PRP Popular for Alopecia Despite Lack of Robust Evidence

Maureen Salamon

July 31, 2017

NEW YORK CITY — Results from three major national studies currently underway should soon supplement the paltry data that now support the use of platelet-rich plasma (PRP) for the treatment of alopecia, according to Neil Sadick, MD, from Weill Cornell Medical College in New York City.

Platelet-rich plasma is the "newest hot therapeutic on the block," but there is no standardized protocol for preparation or administration, he said here at the American Academy of Dermatology 2017 Summer Meeting.

The treatment has been approved only for orthopedic uses by the US Food and Drug Administration (FDA), so it is prescribed off-label for alopecia.

Androgenetic alopecia, commonly known as male-pattern baldness, can affect women too, but the triggers are not as well understood in women as they are in men. Researchers are in the process of generating a "new view" of hair loss — in both men and women — by examining the role of factors such as oxidative stress, inflammation, lymphocytic reactions, and compromised circulation and nutrition, Dr Sadick reported.

Biopsy can help guide treatment recommendations. Patients with inflammation can be treated with high-dose minoxidil, retinoic acid, betamethasone, platelet-rich plasma, nutraceuticals, photobiomodulation with red light therapy, or a combination of treatments, he said. For patients without inflammation, all but betamethasone can be recommended. Combination approaches appear to have synergistic effects.

Despite the lack of established evidence from large, well-designed studies, dermatologists who treat men and women with alopecia should be prepared for patients seeking out platelet-rich plasma, said Maria Hordinsky, MD, from the University of Minnesota in Minneapolis.

You have to get on the bandwagon of PRP if you work with patients with hair loss.

"You have to get on the bandwagon of platelet-rich plasma if you work with patients with hair loss," said Dr Hordinsky, Dr Sadick's copresenter here at the meeting. "There's just no choice. It's very popular."

However, "no one has a set way of doing it," she explained. "We're just getting off the ground, basically."

Dr Sadick explained that he injects a concentrate into the scalp, but others coat the scalp with platelet-rich plasma after microneedling or perform a combination of techniques.

In addition to transforming growth factor beta-1, platelet-rich plasma contains several growth factors — such as epidermal, fibroblast, platelet-derived, vascular endothelial, and keratinocyte growth factors — that are believed to slow hair loss and stimulate new hair growth. Research has suggested that results are better in men than women.

In our practice, "we've seen up to a 10% increase in hair counts," said Dr Sadick. And "probably about one-third of patients had increased hair growth we could document photographically."

He also reported increased hair density and thickness in men and women who underwent microfractional radiofrequency. With this technique, a comb-like device with 36 sharp pins causes "microwounds" in the scalp, which stimulate an anti-inflammatory response and hair growth.

For most dermatologists, minoxidil, finasteride, and photobiomodulation are easy to prescribe for the treatment of alopecia. However, in a small percentage of men, finasteride induces erectile dysfunction that lasts well beyond treatment, and the exact mechanism of photobiomodulation is not known, Dr Hordinsky explained.

Several versions of at-home low-level light devices — which contain either diode lasers or LEDs that emit light continually or in pulses — have come on the market since the first device was approved by the FDA in 2007. Costs range from a few hundred to a few thousand dollars.

"Patients like them. They're sold in stores and are affordable and convenient," said Dr Hordinsky. But "only some have published peer-reviewed evidence regarding efficacy." Direct head-to-head comparisons of the devices are needed.

"I really didn't think the low-energy light worked; I always thought it was just a myth," said Sharona Yashar, MD, a dermatologist in private practice in Culver City, California. About 20% of her patients have alopecia, she reported.

The fact that both Dr Sadick and Dr Hordinsky "use it and recommend it is good information to me," Dr Yashar told Medscape Medical News.

Dr Sadick reports financial relationships with Actavis, Allergan, Almirall, Anacor, Auxilium, Bayer, Biorasi, BTG PLC, Carma Laboratories, Cassiopea SpA, Celgene, Cutera, Cynosure, DUSA Pharmaceuticals, Eclipse Medical, Eli Lilly, Endo International, EndyMEd Medical, Eternogen, Ferndale Laboratories, Galderma, Gerson Lehrman Group, Hydropeptide, Merz Aesthetics, Neostrata, Novartis, Nutraceutical Wellness, Palomar Medical Technologies, Prescriber's Choice, Regeneron, Roche, Samumed, Slender Medical, Solta Medical, Storz Medical, Suneva Medical, Valeant, Vanda, Vascular Insights, and Venus Concept. Dr Hordinsky reports financial relationships with Allergan, Astellas, Concert, Incyte, and Procter & Gamble. Dr Yashar has disclosed no relevant financial relationships.

American Academy of Dermatology (AAD) 2017 Summer Meeting. Presented July 27, 2017.

Follow Medscape Dermatology on Twitter @MedscapeDerm and Maureen Salamon @maureensalamon

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