Jeffrey Rapaport, MD: Meta-analysis shows clinical efficacy in androgenic alopecia; both monotherapy and combination therapy are utilized with positive results. Dermatologists have developed and proven a protocol that entails monthly treatments for 3 to 4 months followed by a maintenance phase.8 They have also found that scarring therapy is another possible area with clinical improvement.

Raja Sivamani, MD: At this time, PRP treatment is in its early stages, as we are still trying to balance 2 factors: how the PRP is obtained, as there are many differences in the methodologies and the final product, and  the clinical evidence for use in hair loss. Both need to be figured out. While early results are promising for the use of PRP for some types of hair loss, more research around the extraction methodology and clinical results isneeded. Furthermore, we are also trying to understand how PRP can be used with other modalities such as microneedling.

Dermatology Advisor: How common is PRP in clinical practice currently?  

Dr Rapaport: PRP for hair restoration is becoming mainstream for AAD members. I cannot give an exact percentage as no studies have examined this. However, a significant percentage of clinicians treating hair disorders are utilizing PRP.

Dr Sivamani: PRP is gaining traction, although it is not in common use in all dermatology practices at this time. However, more and more dermatology practices are starting to incorporate this treatment modality.

Dermatology Advisor: For dermatologists interested in learning how to provide PRP treatments, how would you advise them to pursue this?

Dr Rapaport: The AAD provides several educational opportunities at its biennial meetings. Furthermore, AAD meetings feature exhibitors who can provide an opportunity to purchase the necessary supplies.

Dr Sivamani: I think it is important for dermatologists to visit and learn from other dermatologists who are performing PRP and learn what has and has not worked.

Dermatology Advisor: What are the remaining research needs pertaining to PRP for hair restoration?

Dr Rapaport: Additional research is necessary to provide standardization in both treatment and studies. Longer-term studies with better controls are needed and ideal concentrations have yet to be determined.

Dr Sivamani: We still need to understand how PRP varies from methodology to methodology. There are many claims circulating, and more head-to-head studies are needed. More thoughtfully conducted studies will help continue advancing our knowledge in this area.

Dermatology Advisor: Are there any further points on this topic you would like to mention?

Dr Rapaport: I encourage everyone to visit a board-certified dermatologist, as they are the best equipped to perform a hair consultation and PRP treatment. Unfortunately, non-dermatology providers have been using PRP without the same training and background, and response rates will differ depending upon how treatment is provided.

Dr Sivamani: It is important that patients and clinicians in other specialities seek input from a dermatologist when it comes to hair loss, as they can differentiate between the various forms of hair loss. Currently, there is early evidence that shows promise in treating androgenetic alopecia and alopecia areata. Therefore, it is paramount that the diagnosis on the subtype of alopecia is well-established, and input from a dermatologist is required to ensure that the right diagnosis is made. Utilizing PRP inappropriately will lead to poor results and, perhaps of more importance, be a waste of a patient’s money.

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References

  1. Androgenic alopecia. National Institutes of Health, US National Library of Medicine—Genetics Home Reference. https://ghr.nlm.nih.gov/condition/androgenetic-alopecia#statistics Accessed March 11, 2019.
  2. Gupta AK, Carviel JL. Meta-analysis of efficacy of platelet-rich plasma therapy for androgenetic alopecia. J Dermatolog Treat. 2017;28(1):55-58.
  3. Leo MS, Kumar AS, Kirit R, Konathan R, Sivamani RK. Systematic review of the use of platelet‐rich plasma in aesthetic dermatology. J Cosmet Dermatol. 2015;14(4):315-323.
  4. Motosko CC, Khouri KS, Poudrier G, Sinno S, Hazen A. Evaluating platelet-rich therapy for facial aesthetics and alopecia: a critical review of the literature. Plast Reconstr Surg. 2018;141(5):1115-1123.
  5. Giordano S, Romeo M, di Summa P, Salval A, Lankinen P. A meta-analysis on evidence of platelet-rich plasma for androgenetic alopecia. Int J Trichology. 2018;10(1):1-10.
  6. Gupta AK, Versteeg SG, Rapaport J, Hausauer AK, Shear NH, Piguet V. The efficacy of platelet-rich plasma in the field of hair restoration and facial aesthetics-a systematic review and meta-analysis. J Cutan Med Surg. 2019;23(2):185-203.
  7. Giordano S, Romeo M, Lankinen P. Platelet‐rich plasma for androgenetic alopecia: Does it work? Evidence from meta analysis. J Cosmet Dermatol. 2017;16:374-381.
  8. Hausauer,A, Jones,DH, Evaluating the efficacy of different platelet-rich plasma regimens for management of androgenetic alopecia: a single-center, blinded, randomized clinical trial. Dermatol Surg. 2018;44(9):1191-1200.