Platelet Rich Plasma Therapy in Dermatology

Platelet-rich plasma (PRP) is an autologous serum containing high concentrations of platelets and growth factors. It is an emerging treatment modality that has demonstrated considerable results in the field of medicine. Initial history of PRP dates back to 1970, where hematologists created the term PRP to describe plasma with a platelet count above that of peripheral blood, and was used as a transfusion product for patients with thrombocytopenia. Since then, it has been used predominantly in the field of maxillofacial surgery (as PRF), musculoskeletal field (in sports injuries), cardiac surgery, and facial plastic surgery, and it continues to develop as a versatile therapy in dermatology. Furthermore, combining PRP with other dermatological therapies, such as lasers, microneedling, and dermal fillers, produces synergistic effects, leading to improved aesthetic results.

What is PRP?
PRP is an autologous serum containing high concentrations of platelets and growth factors. Many growth factors are contained within the alpha granules of platelets, such as platelet-derived growth factors, vascular endothelial growth factor, epithelial growth factor, transforming growth factor beta, and insulin-like growth factor. These growth factors are responsible for promoting stem cell regeneration, soft tissue regeneration, and hair follicle re-growth.

How is PRP prepared?
PRP is obtained from the blood centrifugation process, where a concentration three to five times more than the basal concentration of platelets is obtained. Initially, venipuncture is done to obtain certain amount of whole blood. First, centrifugation separates the whole blood sample into three layers: red blood cells (RBCs), platelet-poor plasma (PPP), and the PRP layer. Subsequent centrifugations isolate the PRP layer, while discarding the RBCs and PPP. The now concentrated PRP pellet is activated, releasing growth factors from the alpha granules.

Use of PRP in Dermatology

1. Alopecia

PRP is one of the emerging treatments of alopecia, with fewer side effects. There are multiple studies indicating that PRP has good tolerance and greater efficacy in the treatment of alopecia, precisely, non-scarring alopecia like androgenetic alopecia and female pattern hair loss. The studies reported the end results as the emergence of new hair, root resistance, and increased hair thickness. Comparing with traditional nonsurgical therapies and the surgical approaches, such as hair transplantation, PRP is believed as a promising treatment of AGA, with lower cost and fewer adverse effects

PRP growth factors promote hair re-growth by stimulating stem cell differentiation of hair follicle, inducing and prolonging the proliferative or growth phase, of hair cycle, i.e. anagen phase. Besides, it also promotes angiogenesis to increase perifollicular vascularization. Multiple continued treatments are required for significant aesthetic improvement of increased hair density, each treatment being placed three to four weeks apart. Similarly, maintenance therapy might be required every two to three months. Furthermore, combining PRP injections with other treatment modalities like finesteride, minoxidil, and low level light therapy will definitely enhance the overall efficacy.

2. Skin rejuvenation

Aging is a complex process that occurs as a consequence of both extrinsic and intrinsic factors. Extrinsic factors are UV radiation, environmental pollutants, and exposure to chemicals. Similarly, hormone levels, genetic regulation, and inflammatory factors that generate molecular changes at the cellular, as well as histological levels, acts as intrinsic factors for aging.
There are multiple modalities for aging prevention, ranging from topical medications such as sunscreens, retinols, and vitamin C, to minimally invasive treatment modalities like chemical peels, botulinum toxin, lasers and fillers. However, none of these alternatives is natural, autologous, and chemical-free.
Different studies have shown that PRP produces remarkable changes on aged skin by restoring vitality, increasing dermal collagen levels, recovering elastic consistency, improving vascular inflow, and stimulating smoothness, tone, and appearance. Its advantages over other treatment modalities is that it can be applied at any age, preferably from the 30 years, which is when the visible changes due to photo-ageing begin to appear.

3. Melasma

Melasma is a chronic pigmentary disorder that presents as areas of symmetrical hyperpigmentation, usually brown or grey on areas of the facial surface that have been exposed to the sun. It is a multifactorial disease caused by the increased synthesis of melanin, which occurs due to ultraviolet radiation, estrogen level misbalance, vascular hyperplasia, and skin inflammation. The management of melasma remains a challenge, as it is stubborn and prone to relapse. A variety of treatments have been tried, but often with inconsistent results. PRP has been proposed as newer treatment modality of melasma; its curative effect is related with its pigment metabolism and anti-inflammatory effects, as well as its skin blood vessel remodeling function.

4. Acne scars

Acne is one of the most prevalent dermatological diseases among adolescents, which even persists into adulthood. Possible outcomes of inflammatory acne lesions are acne scars, which have both cosmetic and negative psychological impact. The main types of acne scars are atrophic and hypertrophic scars. Atrophic scars are sub-classified into ice pick, boxcar, and rolling scars, where ice pick scars are the most common ones.

A number of treatment options have shown promising results in reducing acne scars, such as chemical peels, laser therapy, punch techniques, microdermabrasion, microneedling, and combined therapies. All of these therapies are to some extent associated with adverse effects.

PRP has recently received worldwide attention in the treatment of acne scar due to its ability to promote wound healing and collagen synthesis. The basis of this process is local and continuous delivery of a wide range of growth factors that stimulate the physiological wound healing and reparative tissue processes. It is considered one of the safest procedures due to its autologous nature.

Other dermatologic conditions
PRP has been also used for the treatment of periorbital hyperpigentation, skin ulcers, post burns, and striae.




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