The Treatment of Female Pattern Hair Loss with Long Acting Platelet Rich Plasma
Opinion
Female Pattern Hair Loss (FPHL), also referred to as Androgenic
Alopecia (AGA), is the most common type of non-scarring hair loss and,
affects up to 40% of women [1]. Classically, FPHL presents as thinning
over the top of the head and patients are concerned with a widened part.
Unlike male pattern hair loss, the hairline is commonly retained. In
the areas of thinning, the terminal, healthy hairs are fewer in number
and there are many miniaturized and/or vellus hairs. The pathogenesis of
FPHL is complex and likely is triggered by an underlying genetic
predisposition and environmental influence. Originally, it was believed
that androgens were responsible for FPHL hence the term androgenic
alopecia. This notion has been challenged recently as there are reports
of women with FPHL that are androgen insensitive. Thus, in this subset
of patients, the appearance of FPHL is due to factors other than
androgens [2]. On hair shaft biopsy of FPHL, there is often evidence of a
microfolliculitis surrounding the hair bulge of the miniaturized hairs
and this finding is not found surrounding the terminal hairs, suggesting
that inflammation plays a role in FPHL [3].
These findings may explain why some women do not respond to hormonal
therapy such as finasteride but do respond to treatments that target
inflammation, such as platelet rich plasma (PRP) therapy. PRP therapy
involves the use of a patient’s own growth factors to influence and
support the growth of hair. PRP is made through centrifugation of a
patient’s blood during an office visit. The least dense layer is the
platelets within plasma. Within the platelets are granules that contain
more than 20 different growth factors including platelet-derived growth
factor, fibroblast growth factor, transforming growth factor, and
vascular endothelial growth factor [4]. These growth factors are
released into solution by adding calcium chloride or citrate in a
process called “activation”. Once in
solution, the growth factors are concentrated to a level the body never
routinely experiences. The growth factor rich solution (PRP) is then
injected into areas of thinning at the level of the follicle in the
sub-dermis. There are many kits available to physicians to aid in the
production of PRP. Some kits link the growth factors to fibrin, known as
Platelet Rich Fibrin Matrix or Long-Acting PRP (LA-PRP). In hair loss, I
believe this is very advantageous as hair grows slowly and the scalp is
vascular. There are studies showing that traditional PRP is washed away
in as little as 24 hours where as PRFM may last many weeks if not
months slowly releasing growth factors [5]. I believe the duration of
effect is the single most important variable in achieving growth when
treating hair loss with PRP.
In my practice, I only use LA-PRP and I will pretreat the target area
of thinning scalp with a ring block with local anesthesia prior to
LA-PRP injection. The LA-PRP session is routinely completed in a single
office visit lasting less than 30 minutes, and patients have no downtime
from work. The results from a treatment take 2-4 weeks to begin and
last for 6 months. Patients will describe first a reduction in shedding,
a thickening of the shaft diameter, and possibly new hair growth. After
6 months, the improvement from PRP wanes. Patients are comforted in
knowing that all the blood products in this treatment come from their
own blood, eliminating the risk of viral infection, allergy, and
growth-factor rejection. In my experience in over 500 patients, there
has not been an increase in shedding or acute telogen effluvium from
treatment at any point in the treatment course. I have also noted that
increased frequency of sessions of PRP lead to improved results. There
are likely patients who have a genetic predisposition to FPHL and show
both a sensitivity to hormonal as well as inflammatory insult. In these
patients, combined therapy with minoxidil as well as LA-PRP has been
very valuable. There are many reports of shedding upon starting and
stopping minoxidil. This effect seems to be
blunted in females when combining treatment with LA-PRP. The
current literature is becoming populated with various levels of
evidence showing the benefit of PRP for women with FPHL. I would
encourage more research into PRFM as an ideal form of LA-PRP for
FPHL, as this treatment has been invaluable for my patients.
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