Prp hair treatment side effects

Are you looking for a hair loss solution? A therapy that promotes healing in injured joints may help restore your lost hair.

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About 50 million American men and 30 million women have male- or female-pattern baldness. It can begin early in life, but is much more common after the age of 50, when more than 50 percent of men will experience some kind of hair loss.

However, an emerging treatment — platelet-rich plasma (PRP) therapy — appears to help regrow lost hair. And, there are virtually no side effects from PRP, except for a mild feeling of pressure at the injection site, says dermatologist Shilpi Khetarpal, MD.

How does PRP therapy work?

Physicians began using PRP therapy about a decade ago to speed up the healing process in damaged joints after injury or surgery.

During the treatment, a technician draws your blood and spins it in a centrifuge to separate out the platelets and plasma. Doctors then inject the plasma, which helps repair blood vessels, promote cell growth and wound healing, and stimulate collagen production.

Doctors began using PRP in dermatology after researchers found that high concentrations of platelets in plasma cells help promote hair growth by prolonging the growing phase of the hair cycle.

Doctors inject plasma into the scalp where hair loss has occurred. They typically administer injections monthly for three months, then spread them out over about three or four months for up to two years. The injection schedule will depend on your genetics, pattern and amount of hair loss, age and hormones.

Because the treatment is cosmetic, insurance does not cover the procedure, Dr. Khetarpal says. The cost ranges between $500 and $1,000 per injection session.

How does PRP therapy compare with other options?

Other treatments for hair loss currently on the market are often more problematic for many patients, Dr. Khetarpal says.

There are two FDA-approved medications for treating hair loss: finasteride and minoxidil. But you must take these drugs consistently over time and results are inconsistent, she says.

Each drug also sometimes has side effects:

  • Minoxidil may cause dryness and itching on the scalp.
  • Finasteride may cause sexual dysfunction in men.

Hair transplantation is another option, but it requires cuts in the scalp and recovery time is longer, she says.

Because it is a surgical procedure, doctors typically recommend hair transplantation only for those who have dramatic hair loss. A transplant is also more costly and leaves scars. Doctors can perform PRP therapy prior to transplantation, which can provide better results with more dense hair growth, Dr. Khetarpal says.

Researchers see promising results

Recent research bears out the potential of PRP therapy.

In a 2014 study, researchers in India looked at men with male-pattern baldness who used both approved medications, but saw little change in their hair growth.

After four PRP treatments, they had about 30 percent more growth in thinning areas.

A 2017 study out of Italy also found male patients had increased hair and density in areas where doctors used PRP therapy.

Dr. Khetarpal says it takes about three months to see an improvement. After that time, most of her patients – both male and female – have regrown 30 to 40 percent of the hair they’ve lost.

What makes you a good candidate for PRP therapy?

Part of the success of PRP comes from selecting the right patients for therapy, Dr. Khetarpal says. PRP is safe and effective for many people. However, you should not have PRP therapy if you fall into either of these groups:

  • If you have an underlying disorder such as thyroid disease or lupus, you aren’t likely to have good results because these conditions will continue to cause hair loss over time.
  • If you are on blood thinners, your platelets won’t work as effectively and the procedure is not as effective.

PRP therapy works better if your hair loss is recent. It is more challenging to “wake up” hair follicles that have been dormant for a long time, Dr. Khetarpal says.

“I tell people I can get your hair back to what it was five years ago,” she says. “If your hair loss is older, you may see some recovery, but it’s likely not worth your investment of time and money.”

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PRP for Hair Loss Treatment

PRP (Platelet Rich Plasma) for Hair Loss is now the latest trend in hair regrowth and hair loss treatment. PRP therapy for men’s and women’s hair loss is becoming more and more common and is proving to be effective in correcting hair loss when done correctly.

Even though PRP therapy has been around since the 1980’s, doctors only started using it recently as a treatment for certain types of alopecia. Many user experiences have noted good results and the popularity of the procedure is growing rapidly.

PRP for hair loss is a non-surgical procedure that utilizes the stem cells and growth factors from the patient’s own blood to trigger the growth of hair from resting or miniaturized hair follicles. The first step involves drawing the patient’s blood into a 20-22cc specialized tube that is then spun down in a centrifuge for 15 minutes.

The centrifuge will separate the platelets from the rest of the blood. The final product is plasma that has been separated from the white and red blood cells. This plasma is then set aside and gravity allows the platelets to drop out of suspension and collect at the bottom of the tube.

This denser area of platelets in the plasma called Platelet Rich Plasma or PRP. This area will typically have 3 -5 x concentration of platelets and is the key ingredient to success in any PRP procedure. The platelet poor plasma or PPP is usually collected from the top of the tube and discarded; or, in some cases saved for micro-needling treatment post PRP injection.

The platelet-rich plasma then is injected back into the scalp using one of two procedures:

  1. Subdermal: PRP is injected into the subcutaneous fat layer of the scalp using a longer needle with less injections; or,
  2. Dermal: PRP is injected into the scalp into the dermal layer using a shorter needle and higher number of injections.

Often times this procedure can be assisted with the use of a cell matrix or A-cell in the PRP or followed by micro needling or both.

This therapy is mostly used as a growth stimulant hair growth procedure and typically requires multiple procedures over a course of 3-6 months to begin to show results. It is important to note that PRP is not FDA approved for hair growth and there are numerous methods of delivering PRP to scalp. It is important to review what type of procedure your physician may be practicing. You should discuss this with your physician prior to starting a course of treatment and see his or her before and after photos.

PRP for Hair Restoration and Hair Transplantation: PRP can be used in hair transplant surgery to expedite post-operative recovery. During a hair restoration procedure, some physicians will have the individual hair transplants grafts dipped in a patients PRP prior to being placed by into the patient’s scalp. This will potentially provide a greater possibility of healing and promote a better outcome.

Why PRP Has Shown Results for Hair Loss Treatment

Platelet-rich plasma has approximately five times the number of platelets found in ordinary blood. These platelets have:

  1. Platelet-derived growth factor
  2. Transforming growth factor
  3. Insulin-like growth factor 1
  4. Vascular endothelial growth factor
  5. Keratinocyte growth factor

All the above have a positive impact on the growth of hair. Platelets stimulate the healing of wounds and cellular repair and when placed inside the scalp it seems to be able to repair areas of hair loss. Currently, there are clinical studies underway to prove its effectiveness, but those studies still will not be complete until 2019. There have been some previous studies in mice shows that PRP stimulates dermal papillae. One similar study that was done on mice to assess the effect of activated PRP on hair growth in vivo. After one injection every three days for fourteen days, diffuse darkening was noticed. Mice that were injected with activated PRP showed an almost complete hair regrowth as compared to those that were not.

Cost

When it comes to treatment of hair loss, PRP procedure cost varies depending on the type of procedure, if micro-needling or A-cell is included, and the total number of treatment needed. The average cost of one treatment is between $1000-1500 and one requires at least two-three sessions. The more dramatic your hair loss potential the more procedure necessary.

Source: Klinik Dr Inder.

Results

PRP is not a permanent fix. Maintenance of one treatment per year is usually required to maintain results. Additionally, androgenetic alopecia is caused by the hormone, DHT (dihydrotestosterone) and PRP doe not to do anything to mitigate the effects of this hormone. DHT Blockers and additional hair loss product may still need to be used for an optimal long term result.

Despite some limitation, PRP injections have shown a positive therapeutic effect on both male and female hair loss without major side effects. The potential for using this therapy to boost hair loss thickness and density as a standalone treatment or after a hair transplant is good.

Safety of PRP

PRP for hair loss and the scalp is considered very safe because:

  • PRP therapy is immunologically neutral and has no danger of allergies, hypersensitivity or foreign-body reactions.
  • PRP is a sterile technique has to be used at each stage of PRP preparation and application. PRP is quite useful in case a patient has an underlying medical condition that makes him or her prone to infection.
  • PRP has a very short period of inflammation at the sites of wounds thus reducing any possible injection.

The use of PRP does not require FDA approval, however in the US, the device used to prepare PRP must be approved by the FDA. Currently the FDA has not approved PRP as a medication for hair restoration.

On its own, PRP is also used in hair restoration that produces great results. Using thin needles, a patient’s own PRP is injected into the scalp. The growth factors within the blood cells then go to work and trigger growth of hair. This therapy is also suitable for both men and women. The end result of this therapy is a fuller and healthier looking hair.

At times, PRP may be uncomfortable and painful so topical anesthetic or cooling spray is often used. There is virtually no downtime following a procedure and you should be able to be back to work the next day will no noticeable trace of the PRP injections.

Find PRP Doctors in your area who perform PRP Therapy for Hair Loss Find PRP Hair Loss Treatment Providers in your Area

Potential PRP Hair Treatment Side Effects – Should You Be Scared?

Thanks to new technology, you don’t necessarily need to go under the knife for a thicker head of hair. PRP therapy for hair loss is an exciting new non-surgical treatment that significantly reduces hair loss for many patients. It’s also known as platelet-rich plasma therapy.

You may be hesitant to get PRP hair treatment since it’s relatively new. However, PRP has been used since the 1980s for different types of treatments. Since PRP injections use your own blood, adverse side effects are rare and there is no risk of developing a growth of tumor or cancer, according to the information resource website for PRP in Australia.

Let’s take a closer look at potential PRP hair treatment side effects now so that you can choose the best hair restoration method for you.

What is PRP Hair Treatment?

PRP was first developed in the 1970s and has since been used for years for various medical applications. PRP involves having a blood draw as though you were getting lab tests performed. The whole blood is treated with centrifuge to separate the red blood cells from the plasma, the portion of your own blood that contains a relatively high platelet concentration. Platelets are the part of the blood that stops bleeding by clotting and clumping. Doctors then separate the plasma along with the platelets, activate the platelets and inject the serum into the area of your body that is being treated. Doctors have been using this technique for years to stimulate wound healing and improve the appearance of skin.

More recently, researchers have found that PRP can also help stimulate hair growth. Evidence from various studies has supported the idea that PRP is a promising new form of hair growth treatment. So how does it work? The growth factors that are released from the activated platelets can theoretically stimulate cells in your hair follicle to grow, which is great for inactive or implanted hair follicles.

Now that you know how it works, you’re probably wondering if it actually works. In a randomized controlled trial, three PRP treatments were given to patients who suffer with pattern hair loss. This study observed an increase in the number of hairs in the target area and an increase in hair density. No side effects were reported during treatment.

Potential PRP Side Effects

Since PRP uses your own blood, you should not have a reaction to it. Studies have noted that PRP has been found to have a positive effect on male and female pattern hair loss without major adverse side effects. You may experience minimal pain, pinpoint bleeding, and redness when the injections are being delivered. Dr. Krejci notes that patients often comment on a “full” or “tight” feeling in their scalp immediately after injections that can last up to about 1 day. Rarely, she also finds some patients will complain of a mild headache the next day.

Who Shouldn’t Get PRP Treatment for Hair Loss

Though major side effects have not been found in qualified patients, not everyone is suitable for PRP therapy. If you have a history of heavy drug or alcohol use, or a history of smoking, you should not receive PRP hair treatment. You also may not qualify for PRP treatment if you have been diagnosed with any of the following treatments:

  • Hypofibrinogenemia
  • Cancer
  • Sepsis
  • Chronic skin disease
  • Metabolic disorder
  • Systemic disorder
  • Hemodynamic instability
  • Chronic liver disease
  • Platelet dysfunction syndromes
  • Acute and chronic infections
  • Thrombocytopenia

If you’re not ready for surgery yet or can’t undergo a hair transplant, PRP may be a great hair growth solution for you. If you’d like to learn more about PRP and whether it would be a good option for you, feel free to contact us today!

ORIGINAL ARTICLE
Year : 2019 | Volume : 11 | Issue : 2 | Page : 68-79

A study to compare the efficacy of platelet-rich plasma and minoxidil therapy for the treatment of androgenetic alopecia
Kuldeep Verma, Gita Ram Tegta, Ghanshyam Verma, Mudita Gupta, Ajeet Negi, Reena Sharma
Department of Dermatology, Venereology and Leprosy, IGMC, Shimla, Himachal Pradesh, India

Date of Web Publication 9-Apr-2019

Correspondence Address:
Kuldeep Verma
1365, Ram Janki Puram Colony, Mehndi Bagh, Jhansi, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijt.ijt_64_18

Abstract

Background: Androgenetic alopecia (AGA) is the most common cause of hair loss in men with limited treatment options. Platelet-rich plasma (PRP) therapy is one of the newer treatment options in the management of AGA which has shown promising results. Aims and Objectives: This study was aimed at comparing the clinical efficacy of PRP therapy with minoxidil therapy. Materials and Methods: In the study, patients were randomized into two groups – Group A (given PRP therapy) and Group B (given minoxidil therapy). Both groups were followed up over a period of 6 months, and final analysis was done with the help of global photography, hair pull test, standardized hair growth questionnaire, patient satisfaction score; in addition, a comparison of platelet counts in PRP was done, to know that if a clinical correlation exists between platelet concentration and clinical improvement. A total of 40 patients clinically diagnosed with AGA were enrolled in the study with 20 patients in each group. Four patients from Group A (PRP) and six patients from Group B (minoxidil) could not complete the treatment for 6 months and were eventually excluded. Results: At the end of 6 months, 30 patients were evaluated to compare the efficacy of intradermal PRP and topical minoxidil therapy. On global photography, Group A (PRP) was found to have a comparatively better outcome than Group B (minoxidil). In hair pull test, hair growth questionnaire, and patient satisfaction score, Group A was found to be better than Group B. Mean platelet count at baseline was 3.07 ± 0.5 lac/mm, 3 while platelet count in final PRP prepared was 12.4 ± 1.7 lac/mm, and patients with a higher platelet count in PRP had a much better clinical improvement compared to patients with a low platelet count in PRP. Side effects with PRP therapy were minimal with better results which may improve the compliance of the patient. Conclusion: PRP therapy can be a valuable alternative to topical minoxidil therapy in the treatment of AGA.

Keywords: Androgenetic alopecia, minoxidil, platelet-rich plasma

How to cite this article:
Verma K, Tegta GR, Verma G, Gupta M, Negi A, Sharma R. A study to compare the efficacy of platelet-rich plasma and minoxidil therapy for the treatment of androgenetic alopecia. Int J Trichol 2019;11:68-79

Introduction

Androgenetic alopecia (AGA) is a hereditary and androgen-dependent dermatological disorder characterized by miniaturization of scalp hair in a defined pattern. There is an alteration in the hair cycle dynamics leading to vellus transformation of terminal hair follicles. Due to the limited treatment options, it is a growing concern for dermatologist worldwide.
The US Food and Drug Administration (FDA)-approved medical treatment options for the management of AGA are topical minoxidil and oral finasteride. Various other treatments have been tried beside FDA-approved options.
Most of the existing treatment options are relatively slow to act because of which there has been a continuous search for newer modality of treatment among which platelet-rich plasma (PRP) therapy has shown promising results. PRP is autologous preparation of platelets in concentrated plasma. It contains more than 20 growth factors (GF), of which most important GFs include platelet-derived GFs, transforming GF-ß, vascular endothelial GF, and insulin-like GF-1 along with their isoforms. In AGA, PRP induces differentiation of stem cells, prolongs survival of dermal papilla cells, prolongs anagen phase of hair cycle, and increases perifollicular vascular plexus by multiple mechanisms through various GFs.,
This study was aimed at comparing the clinical efficacy of PRP therapy and minoxidil therapy which may help us to know that which is more efficacious, acceptable, and safe form of therapy in the management of AGA.

Materials and Methods

The study was conducted over 1 year with effect from July 1, 2016 to June 30, 2017. This prospective study was aimed at comparing the clinical efficacy of intradermal PRP and topical minoxidil therapy for the treatment of AGA patients attending the outdoor patient Department of Dermatology, Venereology, and Leprosy, Indira Gandhi Medical College, Shimla (H. P).
A detailed history was taken to rule out other causes of hair loss such as telogen effluvium, history of any drugs, or history of any systemic disease. The patients were asked about lifestyle-related factors such as smoking and ultraviolet exposure which can aggravate AGA. Patients were asked for family history of AGA. A thorough clinical examination was performed in eligible patients to rule out any local dermatological disorder of the scalp, and a diagnosis of AGA was made; grade of AGA was assigned as per the Modified Norwood–Hamilton criteria .
Patients were counseled regarding the benefits, side effects, and limitations of both the treatment modalities. An informed written consent was then obtained after explaining the procedure. Enrolled patients were randomized into two groups – Groups A and B using sealed opaque envelope which contained a computer-generated random number. Group A underwent monthly injections of PRP for 4 months while Group B was given treatment with topical minoxidil therapy alone which was applied as 1 ml twice daily for 6 months.
Inclusion and exclusion criteria of PRP and minoxidil therapy are mentioned belowand.

Table 1: Inclusion and Exclusion criteria for PRP therapy
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Table 2: Inclusion and Exclusion criteria for Minoxidil therapy
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Groups A and B were assessed with the help of global photography, hair pull test, patient standardized hair growth questionnaire , patient satisfaction score, and platelet count in PRP. In global photography, a baseline and post treatment photographs at the end of the study period were taken and reviewed by blinded evaluator. Multiple images were taken to cover all areas of the scalp. Four specific views particularly focused were the vertex, mid-pattern, frontal, and temporal views. Hair pull test was done to assess the severity of disease at the start of treatment and then at 6 months. Patients were advised to withhold shampooing for 24 h before a hair pull test. In the hair pull test, about 60 hairs were grasped between the thumb and the index and middle fingers. The hairs were then gently but firmly pulled. More than six hairs or 10% of the total hairs obtained was taken as “positive” hair pull test while six or less hairs or <10% of the total hairs was taken as a “negative” hair pull test. Furthermore, patients assessed their scalp hair using a validated, self-administered hair growth questionnaire developed by Barber et al. which included four questions in the patient’s language on treatment efficacy and three questions on satisfaction with appearance. Each question was found to have a statistical significance in clinical trials in terms of patient perception of hair loss, satisfaction with hair appearance, and hair counts. Thus, it had certain reliability in monitoring response to treatment. However, we finally included only 6 questions out of total 7, omitting the second question of the questionnaire as it was difficult to be interpreted by most of our patients which could possibly result in interpretation error. Patient satisfaction score: patients were asked to interpret their satisfaction with either of the treatment provided at the end of treatment on a scale of 1–10. The mean of score was calculated in either of the group, and results were then statistically analyzed. Platelet count in PRP: final platelet count in PRP prepared was also calculated before injecting. The mean platelet count of four sessions of PRP was calculated in each patient in Group A to evaluate any correlation between platelet count and response to treatment.
Method to prepare PRP: manual double-spin technique was used. About 25–35 ml of venous blood was drawn into a tube-containing anticoagulant sodium citrate, to avoid platelets activation and degranulation. Blood was processed for the first centrifugation (soft spin) at approximately 1500 rpm for 5 min, which separated blood into three layers, namely, bottom-most red blood cell (RBC) layer (around 55% of total volume), topmost acellular plasma layer (platelet poor plasma ) which is around 40% of total volume, and an intermediate PRP layer (around 5% of total volume) called the buffy coat

. Using a sterile syringe PPP, PRP and some RBCs were transferred into another tube without an anticoagulant. This tube underwent a second centrifugation, which was longer and faster than the first spin (hard spin). Hard spin was performed at around 2500 rpm for 15 min. This allowed the platelets (PRP) to settle at the bottom of the tube with a very few RBCs. PPP (80% of the volume) was formed at the top. Most of the PPP was removed with a syringe and discarded, and the remaining PRP was shaken well and platelet count in PRP was performed using automated device. The PRP formed was collected into an insulin syringe, already containing calcium gluconate which acted as an activator by nullifying action of anticoagulant. Ratio of calcium gluconate and PRP in insulin syringe was 1:9. PRP thus formed was injected intradermally in a dose of 0.1–0.2 ml per injection approximately 1 cm apart in interfollicular areas, at a monthly interval for 4 months.

Figure 1: After soft spin

Figure 2: After hard spin

Figure 3: Final platelet-rich plasma prepared

Figure 4: After injecting platelet-rich plasma

In Group B, the patient was advised topical minoxidil in a concentration of 5% for men in a dose of 1 ml which has to be applied twice daily.
Patients in Group A were followed up at every month for 6 months, while patients in Group B were followed up at every 3 months for 6 months. The improvement from either of the groups was assessed by global photography, hair pull test, patient standardized hair growth questionnaire, and patient satisfaction score. Quantitative variables were analyzed by mean ± standard deviation, using Epi-info version 7 (Developer: Centre of Disease control and prevention, Atlanta, Georgia, USA) and unpaired t-test was applied. P < 0.05 was considered as statistically significant.

Results

A total of 40 male suffering from AGA were enrolled in our study with 20 patients in each group. Four patients from Group A left the treatment in between because of the pain at injection site during the procedure while six patients from Group B left the treatment in between because they could not find any results even at 3–4 months of treatment. Thus, four patients from Group A and six patients from Group B were excluded from the study .

Figure 5: Patient distribution

Patient’s demographic and hair loss features at baseline are shown in . The treatment groups were not significantly different at baseline with respect to the age of the patients, the age of onset of hair loss, grade of hair loss, and family history.

Table 3: Characteristics of all patients in the study

Patients were divided from Grade I-V as per the modified Norwood–Hamilton scale. Most of the patients were classified into Grades II and IV in either of the group with not much significant difference among the two groups .

Table 4: Grade of AGA (As per modified Norwood-Hamilton scale)

Global photography

Figure 6: Group A: Patient 1

Figure 7: Group A: Patient 2

Figure 8: Group A: Patient 3

Figure 9: Group A: Patient 4

Figure 10: Group B: Patient 1 (frontal view)

Figure 11: Group B: Patient 1 (mid-pattern view)

Figure 12: Group B: Patient 2

Hair pull test
It was done at the beginning of treatment and then at the end of 6 months. Twelve patients in Group A (75%) had a negative hair pull test compared to only six patients in Group B (42.8%); however, P value was not significant .

Table 5: Hair pull test

Patient standardized hair growth questionnaire

  • Question 1: Since the start of the study, I can see my bald spot getting smaller
    • Results: Ten patients in Group A (62.5%) agreed that their bald spot was getting smaller while seven patients in Group B (50%) agreed that their bald spot was getting smaller; however, P value was not significant (0.5195)

  • Question 2: Since the start of the study, how would you describe the growth of your hair?
    • Results: Eight patients in Group A (50%) reported a moderate increase in hair growth compared to only one patient in Group B (7.1%), P value of which was statistically significant (0.014)

  • Question 3: Since the start of the study, how effective do you think the treatment has been in slowing down your hair loss?
    • Results: Six patients in Group A (37.5%) agreed that PRP therapy was very effective in slowing down hair loss compared to two patients in Group B (14.2%); however, P value was not significant (0.183)

  • Question 4: Compared to the beginning of the study, which statement best describes your satisfaction with the appearance of?
  1. Front of the head: Three patients in Group A were satisfied with the appearance of hairs at the front of the head in Group A compared to four patients in Group B. Results were almost comparable in both the groups, and P value was not significant
  2. Top of the head: Fourteen patients (87.5%) in Group A were satisfied with the appearance of hair on the top of the head compared to five patients (37.71%) in Group B. P value was found to be highly significant (0.004)
  3. Your hair overall: Ten patients (62.5%) in Group A were satisfied in Group A compared to five patients (35.76%) in Group B; however, P value was not significant between the two groups .

Table 6: Patients response when asked about their bald spot getting smaller since the start of the study:

Table 7: Patients response when asked about the growth of their hair since the start of the study:

Table 8: Patients response when asked about how effective the treatment was in slowing down their hair loss:

Table 9: Patients response when asked about the satisfaction with the appearance of hair on front of the head:

Table 10: Patients response when asked about the satisfaction with the appearance of hair on top of the head:

Table 11: Patients response when asked about the satisfaction with the appearance of hair overall:

Patient satisfaction score
Patients in Group A had a mean satisfaction score of 6.56 with standard deviation of 1.09 while patients in Group B had a mean satisfaction score of 4.85 with a standard deviation of 1.46. P value was found to be highly significant and .

Figure 13: Patient satisfaction score

Table 12: Patient satisfaction score:

Mean platelet counts and platelet count in platelet-rich plasma
An initial platelet count was done in all the patients of Group A using automated device, and the mean platelet count was 3.07 ± 0.5 lac/mm 3. Platelet count was again done in the final PRP prepared using the same automated device, and the mean PRP count was 12.4 ± 1.7 lac/mm 3 .

Table 13: Mean platelet count and platelet count in PRP:

Thus, platelet count in PRP was increased to four times the baseline platelet count which is considered optimal in most of the studies.

Discussion

AGA is one of the most common causes of hair loss encountered in general practice. Due to the limited treatment options available, there has been a continuous search for newer treatment options in AGA among which PRP therapy has shown promising results in the recent past.
Although many studies have been done in the past demonstrating the efficacy of minoxidil therapy and PRP therapy independently, there has not been much in the literature about the comparison of both forms of therapies. Hence, in this study, we compared already established minoxidil therapy with relatively newer PRP therapy which could help us to conclude that which is more safer, convenient, and efficient form of therapy in the treatment of AGA.
We used 25–35 ml of venous blood to prepare PRP, which was slightly higher as compared to studies by Betsi et al., Cervelli et al., Khatu et al., and Gkini et al. who used 16 ml, 18 cc, 20 ml, and 16 ml of blood, respectively. In some studies such as Ubel et al., Greco and Brandt et al., and Kang et al., blood volume used was much higher as compared to our study, that is, 80 cc, 60 cc, and 60 ml, respectively.
PRP can be prepared by manual double-spin technique as well as with the help of automated devices. PRP was prepared by manual double-spin method in the present study, and similar methods of PRP preparation were also adopted by Ubel et al. and Khatu et al. PRP preparation through automated devices was preferred in studies such as Betsi et al., Cervelli et al., and Gkini et al., and average time taken by automated devices to separate PRP from blood was 5–10 min in a single spin at 1100–1500 g.
Regarding the use of activator in PRP, we used calcium gluconate which was also used by Gkini et al. while other studies such as Khatu et al. and Ubel et al. used calcium chloride as an activator. Some studies such as Betsi et al. and ‘Greco and Brandt’ et al. have not mentioned the use of activator in their study.
In this study, the mean baseline platelet count was around 3 lac/mm3 which was increased to 12 lac/mm 3 in PRP after centrifugation. The findings were similar to Ubel et al. where the final PRP concentration was 4–6 times the baseline. In studies by Cervelli et al., the platelet concentration in PRP mentioned was 14.84 lac/mm 3 while PRP concentration in the study by Gkini et al. was 11.02 lac/mm 3. In other studies such as Greco and Brandt et al., Betsi et al., and Khatu et al., the final concentration in PRP was not mentioned .

Table 14: Summary of various studies showing mode of PRP preparation, activator used, platelet concentration, volume of PRP and sample size

Even though PRP therapy has been used for over a decade in AGA, there are still no standard treatment protocols regarding number of sessions and interval between the two sessions for giving PRP therapy. We gave PRP therapy at a monthly interval for 4 months, that is, 4 sessions 1 month apart which was similar to Cervelli et al. who gave PRP therapy at monthly interval for 3 months, that is, 3 sessions 1 month apart.
Evaluation methods used in our study were global photography, hair pull test, patient standardized hair growth questionnaire, and patient satisfaction score for both Groups A and B. Apart from this, mean platelet count and platelet counts in PRP were also calculated to clinically correlate with the improvement in the patients of PRP group. Similar evaluation methods were also used by Betsi et al. which included clinical examination, digital images, hair pull test, and patient satisfaction score. In their study, all the patients (100%) had a negative hair pull test after third treatment, and patient satisfaction score was 7.0 on a scale of 1–10. In this study, negative hair pull test was in 12 out of 16 (75%) patients in Group A and mean patient satisfaction score was 6.56 ± 1.09 at the end of treatment. Khatu et al. used global photography, clinical examination, and phototrichogram to evaluate response to treatment in PRP patients, and in their study, 81.81% of patients had negative hair pull test at 3 months (four sessions) of treatment which is slightly higher as compared to our study, that is, 75% at 6 months (four sessions), while patient satisfaction score was 7 on a scale of 1–10 which was almost comparable to our study .

Table 15: Treatment protocols, evaluation methods, and results of various studies in comparison to the present study for Group A (platelet-rich plasma group)

Multiple randomized control trials as well as case series have already established the effectiveness of topical minoxidil therapy for the management of AGA.
In 2002, Olsen et al. conducted a randomized clinical trial of 5% topical minoxidil solution versus 2% topical minoxidil solution and placebo in the treatment of AGA. Patients were given treatment for 48 weeks, and after 48 weeks of therapy, 5% topical minoxidil was significantly superior to 2% minoxidil and placebo in terms of change from baseline in nonvellus hair count (18.6 ± 25.4 in 5% minoxidil vs. 12.7 ± 20.7 in 2% minoxidil vs. 3.9 ± 21.7 in placebo group). Evaluation methods used included hair counts which were obtained from computer-assisted scans of macrophotographs of clipped hair in a 1 cm 2 target evaluation area in the balding vertex scalp, patient self-assessment, and investigator assessment of hair growth using validated hair growth questionnaires. In this study, a different standardized hair growth questionnaire was used for evaluating efficacy of both forms of treatments along with other variables such as global photography, hair pull test, and patient satisfaction score which were not included in the study by Olsen et al.
A randomized study was done by Tsuboi et al. which compared 5% and 1% minoxidil solution for the treatment of AGA in Japanese male patients. They found that after 18 weeks, the mean change in hair count was 22.3 in Group 1 (5% minoxidil) and 17.2 in Group 2 (1% minoxidil) yielding a P value of 0.009 which was statistically significant. Evaluation methods used were photography of hair with CCD microscope system, investigator assessment, and patient self-assessment using a 5-point scale: (i) markedly improved; (ii) moderately improved; (iii) slightly improved; (iv) unchanged; and (v) worsened. In this study, a different standardized hair growth questionnaire was used for evaluating efficacy of both forms of treatments along with other variables discussed in results which were not included in the study by Tsuboi et al.
Recently, Navarro et al. retrospectively compared plasma rich in growth factors (PRGFs) and topical minoxidil therapy for the treatment of AGA. Evaluation methods used were diagnostic trichograms to analyze the anagen/telogen hair change improvement. PRGF-treated patients showed higher anagen hair increase compared to minoxidil-treated ones (6.9% ± 0.4% and 4.6% ± 0.5%, respectively) (P < 0.05). Telogen hair decrease was also higher in PRGF group (5.7% ± 0.3% and 2.6% ± 0.5%, respectively) (P < 0.05). Differences for both anagen/telogen improvement percentages between PRGF and minoxidil protocols proved to be statistically significant (P < 0.05). Global photographs showed an overall volume and quality hair improvement for both treatments. In this study also, intradermal PRP therapy was found to be superior to topical minoxidil therapy for the treatment of AGA although the evaluation method was different except for global photography.
To the best of our knowledge, this was the first prospective study comparing the efficacy of PRP and minoxidil therapy for the treatment of AGA where we concluded that intradermal PRP therapy (Group A) was better than topical minoxidil therapy (Group B). PRP patients had a better outcome on global photography, hair pull test, patient satisfaction score, and patient standardized hair growth questionnaire. Side effects in patients in PRP group were mainly pain at injection site because of which four patients left the treatment and were excluded. No significant side effects were observed in Group B patients except for mild scaling but six patients in this group left medication because they found it to be ineffective even at 3–4 months of treatment and were eventually excluded from the study.

Conclusion

PRP therapy can be a valuable adjuvant to topical minoxidil therapy in the treatment of AGA. Side effects with PRP therapy were minimal with better results which may improve the compliance of the patient. It can be especially preferred in those patients who are unsatisfied or are noncompliant to regular use of minoxidil or oral finasteride therapy. Thus, both forms of therapies can be combined together for improved compliance and better outcome. Major limitation of this study was a small sample size, study period, and no use of unit area trichoscopic analysis for hair density.

Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.

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2. Kaliyadan F, Nambiar A, Vijayaraghavan S. Androgenetic alopecia: An update. Indian J Dermatol Venereol Leprol 2013;79:613-25.
3. Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges 2011;9 Suppl 6:S1-57.
4. Landesberg R, Roy M, Glickman RS. Quantification of growth factor levels using a simplified method of platelet-rich plasma gel preparation. J Oral Maxillofac Surg 2000;58:297-300.
5. Li ZJ, Choi HI, Choi DK, Sohn KC, Im M, Seo YJ, et al. Autologous platelet-rich plasma: A potential therapeutic tool for promoting hair growth. Dermatol Surg 2012;38:1040-6.
6. 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;2014:760709.
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17. Navarro MR, Asín M, Martínez MA, Martínez AM, Molina C, Moscoso L, et al. Management of androgenetic alopecia: A comparative clinical study between plasma rich in growth factors and topical minoxidil. Eur J Plast Surg 2016;39:173-80.

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Will PRP hair treatment cause side effects?

PRP therapy has certainly been depicted as a very promising treatment for stimulating hair growth. Patients who have undergone PRP treatments have noted that their hair is fuller and healthier following a series of three to four sessions. What is perhaps most exciting about PRP hair treatment is that for suitable candidates, the treatment can significantly increase the thickness of the hair without the need for hair transplant surgery.

PRP has been used for other purposes since the 80s, such as activating wound healing or enhancing the skin. The therapy is simple and based on the premise that high concentrations of platelets in plasma cells could promote hair growth by prolonging the growing phase of the hair cycle. Plasma contains white blood cells and platelets, which are rich in growth factors and can stimulate the activity of the hair follicles. Clinical studies have found PRP effective for androgenic alopecia.

The treatment uses the patient’s own plasma and injects it into the scalp in a procedure that takes approximately an hour. The blood is taken from a vein in the arm and is then spun through a centrifuge to separate the red blood cells from the plasma. Because the process uses the body’s own plasma, the possibility of an adverse reaction to the treatment is extremely unlikely. However, while there are no known major side effects from PRP therapy, there are still minor risks and complications associated with the treatment.

Therapies that use injections such as PRP do carry a small risk of injury to blood vessels or nerves or, in extremely rare cases, infection. However, experienced doctors and surgeons have a sophisticated awareness of how to deliver injections in a way that minimizes this risk. Other possible minor side effects include granulomas occuring at the injection site. These occur if the plasma is inadvertently injected into the fat, rather than into the muscle, which can cause the death of fat cells. Some clients have also reported a sensation of tightness in their scalp, or minor headaches after the injections. Some mild pain can also occur as the injections are delivered, along with redness or pinprick bleeding at the injection sites.

While many people are excellent candidates for PRP hair treatment, there is a range of conditions that may preclude certain individuals. If you currently drink or smoke, you will need to cease both habits for at least four weeks before you can undergo PRP. This is because smoking can lower the platelet count in the blood and alcohol can inhibit the body’s ability to create stem cells. Other contraindications include:

  • Cancer
  • Infection in the treatment area
  • Systemic disorders (affecting the entire body)
  • Metabolic disorders
  • Chronic infections
  • Platelet dysfunction syndromes
  • Liver disease
  • Recent corticosteroid injections

During your initial consultation with your hair restoration expert, he or she will discuss your health history in detail to determine whether or not you are a suitable candidate for PRP. Your doctor will also discuss the number of sessions you are likely to need to achieve the best results.

Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol

Androgenetic alopecia (AGA) is a common hair loss disorder caused by genetic and hormonal factors that are characterized by androgen-related progressive thinning of scalp hair in a defined pattern. By the age of 60 years, 45% of men and 35% of women develop AGA. Currently, U.S. Food and Drug Administration-approved treatments for AGA include oral finasteride and topical minoxidil. Due to the limited number of effective therapies for AGA, platelet-rich plasma (PRP) has become an effective alternative treatment. PRP is an autologous concentration of platelets in plasma with numerous growth factors that contribute to hair regeneration. The growth factors contained within the alpha granules of platelets act on stem cells in the bulge area of the hair follicles and stimulate the development of new follicles along with neovascularization. PRP has become a promising treatment modality for AGA. Although there have been several studies previously reported, a standard practice for PRP preparation and administration as well as a method to evaluate results have not been established. This literature review was conducted to evaluate the effectiveness of PRP for AGA and discuss the various treatment protocols that have been proposed.

Hair loss: Diagnosis and treatment

Dermatologist examining a patient with hair loss

To find out what’s causing your hair loss, a dermatologist may use a tool called a dermascope to get a closer look.

Effective treatment for hair loss begins with finding the cause. To get an accurate diagnosis, it helps to see a board-certified dermatologist. These doctors have in-depth knowledge about the many causes of hair loss and experience treating the diverse causes.

How do dermatologists find out what’s causing hair loss?

To pinpoint the cause of your hair loss, a dermatologist begins by gathering information. Your dermatologist will:

  • Ask questions. It’s important to know how long you’ve had hair loss and whether it came on quickly.

  • Look closely at your scalp, nails, any other area with hair loss. This exam provides vital clues about what’s happening.

  • Test the health of your hair. Gently pulling on your hair tells your dermatologist a lot about how your hair is growing and whether it’s prone to breaking.

If your dermatologist suspects that the cause of your hair loss could be a disease, vitamin deficiency, hormone imbalance, or infection, you may need a blood test or scalp biopsy. These tests can be done in your dermatologist’s office.

Once your dermatologist has this information, it’s often possible to tell you what’s causing your hair loss.

Sometimes, your dermatologist needs more information. This might be the case if someone has more than one cause. For example, a woman may have had a baby a few months ago, and this may be causing obvious hair shedding. She may also have early hereditary loss, which isn’t so obvious.

No one hair loss treatment works for everyone

Once your dermatologist finds the cause(s), your dermatologist will tell you whether treatment is recommended. Sometimes, your hair will regrow on its own, making treatment unnecessary.

When hair may regrow on its own

Yes, your hair may regrow on its own. This can happen if you recently:

  • Had a baby

  • Recovered from a major illness or had surgery

  • Underwent cancer treatment

  • Lost 20 pounds or more

  • Developed a mild case of a disease called alopecia areata, which causes your immune system to attack your hair follicles

  • Got rid of psoriasis on your scalp

Your dermatologist can tell you whether your hair may start to grow again on its own.

Sometimes to see regrowth, you need to make some changes.

Changing your hair care (or hairstyle) may help

Some hairstyles and hair care habits can damage hair, leading to hair loss. If your dermatologist finds that this may be causing your hair loss, your dermatologist can recommend changes that will help you stop damaging your hair.

You’ll find tips that dermatologists give their patients at:

  • African American hair: Tips for everyday care

  • Hairstyles that pull can lead to hair loss

  • How to stop damaging your hair

When do dermatologists recommend treatment for hair loss?

While your hair may regrow on its own, your dermatologist may recommend treatment to help it grow more quickly. Sometimes, treatment is essential to prevent further hair loss.

A treatment plan for hair loss may include one or more of the following.

At-home treatments for hair loss

At-home treatments offer convenience, and you can buy many of them without a prescription. Because studies show that the following can help, your dermatologist may include one (or more) in your at-home treatment plan.

Minoxidil (Rogaine®): To use minoxidil, you apply it to the scalp as directed, usually once or twice a day.

When used as directed, minoxidil can:

  • Stimulate hair growth

  • Prevent further hair loss

Minoxidil tends to be more effective when used along with another treatment for hair loss. Many people see some regrowth when using minoxidil, but it takes time to see results, usually about 3 to 6 months.

Should you see regrowth, you will need to keep using it every day. Once you stop applying it, hair loss returns.

Minoxidil can help early hair loss; it cannot regrow an entire head of hair.

Laser for at-home use: You can buy laser caps and combs to treat hair loss at home. While only a few studies have looked at these devices, the results are promising.

In one study, more than 200 men and women who had hereditary hair loss were given either a laser hair comb or a sham device that looked like a laser comb. The patients used the device that they were given 3 times per week for 26 weeks.

The researchers found that some patients using the laser rather than the sham device saw overall thicker and fuller hair.

It’s important to understand that not everyone who used a laser saw regrowth.

More studies are needed to find out who is most likely to benefit from this treatment and whether these devices cause long-term side effects.

Microneedling: A microneedling device contains hundreds of tiny needles. A few studies have shown that it can help stimulate hair growth. In one study, men between the ages of 20 and 35 years old who had mild or moderate hereditary hair loss were treated with either:

  • 5% minoxidil twice a day

  • 5% minoxidil twice a day plus weekly microneedling

After 12 weeks of treatment, the patients treated with minoxidil and microneedling had significantly more hair growth.

Other studies have shown that using microneedling along with another treatment, including platelet-rich plasma or a corticosteroid that you apply to the thinning area, helps improve hair growth.

While you can buy a microneedling device without a prescription, it’s best to check with your dermatologist first. Microneedling can worsen some conditions. It’s also important to get the right microneedling device.

The devices used for hair loss contain longer needles than the those used to treat the skin.

Procedures to help regrow hair

While at-home treatments offer convenience, a procedure performed by a board-certified dermatologist tends to be more effective. For this reason, your dermatologist may include one of the following in your treatment plan.

Injections of corticosteroids: To help your hair regrow, your dermatologist injects this medication into the bald (or thinning) areas. These injections are usually given every 4 to 8 weeks as needed, so you will need to return to your dermatologist’s office for treatment.

This is considered the most effective treatment for people who have a few patches of alopecia areata, a condition that causes hair loss. In one study of 127 patients with patchy alopecia areata, more than 80% who were treated with these injections had at least half of their hair regrow within 12 weeks.

Hair transplant: If you have an area of thinning or balding due to male (or female) pattern baldness, your dermatologist may mention a hair transplant as an option. This can be an effective and permanent solution.

To learn more, go to: A hair transplant can give you permanent, natural-looking results.

Laser therapy: If using minoxidil every day or taking medication to treat hair loss seems unappealing to you, laser therapy may be an option. Also called low-level laser therapy, a few studies suggest that this may help:

  • Hereditary hair loss

  • Alopecia areata

  • Hair loss due to chemotherapy

  • Stimulate healing and hair growth after a hair transplant

Studies indicate that laser therapy is safe and painless but requires many treatment sessions. To see a bit of hair growth, you may need several treatments a week for many months.

Platelet-rich plasma (PRP): Studies show that this can be a safe and effective hair loss treatment. PRP involves drawing a small amount of your blood, placing your blood into a machine that separates it into parts, and then injecting one part of your blood (the plasma) into the area with hair loss.

The entire procedure takes about 10 minutes and usually doesn’t require any downtime.

You will need to return for repeat injections. Most patients return once a month for 3 months and then once every 3 to 6 months.

Within the first few months of treatment, you may notice that you are losing less or minimal amounts of hair.

Prescription medication that can regrow hair

Another treatment option is to take prescription medication. The type of medication prescribed will depend on your:

  • Hair loss cause

  • Overall health

  • Age

  • Expected results

  • Plans for getting pregnant

With any medication, side effects are possible. Ask your dermatologist about possible side effects that you might experience while taking one of these medications to treat hair loss. The medications include:

Finasteride (Propecia®): The U.S. Food and Drug Administration (FDA) approved this medication to treat male pattern hair loss. When taken as directed, finasteride can:

  • Slow down hair loss

  • Stimulate new hair growth

Finasteride is a pill that you take once a day. Taking it at the same time each day seems to produce the best results.

Finasteride: Before and after

This man took finasteride to treat his male pattern hair loss, and within 1 year (B), he had noticeable improvement. After 2 years (C), he had regrown most of his hair.

Like other treatments for hair loss, this, too, takes time to work. It usually takes about 4 months to notice any improvement.

Finasteride tends to be more effective if you begin taking it when you first notice hair loss. A dermatologist may also prescribe this medication to treat a woman who has hereditary hair loss and cannot get pregnant.

If finasteride works for you, you will need to keep taking it to continue getting results. Once you stop, you’ll start losing hair again. Before taking this medication, be sure to discuss possible side effects with your dermatologist.

Spironolactone: For women who have female pattern hair loss, this medication may be an option. It can:

  • Stop further hair loss

  • Increase hair thickness

Studies indicate that this medication is effective in about 40% for women who have female pattern hair loss. In one study of 166 women taking spironolactone, 42% said they had mild improvement, and 31% reported increased thickness.

It’s essential that you not become pregnant while taking spironolactone. This medication can cause birth defects. To prevent pregnancy, your dermatologist will also prescribe a birth control pill if it’s possible for you to get pregnant.

Other medications: If you have an infection or painful inflammation, your dermatologist can prescribe medication to treat these.

For example, if you have a type of hair loss called frontal fibrosing alopecia (FFA), which can cause painful inflammation, your dermatologist may prescribe an antibiotic and antimalarial medication. Scalp ringworm, which is caused by a fungus, requires antifungal medication.

Vitamins, minerals, and other supplements

If your blood test reveals that you’re not getting enough biotin, iron, or zinc, your dermatologist may recommend taking a supplement. If you’re not getting enough protein, your dermatologist can tell you how to boost your intake.

You should only take biotin, iron, or zinc when your blood test shows that you have a deficiency. If your levels are normal, taking a supplement can be harmful. For example, if you take too much iron, you can develop iron poisoning. Early signs of this include stomach pain and vomiting.

Other supplements meant to help with hair loss tend to contain a lot of one nutrient. Because this can cause you to get too much of the nutrient, many dermatologists recommend taking a multivitamin instead.

Wigs and concealers

Do you feel uncomfortable taking medication? Does your schedule limit the amount of time you have for treatment? Is the cost of treatment, which insurance generally will not cover, too expensive?

If you answered yes to any of these questions, your dermatologist may recommend a wig or concealer.

While these cannot slow hair loss or help you regrow hair, they can boost your self-esteem. Another advantage is that a wig or concealer offers immediate results.

Many types of wigs, including ones that can be custom-made for you, are available. If you’re looking for a concealer, such as a spray or powder that can hide hair loss, you’ll find many products available online. With endless choices, it can be helpful to have a dermatologist guide you in selecting one.

What is the outcome for someone who has hair loss?

With an accurate diagnosis, many people who have hair loss can see hair regrowth. If you need treatment for regrowth, the earlier you start, the more likely you are to see regrowth.

It’s important to understand that:

  • Not every type of hair loss can be treated, but a dermatologist may be able to prevent further hair loss.

  • It can take months before you see results from treatment.

  • No one treatment works for everyone, even two people with the same type of hair loss.

  • Sometimes, hair loss is stubborn and requires trying different treatments before finding one that works.

Self-care also plays an essential role in preventing and treating hair loss. To find out what dermatologists recommend, go to Hair loss: Self-care.

Images
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  • New generation of laser and light therapies could provide future treatment options for skin, hair and nail conditions,” News release issued March 16, 2012. Last accessed May 22, 2019.

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Jimenez JJ, Wikramanayake TC, et al. “Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study.” Am J Clin Dermatol. 2014;15:115-27.

Kumar MK, Inamadar AC, et al. “A randomized controlled, single-observer blinded study to determine the efficacy of topical minoxidil plus microneedling versus topical minoxidil alone in the treatment of androgenetic alopecia.” J Cutan Aesthet Surg. 2018;11:211-6.

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