Mechanical and Controlled PRP Injections in Patients Affected by Androgenetic Alopecia
Summary
This paper aims to describe the interfollicular autologous platelet-rich plasma injections (0.20 mL x cm2) in the scalp of 23 patients affected by androgenetic alopecia at a depth of 5 mm using a medical injector gun equipped with a 30 gauge needle, in three sessions.
Abstract
23 patients (18 male and 5 female) aged 21-70 years who displayed male pattern hair loss (MPHL) in Stage 1 to Stage 5 as determined by the Norwood-Hamilton classification scale, and female pattern hair loss (FPHL) in Stage 1 to Stage 2 as determined by the Ludwig classification scale, were treated with non-activated autologous platelet-rich plasma (A-PRP). Autologous blood (55 mL) was harvested using sodium citrate as an anticoagulant. A-PRP (23 mL) was produced for all cases using a closed system according to the transfusion service protocol. Following centrifugation (260 x g for 10 min) the A-PRP was inserted in a laser light selector device, and after the centrifugation, 9 mL of A-PRP was collected.
The scalp of the patients affected by androgenetic alopecia (AGA) was divided into four areas (frontal, parietal, vertex, and occipital); local anesthesia was not performed. Interfollicular A-PRP injections (0.2 mL x cm2) were performed by controlled and mechanical injections scheduled at a depth of 5 mm using a medical injector gun. Treatment sessions were performed with a 30-day interval. For each patient, three treatment sessions were performed.
PRP was injected in the androgen-related areas of scalp affected by hair loss. Placebo (normal saline solution) was loaded in another syringe (10 mL) and injected on the adjacent side in a similar fashion.
Introduction
The clinical injection of non-activated A-PRP has become an attractive resource for targeting hair growth. Here, the protocol of the A-PRP application in AGA is reported, using mechanical and controlled injections. Currently, only oral selective 5-α-reductase inhibitor, topical diaminopirimidilpiperidin-N-ossido (2.0% and 5.0%), and low-level laser therapy (LLLT) are approved by the US Food and Drug Administration (FDA) to combat MPHL1,2.
Diaminopirimidilpiperidin-N-ossido 5% foam is also approved by the FDA for FPHL. The selective 5-α-reductase inhibitor has proven largely ineffective in treating FPHL3, and, given that the drug may cause abnormalities in the external genitalia of male fetuses, is unsuitable for use by pre-menopausal women4. Conversely, daily treatment with 1 mg of selective 5-α-reductase inhibitor has been shown to reduce serum dihydrotestosterone (DHT) levels by 70% and promotes hair growth of anagen hair leading to gradual increase in hair diameter and hair elongation in male AGA patients5,6, through significant improvements in hair density. The use of oral selective 5-α-reductase inhibitor may require up to one year of treatment and users may develop loss of libido, which may persist after the medication is discontinued7.
Recently, the use of LLLT has been proposed to stimulate hair regrowth. Afifi et al.8 reviewed the existing research studies to determine whether LLLT was an effective therapy for AGA. The topical application of activated autologous platelet-rich plasma (AA-PRP) to harvested follicles prior to implantation has already been shown to increase their survival rate by 15% in patients affected by AGA9, as well as exhibit increased hair density 3 months post-surgery with terminal hair density increasing by 19% during that time10. These findings were confirmed in a study following AGA patients treated with calcium-activated PRP over the course of one year11.
Given the positive results of AA-PRP12 and A-PRP13 as an alopecia treatment, and the lack of data for the clinical injections system, the primary aim of this work is to show mechanical and controlled PRP injections protocol.
18 male and 5 female patients aged 21-70 years who displayed MPHL in Stage 2 to Stage 5 as determined by the Norwood-Hamilton classification scale, and FPHL in Stage 1 to Stage 2 as determined by the Ludwig classification scale, were treated with mechanical and controlled injections of A-PRP. AGA diagnoses were made by a medical history, trichoscopic analysis, clinical evaluation with negative hair pull test, laboratory tests, and urinalysis.
The stage of AGA was evaluated using the Norwood-Hamilton and Ludwig scale. All of the participants included in this study were assessed by a medical doctor specialized in dermatology and two plastic surgeon experts in regenerative plastic surgery and alopecia. The authors considered localized and systemic exclusion criteria for all patients. Systemic criteria were represented by blood and/or platelet disorders, anticoagulant and/or antiaggregation therapy, sepsis, immunosuppression, cancer, use of oral selective 5-α-reductase inhibitor or antiandrogens in the previous 12 months.
Localized exclusion criteria were represented by use of diaminopirimidilpiperidin-N-ossido (2.0% and 5.0%) or corticosteroids for topical treatments in the previous 12 months.
Protocol
Representative Results
Discussion
The authors demonstrated that mechanical and controlled injections of A-PRP represent viable AGA treatment options, with reduction of pain during the procedure compared with manual injection performed by the hands of the surgeon. Patients treated with this protocol were found to have greater increases in hair count and total hair density than patients treated with manual injections.
The most important aspect to obtain an improve…
Disclosures
The authors have nothing to disclose.
Acknowledgements
The authors have no acknowledgments.
Materials
| C-PunT system | Biomed Device, Modena, Italy | www.biomeddevice.it | a closed system medical device to obtain autologous concentrated platelet-rich plasma from the blood |
| Ultim Gun | Anti-Aging Medical System | www.aamedicalsystems.fr | a gun medical device to perform a mechanical and controlled injections of autologous platelet-rich plasma in a selected area of the scalp |
| Trichoscan | Tricolog GmbH, Freiburg, Germany). | www.tricholog.de | trihoScan is a digital software-supported epiluminescence technique for measuring hair count (number of hairs per 0.65 cm2), hair density (number of hairs per cm2), hair diameter, anagen-to-telogen ratio, and vellus hair-to-terminal hair ratio. |
| sodium citrate ACD-A | S.A.L.F. | SAAS2205GPO | anticoagulant for PRP preparation |
| 30-Gauge needle | Becton Dickinson | Z192368 | needle for injections |
| 10 mL mL Luer-Lock syringe | Becton Dickinson | BD309695 | syringe for PRP collection |
References
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