) the information highlights the many positive effects of PRP in the treatment of hair loss for men and women, 2) PRP presents as a safe and effective alternative procedure to treat hair loss compared with Minoxidil®, Finasteride®, and Dutasteride®, 3) it is necessary to perform 3/4 injections treatments of PRP, 4) PRP injections work better in male and female patients with mild to moderate androgenic alopecia, and 5) PRP infiltration must be performed with mechanical and controlled injections. Ultimately, combining PRP with Minoxidil® and Finasteride® can hold better clinical outcomes.
It is believed that the future will be based exclusively on regenerative-based therapies for multiple cases of hair loss.
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