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Platelet-Rich Plasma in Androgenic Alopecia: Myth or an Effective Tool
Swapna S Khatu, Yuvraj E More, Neeta R Gokhale, Dipali C Chavhan, Nitin Bendsure
Department of Dermatology, Venereology and Leprosy, Smt Kashibai Navale Medical College, Pune, Maharashtra, India
Address for correspondence: Dr. Swapna S. Khatu, Department of Dermatology, Venereology and Leprosy, Smt Kashibai Navale Medical College, Narhe,
Pune - 411 041, Maharashtra, India. E-mail: drswapnakhatu@gmail.com

ABSTRACT
Platelet-rich plasma (PRP) has become a newer method for the treatment of various types of alopecia. In thisprospective study, safety, efficacy and feasibility of PRP injections in treating androgenic alopecia were assessed.
Eleven patients suffering from hair loss due to androgenic alopecia and not responding to 6 months treatment withminoxidil and finasteride were included in this study. The hair pull test was performed before every treatment session.
A total volume of 2-3 cc PRP was injected in the scalp by using an insulin syringe. The treatment was repeated every
two weeks, for a total of four times. The outcome was assessed after 3 months by clinical examination, macroscopic
photos, hair pull test and patient’s overall satisfaction. Results: A significant reduction in hair loss was observed
between first and fourth injection. Hair count increased from average number of 71 hair follicular units to 93 hairfollicular units. Therefore, average mean gain is 22.09 follicular units per cm2. After the fourth session, the pull test
was negative in 9 patients. Conclusion: PRP injection is a simple, cost effective and feasible treatment option for
androgenic alopecia, with high overall patient satisfaction.
KEYWORDS: Androgenic alopecia, platelet rich plasma, hair pull test

REC Review:
Risk: 5
Efficacy : 2Cost: 20 = maximum risk
5 = least risk
0 = minimum efficacy 5 = maximum efficacy
0 = very expensive
5 = least expensive

INTRODUCTION
Androgenic alopecia or male pattern baldness is a very
common type of hair loss observed in both males andfemales. Platelet-rich plasma (PRP) is an autologous
preparation of platelets in concentrated plasma.
Although the optimal PRP platelet concentrationis unclear, the current methods by which PRP isprepared report 300-700% enrichment, with plateletconcentrations consequently increasing to more than
1,000,000 platelets/L.[1] PRP has attracted attention inseveral medical fields because of its ability to promotewound healing. Activation of alpha granules of platelets
releases numerous proteins, including platelet-derived
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DOI:
10.4103/0974-2077.138352

growth factor (PDGF), transforming growth factor (TGF),
vascular endothelial growth factor (VEGF), insulin-likegrowth factor (IGF), epidermal growth factor (EGF)
and interleukin (IL)-1.[2,3] It is hypothesised that growth
factors released from platelets may act on stem cells in thebulge area of the follicles, stimulating the developmentof new follicles and promoting neovascularisation.[4] The
aim our pilot study was to evaluate the safety, efficacy
and feasibility of PRP for treatment of androgenic
alopecia.
MATERIALS AND METHODS
Between August 2013 and November 2013, all patients
suffering from androgenic alopecia and on topicalminoxidil and finasteride for at least 6 months without
much improvement were considered for PRP therapy.
Written informed consent was obtained. All included
patients were tested by ELISA for HIV, HBS Ag andplatelet count. Exclusion criteria were haematologicaldisorders, thyroid dysfunction, malnutrition and otherdermatological disorders contributing to hair loss. A
1 cm × 1 cm square area was marked over right parietal
area in mid-pupillary line, 10 cm proximal to righteyebrow in each patient. Baseline follicular units weremanually counted with the help of trichoscan in this areaby dividing into four small quadrants [Figures 1 and 2].

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107Khatu, et al.: Platelet rich plasma

Figure 1: Pre-treatment trichoscan image

Figure 2: Post-treatment trichoscan image

Before each session, the hair pull test was performed
three times by the same clinician. All patients wereadvised to avoid washing hair two days prior to thetreatment. A bundle of approximately 50-60 hair wasgrasped between the thumb, index and middle finger
from the base close to the scalp. The hair was firmly
tugged away from the scalp, and the extracted hair
was counted in every session. To evaluate overall hair
growth, hair volume, hair quality and fullness, global
pictures were taken in every session from front, vertex,
lateral and back view.

cm apart) under proper aseptic precaution in minor
operation theatre. A total volume of 2-3 cc was injected.
The treatment was repeated every two weeks for foursessions. At each visit, hair count was noted over theprefixed square area. Subjective improvements ofpatients were noted on a scale of worst (1) to best (10).
We evaluated all the patients at the end of 12 weeks.

PRP was prepared by collecting 20 cc of fresh bloodin sodium citrate containing vaccutainers in minor
operation theatre under proper aseptic precaution.
The tubes were rotated in a centrifugation machine at
1500 revolutions per minute for 6 minutes. The firstcentrifugation is called “soft spin”, which allows blood
separation into three layers, namely bottom RBC layer(55% of total volume), topmost acellular plasma layer
called platelet poor plasma (PPP, 40% of total volume)
and an intermediate PRP layer (5% of total volume)
called the “buffy coat”. Separated buffy coat with PPP
was collected with the help of Finn pipette in anothertest tube. This tube underwent a second centrifugation,
which was longer and faster than the first, called “hardspin”, comprising at 2500 revolution per minute for
15 minutes. This allows the platelets (PRP) to settle atthe bottom of the tube. The upper layer containing PPP
was discarded and the lower layer of PRP was loadedin an insulin syringe containing calcium chloride (1 partcalcium chloride and 9 parts of PRP) as an activator.[5]One hour prior to administration of PRP, anaesthetic
cream was applied over the bald area. Area of the scalp
to be treated was cleaned with cetavlon, spirit andpovidone-iodine. With the help of insulin syringe PRP
was injected over affected area by nappage technique(multiple small injections in a linear pattern one-108

RESULTS
Eleven male patients in the age group of 20-40 years
were included in the study. According to Hamilton
classification of male pattern baldness, 4 patients werein grade 2, 4 patients were in grade 3 and 3 patients werein grade 4 androgenic alopecia.
Before treatment, all our patients (100%) had a positive
hair pull test with mean number of 10 hair. After thefourth session, the pull test was negative in 9 patients(81.81%) with average number of three hairs. A significant
reduction in hair loss was observed between first andfourth injection as noticed by patients. Global pictures
also revealed a moderate improvement in hair volume
and coverage. [Figures 3 and 4] Hair count depicted
average number of 71 hair follicular units over marked
area before starting the treatment, and after 4 sessionsof PRP, average number of follicular units was 93.09
follicular units. Therefore, average mean gain is 22.09
follicular units per cm2. Overall, patient satisfaction washigh with a mean result rating of 7.0 on a scale of 1-10.
The side effects after PRP injections were minimal pain,
redness at the time of injections and pinpoint bleeding.
DISCUSSION
Hair loss has a significant influence on psychologicaldistress and is associated with low self-esteem anddepression. Treatment options for androgenic alopecia
are very limited and include topical minoxidil andJournal of Cutaneous and Aesthetic Surgery - Apr-Jun 2014, Volume 7, Issue 2

Khatu, et al.: Platelet rich plasma

Figure 3: Pre-treatment clinical photograph

Figure 4: Post-treatment clinical photographoral finasteride (FDA approved) either alone or in
combination.[6,7] However, there are several reportedside effects such as headache and increase in otherbody hairs for minoxidil[6] whereas loss of libido has
been reported with oral finasteride. Finasteride alsointerferes with genital development in a male fetus andis contraindicated in pregnant women and those likely
to become pregnant.[7,8]difference in the yield of follicular units on comparing
the experimental with the control areas of the scalp.
The areas treated with platelet plasma growth factors
demonstrated a yield of 18.7 follicular units per cm2
whereas the control areas yielded 16.4 follicular units
per cm2, an increase in follicular density of 15.1 percent.[4]PRP has already attracted attention in plastic surgery,orthopaedic surgery and cardiac surgery because of its
potential use in skin rejuvenating effects, rapid healing,
reduced infection, decreased chance of hypertrophic
keloids and scars.[9,10] Growth factors are known to activate
the proliferative phase and transdifferentiation of hairand stem cells and produce new follicular units. bFGF isreported to promote the in vitro proliferation of papillacells, and thereby plays a key role in elongating hair shaft.[11]We prepared PRP by double spin method, in whichblood cell layers were manually separated. Activationof platelets through coagulation triggers the secretionof various growth factors, which produce mitogenic
effects in various cell types. Activated PRP promotes
the proliferation of dermal papillary cells and prevents
their apoptosis.
In our study, the hair pull test became negative after
four sessions of PRP. This finding is comparable with thestudy conducted by Besti et al.[12] This study also observed
significant improvement in hair volume and coveragein global pictures, but according to our study, only
moderate improvement in hair volume and coverage
was observed.[12]Uebel et al. observed a significant improvement in hairdensity and stimulation of growth when follicular unitswere pre-treated with platelet plasma growth factors
before their implantation. There was a significant

Our study has some limitations. Trichoscopic hairevaluation could have given more objective results.
Sample size is very small. Mean follow up of patients is
also short to draw conclusion regarding the long-term
effectiveness of treatment. Thus, further studies areneeded with longer follow up and with large sample size.
CONCLUSION
PRP injection for androgenic alopecia is a simple, costeffective and feasible treatment option for hair loss
and can be regarded as a valuable adjuvant treatment
modality for androgenic alopecia. Although PRP has
sufficient theoretical scientific basis to support its use inhair restoration, hair restoration using PRP is still at its
infancy. Clinical evidence is still weak. Considering its
excellent safety profile and relatively low cost, PRP hairtreatment is a promising treatment option for patientswith thinning hair.
ACKNOWLEDGEMENT
We would like to acknowledge Dr Vimal Arun Harke forhelping us in preparing PRP.

REFERENCES
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Olsen EA, Weiner MS, Delong ER, Pinnell SR. Topical minoxidil in malepattern baldness. J Am Acad Dermatol 1985;13:185-92.
Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W,et al. Finasteride in the treatment of androgenic alopecia. J Am Acadof Dermatol 1998;39:578-89.
Messenger AG. Medical management of male pattern hair loss. Int JDermatol 2000;39:585-6.
Gardner MJ, Demetrakopolous D, Klepchick PR, Mooar PA. The efficacy
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Glover JL, Weingarten MS, Buchbinder DS, Poucher RL, Deitrick GA
3rd, Fylling CP. A 4-year outcome based retrospective study of woundhealing and limb salvage in patients with chronic wounds. Adv Wound
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11. Katsuoka K, Schell H, Wessel B, Hornstein OP. Effects ofepidermal growth factor, fibroblast growth factor, minoxidil andhydrocortisone on growth kinetics in human hair bulb papilla cellsand root sheath fibroblasts cultured in vitro. Arch Dermatol Res
1987;279:247-50.
12. Besti EE, Germain E, Kalbermatten DF, Tremp M, Emmenegger V.
Platelet-rich plasma injection is effective and safe for the treatmentof alopecia. Eur J Plast Surg 2013;36:407-12.
How to cite this article: Khatu SS, More YE, Gokhale NR, Chavhan
DC, Bendsure N. Platelet-rich plasma in androgenic alopecia: Myth oran effective tool. J Cutan Aesthet Surg 2014;7:107-10.
Source of Support: Nil. Conflict of Interest: None declared.

Commentary

Platelet Rich Plasma in Androgenic Alopecia: Where do we Stand?
Kiran Godse
Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India
Address for correspondence: Dr. Kiran Godse, Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Nerul, Navi Mumbai - 400 706,
Maharashtra, India. E-mail: drgodse@gmail.com

Dear Editor, In this issue an article titled ‘Platelet richplasma in androgenic alopecia: myth or an effective
tool’ has shown favourable results with platelet
rich plasma (PRP) in androgenic alopecia. [1] There
has been growing interest in PRP as a procedure indermatology.
Literature review shows limited number of articles on
PRP in various indications like androgenic alopecia,
healing in chronic ulcers and skin rejuvenation. PRP
seems to be rational therapy with science of growth
factors in tissue regeneration. Level of evidence ofvarious studies in androgenic alopecia is from low tomedium.[2] Well-defined double blind trials or split facetrials will definitely increase the confidence of cliniciansin this procedure.
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Methods of preparation vary with different kits andwith manual methods. In addition there is no consensus
for frequency of this procedure in various indications.
Once a month for three months seems to be appropriate
for hair growth. Automated kits seem to give betterresults. In general, platelet concentration should be four
to five times normal counts to achieve optimum results.
Giusti et al., have showed optimum concentration ofplatelets around 15 lacs/mm3 for angiogenesis in humanendothelial cells.[3]Precautions like using proper numbering of blood
samples, maintenance of sterile environment throughout
the procedure, avoidance of infection and temperature
control are important for consistent results. Transmissionof infections through this procedure is a theoreticalpossibility. Patients with bleeding disorders, platelet
dysfunction syndrome, anti coagulant therapy arecontraindications for this procedure.
PRP has shown reliable results in ulcer healing in an
Indian study.[4] PRP is also a useful adjuvant to fractionallaser therapy in skin rejuvenation.[5] In hair transplant
procedures, Ubel reported that enriching hair root grafts

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