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Platelet rich plasma: Good for whatever ails you?

DII small banner By Warren R. Heymann, MD
Jan. 13, 2017

platelet rich plasma alopecia
Hair regrowth in ophiasis-type alopecia areata after platelet-rich plasma (PRP) injection. Occipital hair loss before treatment (A) and occipital hair regrowth 3 months after administration of PRP at a concentration 3.5 times above baseline (B).
Credit: JAAD

Okay, okay, I admit it. The first time I ever heard of injecting autologous platelet rich plasma (PRP) for pattern alopecia, my suspicion was that it was being sold by the proverbial snake-oil salesman. I did my utmost to ignore it, but increasingly its use is being reported, and patients are asking questions. It’s time to examine at what PRP is about.

The premise behind utilizing PRP is based on its abundance of growth factors including: PDGF (which promotes chemotaxis of macrophages and neutrophils, and is also involved in re-epithelialization, matrix formation, and remodeling), TGF-b (which inhibits macrophage and lymphocyte proliferation, mesenchymal stem cell proliferation, neutrophil and monocyte chemotaxis, matrix formation), FGF (has a mitogenic effect on fibroblasts, endothelial cells, mesenchymal stem cells, chondroblasts, and osteoblasts; it promotes angiogenesis), EGF (which promotes fibroblast migration and proliferation), VEGF (promotes angiogenesis and increases vessel permeability), and CTGF (promotes platelet adhesion, white blood cell migration and angiogenesis; it also regulates collagen synthesis) (1)

Reviewing PubMed revealed that PRP has been touted for oral lichen planus, alopecia areata, pattern alopecia, pyoderma gangrenosum, ulcers (diabetic, livedoid, dermatomyositis-associated, and venous), skin rejuvenation, and scars (acne, striae).

In their review of the PRP literature, Leo et al reviewed 22 manuscripts: Four evaluated hair-related applications, eight evaluated the treatment of scars and postprocedure recovery, eight evaluated skin rejuvenation and dermal augmentation, and two evaluated treatment of striae distensae.  They concluded that PRP is a relatively new treatment modality with studies suggesting its utility in aesthetic dermatology. (2)

In a split scalp study on 20 patients with androgenetic alopecia, Gentile et al found that at the end of the 3 treatment cycles, the patients presented clinical improvement in the mean number of hairs, with a mean increase of 33.6 hairs in the target area, and a mean increase in total hair density of 45.9 hairs per cm2 compared with baseline values. No side effects were noted during treatment (3). There was only one clinical photograph in the study, but regrowth of hair was evident.

There are two studies utilizing PRP in pyoderma gangrenosum (PG). A 64-year-old woman with a history of ulcerative colitis on azathioprine, developed recalcitrant PG that failed to improve with methylprednisolone or infliximab. Six applications of weekly PRP (in a calcium alginate dressing) demonstrated 50% improvement; one more topical application was given 4 months later, with topical steroids and infliximab throughout her course when PRP was not utilized. Complete healing was noted by 6 months (4). Another two recalcitrant cases of PG were observed to have an impressive response to PRP gel applied to the lesions without the use of other systemic or topical agents (5).
Goldstein et al evaluated the efficacy and safety of autologous PRP injections for the treatment of vulvar lichen sclerosus (VLS). Twelve patients (of 15 initial recruits) with biopsy proven VLS received 2 separate treatments of PRP separated by 6 weeks. Evaluation by dermatopathologists determined that 7 had decreased inflammation on their post-treatment biopsies, 3 had no change, and 2 had a “minimal” increase in inflammation. A repeated measures ANOVA showed that these results were statistically significant. Changes in subjective VAS scores for pruritus and burning were not statistically significant. No adverse reactions were reported except transient discomfort and bruising at the biopsy and injection sites (6).

In conclusion, I’m no longer as skeptical about the use of PRP for multiple disorders. In throwing the proverbial kitchen sink of growth factors at the conditions, something is bound to work! Future studied are needed to elucidate the pathogenesis of alopecia, inflammatory dermatoses, etc. so that the precise beneficial component(s) of PRP can be ascertained. In the interim, standardizing PRP preparation, and performing larger prospective comparative trials are in order before I replace the question mark of the title with a period (or exclamation mark)!

1. Piccin A, et al. Platelet gel: A new therapeutic tool with great potential. Blood Transfus 2016; 25: 1-8.
2. Leo MS, et al. Systematic review of the use of platelet-rich plasma in aesthetic dermatology. J Cosmet Dermatol 2015; 14: 315-23.
3. Gentile P, et al. The effect of platelet-rich plasma in hair regrowth: A randomized placebo-controlled trial. Stem Cells Trans Med 20215; 4: 1317-23.
4. Alvarez-Lopez MA, et al. Refractory pyoderma gangrenosum treated with platelet-rich plasma. J Eur Acad Dermatol Venereol 2016; 30: 1423-4.
5. Budamakuntla L, et al. Autologous platelet rich plasma in pyoderma gangrenosum – two case reports. Indian J Dermatol 2015; 60: 204-5.
6. Goldstein AT, et al. Intradermal injection of autologous platelet-rich plasma for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol 2017; 76: 158-60.

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