One of the more exciting uses of Platelet Rich Plasma (PRP) injections is its extended use for alopecia treatments in patients. Though it is generally used in combination with other treatments for the hair it has been shown to work as well as a stand-a-lone treatment option in postmenopausal women and early correction of hair miniaturization in men.
Within each dormant hair shaft (bulge) there are stem cells responsible for the growth cycle of hair, it does not contain pigment or melanin but is responsible for the signaling and production of the hair follicle cell within the hair matrix. Platelet Rich Plasma (PRP) when introduced to the scalp will trigger a number of biological activities through the release of glycoproteins thus activating specifically KGF/FGF7 – Keratinocyte growth factor. KGF/FGF7 is a paracrine mediator of epithelial cell growth including hair. CD34+Cells and other cytokines (Alpha SDF-1α) attract additional stem cells to the damaged area and regeneration site. There are other growth factors released within the PRP and they also help in differentiation, proliferation, and inducing other intracellular events. It is believed that these various biological activities and events will activate a dormant hair follicle and allow for new hair growth.
So why doesn’t PRP work for all patients suffering from thinning hair or patterned baldness? There are medical conditions and reasons for thinning and balding hair and there are certain hair follicles where the stem cells are permanently damaged (i.e. fibrosis). Differing delivery methods concerning PRP and the concentration of PRP can influence outcomes as well. Typically platelet rich plasma (PRP) for alopecia treatments are injected at a depth of 1.5-2.0mm (the depth of the bulge associated with the hair shaft). Micro needling devices are also commonly used in combination with the PRP injections to create greater results. The correlation of using micro needling devices relate to various controlled studies showing that minoxidil using a micro needling delivery systems yielded greater results than by using just the topical formulation, both delivery methods is an inexact method of delivery.
The second issue with PRP deals with the variability of platelet concentrations within PRP. Single spin methods in preparing PRP are inferior to the dual spin units in preserving CD34+Cells and in the concentration of platelets needed for differentiation, regeneration, angiogenesis, and new cell proliferation to begin. The FDA Approved dual spin method for harvesting blood platelets yields over 6 times more than other methods of harvesting platelets. Other factors affecting successful outcomes are the handling of the PRP and in proper diagnosis of the type of hair loss the patient is suffering from (i.e. Alopecia Areata).
There are other considerations in determining if PRP is the right choice for treatment of alopecia, changes to the endocrine system in women, testosterone levels, other immune privileged conditions, and early detection will influence the benefits of treatment.
The practical side of using PRP in alopecia treatments is that there are a number of hair follicles that are dormant despite their condition. Platelet Rich Plasma has been shown to initiate hair growth for these dormant cells due to the biological nature of the treatment and interaction of stem cells within the hair follicle. Therefore, whether used in combination with hair transplantation, use of medications (i.e. 82m or Finasteride+), amniotic tissue growth factors, red led light therapies, or other type of alopecia treatments there is a real patient benefit of using PRP in combination with other therapies or by itself.