Hair loss, a significant dermatological and aesthetic concern, afflicts a substantial portion of the global population, presenting in diverse phenotypes, most notably androgenetic alopecia and telogen effluvium. Androgenetic alopecia, or pattern hair loss, is marked by progressive follicular miniaturization in a characteristic distribution, leading to hair thinning predominantly at the temples and vertex. Telogen effluvium is characterized by a diffuse, transient shedding of hair precipitated by various etiological factors, including physiological stress, nutritional deficits, and hormonal fluctuations.
Platelet-rich plasma (PRP) therapy has recently garnered attention within the domain of hair restoration, predicated on the autologous administration of concentrated platelets and bioactive molecules, ostensibly to catalyze follicular regeneration and enhance hair caliber. This therapeutic approach leverages the premise that platelet-derived growth factors can actuate the anagen phase of hair growth through the modulation of cellular proliferation and differentiation within the hair follicle.
The scientific scrutiny of PRP therapy's effectiveness in hair restoration is ongoing, with empirical evidence presenting a heterogeneous picture regarding its efficacy. This blog post aims to dissect the multifaceted landscape surrounding the success rates of PRP treatment for hair loss, emphasizing the critical analysis of existing research methodologies, the variability in patient response predicated on individual and procedural factors, and strategies for healthcare providers in setting realistic expectations with patients considering this treatment.
What is PRP For Hair Growth?
PRP therapy, an approach being explored for its potential application in treating alopecia, relies on the autologous extraction and concentration of platelets from the patient's own blood. This process leverages the premise that platelets can release growth factors and cytokines that may influence hair follicle activity and health. [1]
Deriving PRP involves drawing blood from the patient, followed by centrifugation to separate the blood components. This centrifugation process yields a fraction of plasma that is enriched with platelets. This concentrated, platelet-rich plasma is then prepared for administration to the patient. The aim is to administer the PRP preparation to regions displaying hair thinning or loss with the intention of influencing hair follicle physiology.
The theoretical underpinning for PRP's utility in mitigating hair loss hinges on the premise that the concentrated presence of growth factors and bioactive proteins can stimulate dormant hair follicles, promoting stem cell activation in the hair bulge area, augmenting follicular angiogenesis, and enhancing the nutritional milieu of the hair follicle. These mechanisms collectively aim to transition hair follicles into the anagen phase of the hair growth cycle, thereby counteracting the manifestations of alopecia. [2]
How Does PRP Hair Treatment Work for Hair Loss?
The efficacy of PRP therapy in the management of alopecia remains a subject of empirical inquiry within the scientific community. This therapeutic modality, predicated on the administration of autologously derived platelet-concentrated plasma, posits a multifaceted mechanism of action in promoting hair follicle health and activity.
The potential mechanisms through which PRP may facilitate hair growth encompass:
1. Increased Growth Factors and Cytokines
Platelets are a rich source of growth factors such as platelet-derived growth factor (PDGF), transforming growth factor (TGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These molecules are instrumental in modulating cellular processes such as proliferation, differentiation, and angiogenesis. The concentrated delivery of these factors to the scalp is theorized to activate hair follicles, encouraging their progression into the anagen phase, amplifying cellular metabolic activity, and fostering the proliferation of dermal papilla cells. [3]
2. Enhanced Scalp Blood Supply
The angiogenic properties of certain growth factors in PRP, notably VEGF, may facilitate the improvement of blood supply to the follicle. This enhanced vascularization is proposed to support the follicular environment by delivering increased oxygen and nutrients, essential for healthy hair growth and follicle vitality. [4]
3. Improved Follicular Microenvironment
By altering the local microenvironment of the hair follicles, PRP may improve the conditions necessary for hair growth. This includes not only the direct effects of growth factors on follicles but also the modulation of the extracellular matrix and improvement in follicular anchoring, potentially reducing hair shedding and promoting denser hair growth. [5]
Understanding Platelet Rich Plasma Success Rates
The determination of a singular, universally applicable success rate for PRP therapy in the treatment of alopecia presents a formidable challenge, attributed to an array of factors that include methodological diversity, patient heterogeneity, and the intrinsic complexity of measuring hair restoration outcomes.
Clinical investigations into PRP's efficacy are often characterized by limited sample sizes, which may constrain the statistical power and generalizability of findings. Furthermore, the lack of standardization in PRP preparation protocols, treatment frequencies, and outcome measures across studies introduces significant methodological variability. This, in turn, hampers the direct comparability of research outcomes.
Additionally, the wide spectrum of patient characteristics, including variations in age, gender, alopecia type and stage, and concomitant therapies, further diversifies treatment responses, rendering the aggregation of data and formulation of overarching conclusions more complex. [6]
Reputable medical journals have reported success rates for PRP therapy in alopecia treatment, with findings often presented as ranges due to the aforementioned research heterogeneity. For instance, one study reported hair density improvement of 13% following PRP treatment [7], reflecting the broad variability in outcomes. It is imperative, however, to interpret these figures within the context of the study's design, the baseline characteristics of the patient cohort, and the specific outcome measures employed.
The importance of contextualizing success rates cannot be overstated. An increase in hair density, while quantitatively measurable, may be complemented by subjective assessments of hair quality and patient satisfaction, which are equally critical in evaluating the therapeutic value of PRP therapy. Furthermore, the clinical significance of PRP treatment outcomes should be weighed against the backdrop of existing therapeutic options, considering both efficacy and safety profiles. [8] [9]
Factors Influencing PRP Hair Treatment Success
The success of PRP therapy in treating hair loss is influenced by multiple factors. These include the underlying cause and duration of hair loss, which determine the scalp's responsiveness to treatment. The patient's overall health and the condition of the scalp are crucial, as they can significantly affect PRP efficacy.
The number of PRP sessions and the patient's adherence to the treatment protocol also play pivotal roles in achieving optimal outcomes, as do the skill and technique of the provider in administering the treatment to the targeted areas. Patient compliance with post-treatment care recommendations is likewise vital for sustaining the benefits of the therapy. Additionally, concomitant medications or treatments for hair loss may serve as confounding variables, potentially influencing the therapy’s effectiveness. [10] [11]
Setting Realistic Expectations with Patients
Effective communication and the establishment of realistic expectations are paramount in the clinical management of patients considering PRP therapy for hair loss. Healthcare professionals bear the responsibility of elucidating the nuances of PRP treatment outcomes, distinguishing between potential hair regrowth and the stabilization of hair loss, which are contingent upon individual patient factors. These discussions should be grounded in a comprehensive assessment of the patient's hair loss etiology, severity, and overall health status, which informs the potential efficacy and limitations of PRP therapy.
Moreover, the principle of informed consent is integral to the patient-provider dialogue regarding PRP therapy. This encompasses a transparent presentation of possible adverse effects, such as discomfort at injection sites, scalp tenderness, and, in rare instances, infection. Additionally, the limitations of PRP therapy, including the variability in response and the need for maintenance sessions, should be communicated clearly to patients.
Potential Limitations and Risks
As PRP therapy garners attention across various medical and aesthetic fields, it's imperative for healthcare professionals to critically assess its limitations and the risks entailed. A thorough comprehension of these factors is pivotal for guiding informed patient consultations on PRP therapy's broad applications.
1. Limited Clinical Evidence
The employment of PRP therapy, while promising, is marked by a scarcity of extensive, longitudinal clinical studies. The substantiation of PRP's effectiveness across different treatment areas, along with a nuanced understanding of its potential side effects and the identification of optimally responsive patient profiles, is an active field of study. The variability observed in treatment efficacy, influenced by the health status and specific goals of individual patients, necessitates a prudent approach from practitioners. Staying abreast of emerging research and delivering a balanced evaluation of PRP therapy's potential and safety across its various applications is essential.
2. FDA Approval
The instruments and protocols for PRP preparation and application have received clearance from regulatory entities like the U.S. Food and Drug Administration. However, specific uses of PRP therapy lack explicit FDA endorsement. As PRP is derived from a patient's own biological materials, it falls outside the purview of drug regulation, affording healthcare providers discretion in its use, tailored to the unique requirements of their patients. [12]
3. Potential for Adverse Reactions
Despite PRP's autologous origin—which significantly reduces the chances of allergic reactions or rejection—there remains a possibility for adverse effects. These can encompass localized discomfort, injection site pain, infection risk, and other procedural complications. It is therefore crucial for healthcare providers to engage in detailed discussions with patients about these risks, ensuring a well-rounded understanding of the safety aspects of PRP therapy for diverse applications.
SELPHYL® Disclaimer
SELPHYL® has not been approved by the FDA for subcutaneous, submucous, or intradermal injections in aesthetic medicine, and the safety and effectiveness of SELPHYL® for these conditions have not been established.
SELPHYL® is designed to be used for the safe and rapid preparation of autologous platelet-rich plasma (PRP) from a small sample of peripheral blood at the patient's point of care. The PRP is mixed with autograft and/or allograft bone prior to application to a boney defect to improve handling characteristics.
As of the time of writing, SELPHYL® has no known serious, life-threatening, or fatal risks apart from the adverse reactions described above.
SELPHYL® Limitations, Restrictions, Cautions, and Warnings
Prescription only.
Do not use the kit if the sterile packaging is damaged or compromised.
Follow universal safety precautions for blood collection and sharps disposal.
During blood draw, failure to align and properly seat tubes in the tube holder can result in a loss of vacuum and a loss of blood draw.
During PRP transfer, failure to align and securely seat tubes simultaneously in assembled blood transfer device tube holders can result in a loss of vacuum and the failure of PRP to transfer to the red-top PRFM tube.
Do not initiate the transfer of PRP into the red-top PRFM tube until the physician is ready to complete the procedure.
Do not reuse.
SELPHYL® Contraindications
These are not in FDA-required labeling and are part of SELPHYL®’s clinical evaluation for EU CE requirements.
Direct connection to a patient’s vascular system of circulating blood volume.
Other health conditions and diseases may also contraindicate the use of autologous PRP, including but not limited to low platelet count, sepsis, localized infection in the treatment area, anemia, malignancy with hematologic or bony involvement, and anticoagulation therapy.
Conclusion
In the realm of alopecia management, PRP therapy emerges as a treatment with potential, albeit characterized by variable success rates influenced by multifactorial patient-specific elements. Key to harnessing PRP's therapeutic prospects is the individualized assessment of patients, where healthcare professionals delineate achievable outcomes, tailoring expectations to the clinical scenario at hand. The conversation surrounding PRP therapy necessitates a candid discussion on its scope, including the possibility of transient discomfort and scalp tenderness, as well as the requirement for ongoing treatment sessions to sustain benefits.
The dynamic landscape of PRP research mandates continuous engagement with emerging studies, enhancing the evidence base guiding clinical decisions. For medical professionals, staying abreast of advancements in PRP applications for hair loss is essential, ensuring that patient consultations are informed by the latest scientific insights. This approach not only fosters informed decision-making but also aligns therapeutic interventions with the current understanding of PRP efficacy and safety profiles, optimizing patient care in the domain of hair restoration.
About the Author
Dr. Ali is a medical journalist and copywriter currently partnering with Selphyl® in crafting medical-related articles.
References
Selphyl. About PRFM. Selphyl. Published June 1, 2023. https://www.selphyl.com/about-prfm
Anitua E, Pino A, Jaén P, Navarro MR. Platelet rich plasma for the management of hair loss: Better alone or in combination?. J Cosmet Dermatol. 2019;18(2):483-486.
Paichitrojjana A, Paichitrojjana A. Platelet Rich Plasma and Its Use in Hair Regrowth: A Review. Drug Des Devel Ther. 2022;16:635-645.
Gentile P, Garcovich S, Bielli A, Scioli MG, Orlandi A, Cervelli V. The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial. Stem Cells Transl Med. 2015;4(11):1317-1323.
Li M, Qu K, Lei Q, Chen M, Bian D. Effectiveness of Platelet-Rich Plasma in the Treatment of Androgenic Alopecia: A Meta-Analysis. Aesthetic Plast Surg. 2024;48(5):977-984.
Justicz N, Derakhshan A, Chen JX, Lee LN. Platelet-Rich Plasma for Hair Restoration. Facial Plast Surg Clin North Am. 2020;28(2):181-187.
Siah TW, Guo H, Chu T, et al. Growth factor concentrations in platelet-rich plasma for androgenetic alopecia: An intra-subject, randomized, blinded, placebo-controlled, pilot study. Exp Dermatol. 2020;29(3):334-340.
Hetz SP, Martin J, Pototschnig H. Patient Satisfaction and Clinical Effects of Platelet-Rich Plasma on Pattern Hair Loss in Male and Female Patients. Cureus. 2022;14(9):e28801.
Stevens J, Khetarpal S. Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol. Int J Womens Dermatol. 2018;5(1):46-51.
Gentile P, Garcovich S. Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia Compared with Minoxidil®, Finasteride®, and Adult Stem Cell-Based Therapy. Int J Mol Sci. 2020;21(8):2702.
Elena EP, Irina OS. Combination therapy with platelet-rich plasma and minoxidil leads to better clinical results than monotherapy with these methods in men with androgenetic alopecia. Int J Trichology. 2022;14(1):1-7.
Johns Hopkins Medicine. Platelet-Rich Plasma (PRP) Injections. Accessed April 8, 2024. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/plateletrich-plasma-prp-treatment