Platelet-Rich Fibrin Matrix (PRFM) for Androgenetic Alopecia

Abstract

The objective of this study was to determine the effect of platelet-rich fibrin matrix (PRFM) treatment on androgenetic alopecia. Prospective cohort study of 15 (9 male and 6 female) subjects with androgenetic alopecia for at least 1 year who were treated with intradermal injections of autologous PRFM three times on a monthly basis. Hair density indices were measured in triplicate in the same area of the scalp before the treatment and 1, 2, 3 and 6 months after initial treatment. Hair density index (HDI) measurements were obtained and compared with pretreatment values for each subject. After a series of three intradermal PRFM injections, hair density indices increased significantly at 2 (47.4 ± 22.7%, p = 0.0031) and 3 (106.4 ± 56.9%, p = 0.0277, paired t-test) months after the initial treatment, and approached statistical significance at 6 months (75.1 ± 46.82%, p = 0.0606) after the initial treatment. Patients who achieved greater than 25% increase in HDI by 2 months after the initial treatment were more likely to have greater than 25% improvement at 6 months after the initial treatment (100 vs. 16.7%, p = 0.0476). Androgenetic alopecia affects a significant number of both men and women. A series of intradermal injections of autologous PRFM increased the HDI in patients with androgenetic alopecia at 2 and 3 months after initial treatment; this improvement approached statistical significance at 6 months after initiating treatment. Autologous PRFM injections may be a valuable treatment for androgenetic alopecia, particularly in cases with mild hair loss. The level of evidence is level 2.

Keywords

platelet-rich fibrin matrix - platelet-rich plasma - growth factors - alopecia - hair restoration

• References

• 1 Semalty M, Semalty A, Joshi GP, Rawat MSM. Hair growth and rejuvenation: an overview. J Dermatolog Treat 2011; 22 (3) 123-132
• 2 Mecklenburg L, Tobin DJ, Müller-Röver S , et al. Active hair growth (anagen) is associated with angiogenesis. J Invest Dermatol 2000; 114 (5) 909-916
• 3 Kozlowska U, Blume-Peytavi U, Kodelja V , et al. Expression of vascular endothelial growth factor (VEGF) in various compartments of the human hair follicle. Arch Dermatol Res 1998; 290 (12) 661-668
• 4 Han JH, Kwon OS, Chung JH, Cho KH, Eun HC, Kim KH. Effect of minoxidil on proliferation and apoptosis in dermal papilla cells of human hair follicle. J Dermatol Sci 2004; 34 (2) 91-98
• 5 Tosti A, Piraccini BM. Finasteride and the hair cycle. J Am Acad Dermatol 2000; 42 (5 Pt 1) 848-849
• 6 Kang J-S, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol 2014; 28 (1) 72-79
• 7 Zimber MP, Ziering C, Zeigler F , et al. Hair regrowth following a Wnt- and follistatin containing treatment: safety and efficacy in a first-in-man phase 1 clinical trial. J Drugs Dermatol 2011; 10 (11) 1308-1312
• 8 Uebel CO, da Silva JB, Cantarelli D, Martins P. The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg 2006; 118 (6) 1458-1466 , discussion 1467
• 9 Rastegar H, Ahmadi Ashtiani H, Aghaei M, Ehsani A, Barikbin B. Combination of herbal extracts and platelet-rich plasma induced dermal papilla cell proliferation: involvement of ERK and Akt pathways. J Cosmet Dermatol 2013; 12 (2) 116-122
• 10 Takikawa M, Nakamura S, Nakamura S , et al. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth. Dermatol Surg 2011; 37 (12) 1721-1729
• 11 Li ZJ, Choi H-I, Choi D-K , et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg 2012; 38 (7 Pt 1) 1040-1046
• 12 Cohen B. The cross-section trichometer: a new device for measuring hair quantity, hair loss and hair growth. Dermatol Surg 2008; 34 (7) 900-910
• 13 Jimenez F, Ruifernández JM. Distribution of human hair in follicular units. A mathematical model for estimating the donor size in follicular unit transplantation. Dermatol Surg 1999; 25 (4) 294-298
• 14 International Society of Hair Restoration Surgery. International Society of Hair Restoration Surgery: 2011 Practice Census Results. Available at: http://www.ishrs.org/sites/default/files/users/user3/FinalPracticeCensusReport7_11_11.pdf . Accessed October 27, 2013
• 15 Garza LA, Liu Y, Yang Z , et al. Prostaglandin D2 inhibits hair growth and is elevated in bald scalp of men with androgenetic alopecia. Sci Transl Med 2012; 4 (126) 26ra34
• 16 Sun T-T, Cotsarelis G, Lavker RM. Hair follicular stem cells: the bulge-activation hypothesis. J Invest Dermatol 1991; 96 (5) 77S-78S
• 17 Lavker RM, Miller S, Wilson C , et al. Hair follicle stem cells: their location, role in hair cycle, and involvement in skin tumor formation. J Invest Dermatol 1993; 101 (1, Suppl): 16S-26S
• 18 Yang CC, Cotsarelis G. Review of hair follicle dermal cells. J Dermatol Sci 2010; 57 (1) 2-11
• 19 Cotsarelis G. Epithelial stem cells: a folliculocentric view. J Invest Dermatol 2006; 126 (7) 1459-1468
• 20 Akiyama M, Smith LT, Holbrook KA. Growth factor and growth factor receptor localization in the hair follicle bulge and associated tissue in human fetus. J Invest Dermatol 1996; 106 (3) 391-396
• 21 Festa E, Fretz J, Berry R , et al. Adipocyte lineage cells contribute to the skin stem cell niche to drive hair cycling. Cell 2011; 146 (5) 761-771
• 22 Sclafani AP. Platelet-rich fibrin matrix for improvement of deep nasolabial folds. J Cosmet Dermatol 2010; 9 (1) 66-71
• 23 Roy S, Driggs J, Elgharably H , et al. Platelet-rich fibrin matrix improves wound angiogenesis via inducing endothelial cell proliferation. Wound Repair Regen 2011; 19 (6) 753-766
• 24 Sclafani AP, McCormick SA. Induction of dermal collagenesis, angiogenesis, and adipogenesis in human skin by injection of platelet-rich fibrin matrix. Arch Facial Plast Surg 2012; 14 (2) 132-136