On the first day of the 2023 AAD Annual Meeting, Neil S. Sadick, MD, FAAD, highlighted the role of platelet-rich plasma (PRP) in combination therapy for treating alopecia during his session, “Platelet-Rich Plasma and Combination Procedural Options for Alopecia.”

He opened the session by reviewing the therapeutic goals of PRP, which include improving hair density and hair thickness and gaining some anti-inflammatory efficacy. He showed the mechanism of action consisting of improvement in angiogenesis such as vascularization in addition to a decrease in inflammation and oxidative stress on the stem cells of the hair follicles. Hopefully, this also includes triggering stem cell regeneration. He also briefly went over the injection technique, which typically consists of mid to deep dermal injections.

“It's generally felt that higher numbers of platelets are important in PRP, but it still is somewhat of a controversial effect. We're still trying to learn more in our research laboratory as well as others around the country,” he stated.

He continued by addressing the advances in PRP. There are 2 major advances, such as:

• Combination of PRP plus hyaluronic acid where the hyaluronic acid acts as a stabilizer to keep the PRP in place at the injection site
• Topical PRP preparations that are currently being reviewed

Next, Dr Sadick went on to address the combination therapy typically used in the United States, which is PRP and oral minoxidil. He also highlighted other combination therapies, such as fractional lasers and microneedling. The role of microneedling or fractional heating microneedling may be to upregulate the cytokines associated with dermal wound repair. That may have a stimulatory effect on the stem cells and the hair follicles. In fact, microneedling is one of the most common types of technology used with PRP. Fractional lasers are currently being researched. In reviewing the mechanism of action, Dr Sadick emphasized that this is a clinical wound healing type of response, which upregulates the cytokines associated with dermal wound repair, secondarily affecting the stem cells of the hair follicles. However, he added, many people are now using fractional lasers by themselves or in combination with PRP to try to stimulate more hair growth.

“The whole concept of scalp health and a lot of our basic research over the years has been on the role of inflammation in hair loss,” he noted, “So, the general feeling is that if you can keep the hair follicles cleansed and decrease organisms around them, then you can decrease inflammation and hopefully hair loss in that setting,” he added.

Finally, Dr Sadick noted that although PRP and oral minoxidil combination therapy is the standard of care most physicians are following at this time, there are other modalities and technologies that can induce dermal remodeling and improve the wound healing response that stimulates the stem cells of hair follicles.

He shared that clinicians are still trying to understand the durability or the mechanism of action of heating programs and the effect on stimulation of stem cells and wound healing in addition to subsequent increased hair growth. He emphasized that physicians do not really have standardized maintenance programs or settings to use for the technology at this time, but studies are now in progress.

“I believe next year there will be some more consensus recommendation, both for treatment of hair loss using PRP and oral minoxidil in addition to some of the newer technologies included in this setting as well,” he concluded.

Reference
Sadick N. Platelet rich plasma and combination procedural options for alopecia. Presented at: 2023 AAD Annual Meeting; March 17–21, 2023; New Orleans, LA.