PRP TREATMENT ( PLATLET RICH PLASMA )
PRP with its autologous supply of millions of growth factors works in a multipronged manner, serving as an ‘elixir’ for hair growth and improving overall environment.
PRP is a simple, cost-effective and feasible treatment option with high patient satisfaction for hair loss and can be regarded as a valuable adjuvant treatment modality for androgenic alopecia and other types of non-scarring alopecias.
The most interesting fact in origin of hair is that it arises from amalgamation of ectodermally derived structures giving rise to follicular unit and sebaceous glands and mesoderm tissues forming dermal papillae (DP) which gives rise to arrector pili muscle (APM) and adipocytes. In the bulge area, primitive stem cells of ectodermal origin are found, which express a number of ECM proteins, one of which is nephronectin with five EGF-like repeats.
Interactions between these two kinds of cells (DP and Bulge area) as well as with binding growth factors (PDGF, TGF-β, and VEGF) activate the proliferative phase of the hair, giving rise to the future follicular unit. Reciprocal interactions between epidermal stem cells, dermal papilla cells and epidermal basement membrane are essential for HF ( Hair Follicle) formation and maintenance. GFs appear to act in the bulge area of the follicle, where they bind to their respective receptors located in stem cells.
PRP contains numerous growth factors that give signals to different target stem cells to regenerate, which means that they play highly important role in the mechanism of tissue reparation, enhamncement of tissue healing and regeneration on different levels. PRP contains more than 20 types of growth factors, such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF-β1). These factors regulate cell migration, proliferation, remodelling of the extracellular matrix (ECM) and promotion of angiogenesis, creating a beneficial environment for enhanced wound healing
PDGF induces and maintains anagen phase in hair cycling. PDGF signals are involved in both epidermis-follicle interaction and the dermal mesenchymal interaction required for hair canal formation and the growth of dermal mesenchyme.
VEGF seems to be a major mediator of HF growth and cycling thereby, providing direct evidence that improved follicle revascularization promotes hair growth. PRP injections improve cutaneous ischemic conditions and increase vascular structures around HFs.
The IGF-1, produced by DP cells acts on IGF-1 receptor on keratinocytes, promoting hair growth through stimulation of the proliferation of keratinocytes in HFs and preventing HF from developing catagen like status .
Basic fibroblast growth factor (b FGF) promotes the proliferation of cells of papilla in vitro, and therefore, plays a key role in hair shaft elongation .
The activation of stem cells is cyclic which involves periodic β-catenin activity.
Activated PRP also increases levels of the anti-apoptotic protein Bcl-2, thereby preventing apoptosis. It contributes to the formation of hair epithelium and the differentiation of stem cells into HF cells, through β-catenin up regulation and prolongs anagen phase of hair cycle through an increase in expression of fibroblast growth factor-7.
PRP with its growth factors actually acts on different levels on the hair follicle. Not only does it act on hair follicle stimulation, neovascularization, new hair formation and hair strengthening but also on reducing the hair loss, lengthening the hair growth phase, and reversing the hair follicle miniaturization. As a result of the numerous growth factors, PRP enables complete hair regeneration and rejuvenation and serves as an *elixir * for hair growth.
Alves and Grimalt significant differences 6 months after the first PRP treatment, with an increase in mean anagen hairs (67.6 ± 13.1), telogen hairs (32.4 ± 13.1), hair density (179.9 ± 62.7), and terminal hair density (165.8 ± 56.8) when compared with baseline; though when compared to control group, the only significant value was an increase hair density Kang et al. used a CD34+ cell-containing PRP preparation in 13 patients with AGA and placental extract preparation in a control group. They report an excellent improvement after 3 months of treatment, with an increment in hair count of 20.5% ± 17%, and an increment in hair thickness of 31.3% ± 30.1%.
More than 1 million/µL of platelet concentration (about four to seven times the mean levels) is therapeutically effective concentration. In our clinic we use RegenLab PRP system which allows platelet concentration of 1.1million/μl for maximum efficiency in hair growth.
PRP in alopecia areata concluded that PRP is a safe and alternative treatment for AA as well as cicatricial alopecia, recalcitrant alopecia areata and traction alopecia.