Hair loss has become a so widely spread dilemma negatively affecting the personal and professional lives of men and women alike. Alopecia is the medical term for excessive or abnormal hair loss. Pattern Hair Loss refers to the loss of hair that predominantly affects the front and top of the scalp. Despite, being a problem for both genders, hair loss manifests many differences for men and women including presentation, prevalence, and pathophysiology.
Androgenetic alopecia (AGA) is the most prevalent type of hair loss and it’s related to hormones (androgens) and genetics though the causes are not fully understood. By the age of 50, it affects almost 50% of white males and at least 25% of females1. Also, almost 50% of women are affected by AGA during the course of their life time. This growing unwanted trend of hair loss which often breeds psychological damage to self-esteem and confidence in affected individuals has put recent scientific research and technology on alert to provide discoveries on wound and tissue healing so as to come up with efficient solutions. Hair loss affects every aspect of the hair loss victims’ life, including interpersonal relationships as well as their professional lives. It is not uncommon for people to totally change career paths as a result of their hair loss.2 Effective research is slowly but evidently proving that exclusive PRP (Platelet-Rich Plasma) treatment with other combination treatments are close to providing ideal revolutionary solutions to Pattern hair loss. AGA progressively causes decrease in hair thickness and density, miniaturization of the hair follicle, and potentially significant baldness.
MPHL is Pattern hair loss when it affects males, and AGA accounts for more than 95% of hair loss in men. Although different patterns exist, it is generally characterized by a receding hairline at the temples and hair thinning at the scalp vertex or calvaria. An underlying genetic factor that makes hair follicle sensitive to dihydrotestosterone (DHT) brings about the inability to grow thick, full hair by causing progressive hair thinning and miniaturization of the hair follicle. In order to prescribe an effective treatment procedure for MPHL, it’s very important to understand the progression levels of the hair loss. This can be done through densitometry (assessing the degree of miniaturization of the hair follicles with a densitometer) or by using the Hamilton-Norwood Scale.
The various options of treatment available for MPHL constitute; minoxidil 5% and finasteride (FDA approved), ketoconazole 2% shampoo, low-level laser (light) therapy (LLLT)3, topical growth factors and hair products (ie, Qilib or Revivogen), oral supplements (i.e. Viviscal or Nutrafol), micro-needling (pen or roller), Surgical Hair Restoration and the revolutionary nonsurgical hair restoration with platelet-rich plasma (PRP), PRP and ACell.
Androgenic alopecia (AGA) in women as in men rarely leads to total hair loss. However, the hair thinning pattern and presentation is different from that in males; it usually begins with a widening through the center hair part and often progresses with Hair thinning mainly on the top and crown of the scalp.4
In addition to many women presenting with diffuse thinning which make it more difficult to diagnose, there’s often minimal disruption to the frontal and temporal regions in FPHL. The extensiveness of female pattern hair loss (FPHL) seem to progress with age and menopause especially. Approximately (12%) of women first develop clinically detectable FPHL by age 29 years, 25% by age 49 years, 41% by 69 years, and more than 50% have some element of FPHL by 79 years of age.5 Estrogen levels decline when women approach menopause. Androgen levels could also increase leading to relative increase in DHT. In most such cases, health care providers hardly relate hair loss to the overproduction of androgens because lab results may not reflect abnormal androgen levels. Just like men, these women have a genetic propensity for follicular miniaturization.
Understanding the causes and progression levels of FPHL is essential in the prescription of effective treatment. Women often have multifactorial causes related to hair loss, but the common causes often include; genetics, improper hair care, anemia, pregnancy (just after delivery), menopause, and extreme weight loss.7 Since women present differently on clinical examination, the progression of Androgenic Alopecia is generally classified on the Ludwig scale. It is also vital to use the Savin or Olsen Scale.5
Considering the common presentation and manifestation of FPHL, it is, therefore necessary to rule out underlying androgen-secreting tumors, endocrine disorders, medication-induced alopecia, telogen effluvium, alopecia areata, as well as inflammatory and autoimmune disorders as regular causes.2
The diagnosis of androgenic alopecia (AGA) in women is usually a lot more complicated than in men as further evaluation of differentials require assessing for the typical progressive hair loss pattern and exclusion of other hair loss causes. Trichoscopy and Biopsy can be respectively used for further evaluation and exclusion of the other hair loss causes while Histology would demonstrate perifollicular fibrosis. these recommended diagnostic tests would constitute; hormone levels (dehydroepiandrosterone, total testosterone, androstenedione, prolactin, follicle-stimulating hormone, and luteinizing hormone); comprehensive metabolic panel; zinc; Lyme disease screen; serum iron; serum ferritin; total iron binding capacity; TSH (T3, T4,); VDRL test (a screening test for syphilis); complete blood count; scalp biopsy; hair pull; and densitometry.2
The only FDA-approved medication for women is Minoxidil (2% and 5%). Alternative treatments for women include; Aldactone/Spironolactone; estrogen/progesterone; ketoconazole 2% shampoo; oral contraceptives (caution for women older than 35 years); finasteride (contraindicated in women of childbearing age); LLLT;3 topical growth factors; surgical hair restoration; micro needling (pen or roller); topical hair products (ie, Qilib or Revivogen); oral supplements (ie, Viviscal or Nutrafol); and nonsurgical hair restoration with PRP; PRP and ACell.
Platelet Rich Plasma Therapy in Hair Restoration
PRP heart treatment is an exciting non-surgical alternative for patients who require stimulation of hair growth for hair loss conditions both men and women. Although PRP is not FDA approved for use in hair restoration, it has some other of its systems FDA approved and has shown remarkable and revolutionary results in the treatment of AGA. Platelet-rich plasma (PRP) is an autologous preparation of platelets in concentrated plasma. Although the ideal and most efficient PRP platelet concentration is debatable, majority of the current preparation techniques reportedly involve 300% to 700% enrichment, with platelet concentrations consequently increasing to more than 1,000,000 platelets per micro liter of blood.8 PRP has attracted attention in several medical fields because of its ability to promote wound healing.
Generally, platelets were previously thought only to contribute to hemostasis (first stage of wound healing), but they are now known to initiate wound healing, regeneration, and even hair restoration by secreting various growth factors and cytokines. In this process, referred to as “activation,” platelet alpha granules become activated and release numerous proteins, including platelet-derived growth factor (PDGF- promotes blood vessel growth, cell replication and skin formation), transforming growth factor (TGF- enhances growth of matrix between cells and bone metabolism), vascular endothelial growth factor (VEGF- promotes blood vessel formation), insulin-like growth factor (IGF- normal physiology regulator in nearly every type of cell in the body), epidermal growth factor (EGF- promotes cell growth and differentiation, blood vessel formation, collagen formation), interleukin (IL)-1,9 and Fibroblast Growth Factor-2 (FGF-2 which Laboratory studies have indicated promotes the proliferation and growth of human dermal fibroblasts and human adipose-derived stem cells.)
PRP when used to target regeneration of hair growth in follicles enhance healing and the formation of new cell development as well as going further to accelerate regeneration rate and degree so that telogen hairs are expected to cycle to anagen in a timely manner. In addition, the anagen phase also gets prolonged playing an important role in hair restoration because it is particularly effective in stimulating inactive hair follicles, causing them to revert to the growth phase. PRP is a potential emerging non-surgical therapy for the natural stimulation of hair follicle to tackle thinning hair. Although large scale clinical studies are pending, the current medical advancement contains credible optimistic results.
PRP Hair Treatment Procedure
In most treatment cases, visible results start showing in patients within 60 days of the first injection section. Like for every other procedure, results can vary among individuals. Also, the longer the hair has been dormant, the slower it responds. Women, in particular, are more likely to take much longer before seeing results. In order to guarantee long term success, maintenance with PRP is necessary especially because, AGA is a chronic and progressive genetic disorder.
PRP hair treatment for AGA could cost between $600 to $900 per treatment session and the creation of patient payment packages which include at least the first year of maintenance sessions will boost compliance through the maintenance phase. Though cost and time could limit lots of patients on following up on maintenance sessions, it is highly recommended for patients to have a treatment every 3 to 4 weeks, especially for the first 4 months.
Safety, contraindications, and other complications are greatly taken into consideration in the PRP process. Even though the entire PRP procedure is immunologically neutral and poses no danger of allergy, hypersensitivity, or foreign-body reactions, sterility should be very much respected throughout every stage of the preparation and application of PRP to reduce or shut out any risk of infection. When using intradermal administration, a brief period of inflammation at the wound site may be experienced. Other possible complications include Nerve trauma and hematoma.10
Contraindication for PRP use includes critical thrombocytopenia (low platelet count); hypofibrinogenemia, hemodynamic instability (collapse); infection (sepsis); acute and chronic infections; chronic liver disease; anticoagulation therapy (warfarin, dabigatran, heparin); scarring alopecia; and incidence of excessive drinking or smoking.
Majority of specialists who make use of PRP to address hair restoration encourage, prescribe and utilize combination treatments as they believe improved results are possible. The most common combination is with ACell (a non-cross-linked, completely re-absorbable, acellular extracellular matrix that also is used in wound healing.) The protein in ACell is developed from pig’s bladder and should therefore be avoided in those with an allergy to porcine material and patients who could possibly have a foreign body reaction to the material.
Microneedling combination with PRP is also thought to prolong the effects of PRP and improve results. Microneedling is also a common hair loss treatment which can be performed at the time of PRP treatment or later with a Microneedling Roller. The FDA-approved depth for microneedling rollers is 0.25mm.
PRP is also administered to accompany surgical hair transplant and restoration procedures.
In summary, PRP therapy is an evolving potential non-surgical solution to hair loss in both men and women pending extensive research and adequate applications to enable total breakthrough in the evaluation important of issues like; the safety and efficacy of PRP protocols and combination; comparative analyses of the numerous PRP systems; conclusive patient evaluation and maintenance etc.
Despite pending research, it’s very accurate to say PRP for hair restoration is a valuable addition to dermatology.
Vary JC, Jr (November 2015). “Selected Disorders of Skin Appendages–Acne, Alopecia,
Hyperhidrosis.”. The Medical clinics of North America. 99(6): 1195-211. PMID 26476248. doi:1016/j.mcna.2015.07.003
American Hair Loss Association website. americanhairloss.org. Accessed July 09, 2017.
Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for
treatment of hair loss. Lasers Surg Med. 2014;46(2):144-151.
“Female pattern baldness”. MedlinePlus. Dec 15, 2012. Retrieved Dec 15, 2012.
Dinh QA, Sinclair R. Female pattern hair loss: current treatment concepts. Clin Inter Aging.
Landesberg R, Roy M, Glickman RS. Quantification of growth factor levels using a simplified
method of platelet-rich plasma gel preparation. J Oral Maxillofac Surg 2000;58:297–301.
Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 2004;62:489–96.
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