Platelet-Rich Plasma May Help Vascular Ulcers, but Not Diabetic Ulcers

Two medical vials in his hands with the blood plasma after centrifuge
Investigators sought to determine the safety and effectiveness of platelet-rich plasma on ulcers with different causes.

Platelet-rich plasma (PRP) may be an effective treatment option for patients with vascular ulcers, a new study found. Despite the effectiveness of PRP for vascular ulcers, there does not seem to be a beneficial effect for patients with diabetic ulcers. Findings from this study were published in the Journal of Cosmetic Dermatology.

Researchers from China performed a systematic literature search to identify studies of PRP for cutaneous ulcerations that reported efficacy and safety outcomes. Trials included patients who were treated with PRP, platelet gel, platelet-concentrated plasma, or plasma-rich growth factors and patients with ≥1 ulcer (eg, vascular ulcer, decubitus ulcer, or diabetic ulcer). Studies eligible for inclusion reported ≥1 efficacy or safety outcome, including healing rate, final area, healing time, ulcer closure velocity, percentage area reduction, and adverse events (eg, anemia, contact dermatitis, edema, infection, and pain). A total of 19 randomized controlled trials with 909 patients were included in the meta-analysis.

Compared with conventional ulcer management, PRP was associated with a slightly better healing rate in the general pooled data (risk ratio [RR] 1.49; 95% CI, 1.10-2.02; P =.01), as well as the vascular subgroup (RR, 3.07; 95% CI, 1.05-9.04; P =.04). There was no difference between treatment strategies in the diabetic subgroup (RR, 1.28; 95% CI, 0.95-1.72; P =.10) and pressure subgroup (RR, 7.37; 95% CI, 0.99-54.94; P =.05).

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In the vascular subgroup analysis, there was a significantly smaller final area (mean difference [MD], −7.57; 95% CI, −13.80 to −1.33; P =.02). No differences were observed in the overall dataset (MD, −1.27; 95% CI, −5.62 to 3.07; P =.57) and the diabetic subgroup (MD, 0.90; 95% CI, −3.31 to 5.11; P =.67) in the final area. For ulcer closure velocity, no differences were observed in the general pooled data (standard MD [SMD], 0.74; 95% CI, −0.12 to 1.60; P =.09) and the vascular (SMD, 0.27; 95% CI, −0.26 to 0.79; P =.32) and diabetic (SMD, 1.07; 95% CI, −0.40 to 2.54; P =.15) subgroups. There was no significant difference between groups in terms of healing time in the pooled data (MD, −26.61; 95% CI, −58.86 to 5.65; P =.11).

A limitation of the study included the variability in PRP preparation processes, dosages, and platelet concentrations.

According to their findings, the researchers suggested that a “PRP option should be carefully considered for each patient in accordance with their ulceration etiologies.”

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Shen Z, Zheng S, Chen G, et al. Efficacy and safety of platelet-rich plasma in treating cutaneous ulceration: a meta-analysis of randomized controlled trials. J Cosmet Dermatol. 2019;18(2):495-507.