Platelet-rich plasma for hair regrowth requires art and science

Platelet Rich Plasma (PRP) has become a hot commodity in the multi-billion dollar hair loss treatment industry, but there is no gold standard on how to prepare or delivering the treatment is highly technique-dependent, leaving plenty of room for suboptimal results. , according to several experts at the annual meeting of the American Academy of Dermatology (AAD).

“The process is the product,” emphasized Terrence Keaney, MD, associate clinical professor at the George Washington School of Medicine in Washington, DC, as well as co-founder of SkinDC, a private practice in Arlington, Virginia. He characterized PRP as a “growth factor cytokine cocktail”, for which the relative benefits depend entirely on the ingredients.

In other words, the effectiveness of PRP depends primarily on the multiple steps in which blood drawn from a patient is separated into its components, processed to create a platelet-rich product, and then administered to the patient by injection or in conjunction with micro needles. . Although the goal is a concentration of platelets two to five times higher than that found in whole blood, it is not as simple as it sounds.

Many PRP device kits available

“There’s a ton of [centrifuge] devices on the market and many differences in platelet concentration optimization methodology,” Keaney explained. In addition, there are many proprietary collection tubes using different types of anticoagulants and different separating gels which also play a role in the goal of optimizing a platelet-rich and easily activated product.

“Recognizing that each step in the preparation of PRP introduces a source of variation that affects the composition and efficacy of the final product,” said Steven Krueger, MD, who is completing his residency in dermatology at the University of Massachusetts, Worcester, but who has become an expert in the field. He contributed a chapter on this topic to the recently published book, Aesthetic Clinician’s Guide to Platelet Rich Plasma.

The importance of the technique is reflected in the inconsistent results of published controlled trials. Unfortunately, the authors of many studies did not provide details of their protocol. Ultimately, Krueger said this lack of clarity among available protocols has created a serious hurdle in determining which steps are important and how to move the field forward.

Keaney agreed. Due to the frequent lack of detail on how PRP was treated in available studies, the effort to draw conclusions about experiences in different centers is like “comparing apples to oranges”.

“What is the ideal dose and concentrate? We don’t know,” Keaney said.

The first centrifuge device to receive regulatory approval was developed for orthopedic indications over 20 years ago. There are now at least 20 centrifuge devices with FDA 510K clearance to separate blood components to produce PRP. The 510K designation means they are “substantially equivalent” to an already approved device, but Krueger cautioned that their use in preparing PRP for the treatment of hair loss remains off-label.

Inferior devices are marketed

In the ever-expanding world of PRP, there is also a growing range of PRP kits. Some of these kits have been cleared by the US Food and Drug Administration (FDA), but some have not. Krueger warned that commercially available collection tubes are inferior imitations of more established products. He specifically warned against do-it-yourself PRP kits, which are likely less effective at isolating platelets and can also be contaminated with pyogens that cause infection.

“Please use an FDA cleared kit,” he said, warning that the risk of not doing so is not only associated with lack of efficacy, but also with a significant risk of adverse events. serious.

Among centrifuge devices, Krueger and Keaney generally recommend single-spin devices over double-spin devices, especially in centers with a limited volume of PRP-based hair loss procedures. These are generally simpler.

When properly prepared, the effectiveness of PRP upon application can also be influenced by activation strategies. Although the exact mechanism of PRP in stimulating hair growth is not completely defined, the role of platelets in the release of growth factors is considered critical. There are a number of methods to stimulate platelets upon administration, such as exposure to endogenous collagen or thrombin or exogenous chemicals, such as calcium chloride, but again the techniques differ and the optimal approach is unknown.

One of the concerns, according to Keaney, is the recent and largely unregulated growth of regenerative cell and tissue products for the treatment of a wide range of clinical disorders or cosmetic problems. He warned of a “wild Wild West mentality” that attracted providers with inadequate training and experience. This, in turn, is now attracting the attention of the FDA as well as those involved in enforcing FDA guidelines.

“There’s definitely more review of regenerative products,” he said, noting that he’s careful about how he markets PRP. While it’s reasonable to offer this treatment off-label as an in-office procedure, he noted that it’s illegal to advertise off-label products. He said he became more cautious about including this option among the hair regrowth services offered in his practice.

Omer E. Ibrahim, MD, a dermatologist affiliated with Chicago Cosmetic Surgery and Dermatology, agreed. While he also believes there is good evidence to support PRP as a treatment option for hair loss, particularly for androgenic alopecia, he also expressed caution about promoting this. approach to the exclusion of other options.

“Patients ask me for a PRP consultation, but there is no PRP consultation in my office,” Ibrahim said. It integrates PRP into other strategies. “I emphasize that this is one part of a multi-pronged approach,” he added.

Ibrahim reported financial relationships with Alastin Skincare, Allergan, Eclipse Medical, Galderma USA and Revision Skincare. Keaney reported financial relationships with Allergan, DermTech, Evolus, Galderma USA, Merz Aesthetics, Revance Therapeutics and Syneron Candela. Krueger did not report any relevant financial relationships.

American Academy of Dermatology 2022. Presented March 25, 2022.

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Christopher S. Washington