Platelet Rich Plasma in Androgenic Alopecia: Where do we Stand?

Dear Editor, In this issue an article titled ‘Platelet rich plasma in androgenic alopecia: myth or an effective tool’ has shown favourable results with platelet rich plasma (PRP) in androgenic alopecia.[1] There has been growing interest in PRP as a procedure in dermatology.

Literature review shows limited number of articles on PRP in various indications like androgenic alopecia, healing in chronic ulcers and skin rejuvenation. PRP seems to be rational therapy with science of growth factors in tissue regeneration. Level of evidence of various studies in androgenic alopecia is from low to medium.[2] Well-defined double blind trials or split face trials will definitely increase the confidence of clinicians in this procedure.

Methods of preparation vary with different kits and with manual methods. In addition there is no consensus for frequency of this procedure in various indications. Once a month for three months seems to be appropriate for hair growth. Automated kits seem to give better results. In general, platelet concentration should be four to five times normal counts to achieve optimum results. Giusti et al., have showed optimum concentration of platelets around 15 lacs/mm3 for angiogenesis in human endothelial cells.[3]

Precautions like using proper numbering of blood samples, maintenance of sterile environment throughout the procedure, avoidance of infection and temperature control are important for consistent results. Transmission of infections through this procedure is a theoretical possibility. Patients with bleeding disorders, platelet dysfunction syndrome, anti coagulant therapy are contraindications for this procedure.

PRP has shown reliable results in ulcer healing in an Indian study.[4] PRP is also a useful adjuvant to fractional laser therapy in skin rejuvenation.[5] In hair transplant procedures, Ubel reported that enriching hair root grafts in PRP solution showed better results in the form of an increase in hair density.[6]

Though PRP is a newer technique in a dermatosurgeon's armamentarium that can be combined with other therapies like fractional lasers, needle radiofrequency and microneedling, monotherapy is yet to show consistently good results in various studies.