SciELO - Scientific Electronic Library Online

 
vol.21 issue2Historical notes needed in laparoscopic cholecystectomy author indexsubject indexarticles search
Home Pagealphabetic serial listing  

My SciELO

Services on Demand

Journal

Article

Indicators

  • Have no cited articlesCited by SciELO

Related links

  • Have no similar articlesSimilars in SciELO

Share


Gaceta Médica Espirituana

On-line version ISSN 1608-8921

Gac Méd Espirit vol.21 no.2 Sancti Spíritus May.-Aug. 2019  Epub Aug 02, 2019

 

Editorial

Platelet rich plasma against androgenic alopecia

Vladimir Sánchez Linares1  * 
http://orcid.org/0000-0002-6889-5299

Laura Nieda Rosales2 

1Policlínico Centro, Sancti Spíritus, Cuba.

2Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus, Cuba.

In recent years there has been an advance in knowledge related to regenerative medicine, one of the pillars that supports it is the administration of growth factors contained in platelet rich plasma (PRP), these have demonstrated their potential in the repair of different tissues, have been used in specialties such as orthopedics, angiology, stomatology, maxillofacial, ophthalmology and dermatology, with results that show the benefits of treatment. 1

Traditionally, platelets are considered as the agents responsible for hemostasis, but they also play an essential role in the repair and regeneration of different tissues. 2

PRP is an autologous plasma volume that contains a platelet concentration higher than baseline (150,000-350,000 / μL) that is obtained after centrifugation. The platelet concentration of this fraction is 3 to 8 times the baseline physiological concentration, which is ideal to ensure an optimal contribution of growth factors. Consequently, PRP is a concentrated suspension of centrifuged blood that contains high concentrations of thrombocytes and protein stores, as well as growth factors that are vital to initiate and accelerate tissue repair and regeneration. 3

PRP is obtained from the extraction of venous blood that is then processed to obtain the platelet concentrate. After extracting between 10 and 40 cm3 of venous blood in tubes with sodium citrate, a protocoled centrifugation is carried out; when centrifuging the separation of the different fractions of the blood is achieved; red blood cells concentrate at the bottom of the tube; platelets, in the upper part in abundant plasma and leukocytes, in the intermediate zone. If the procedure is performed properly, the highest concentration of platelets will be in the area near the red blood cells and this plasma should be used. To achieve platelet degranulation, it must be activated with calcium chloride in optimal concentration; at the end of this procedure, the plasma rich in autologous growth factors is obtained. 4

The therapeutic use of platelets in regenerative medicine is based on the release, after platelet activation, of a large number of growth factors and bioactive molecules with the latter ability to improve tissue healing. Among platelet growth factors, platelet-derived growth factor is important in tissue regeneration because it is attached to blood vessels, acts as a mitogen of mesenchyme cells and enhances the activity of cells with receptors for the factors of platelet growth, which as a whole helps to maintain and prolong the action initiated by the rest of the growth factors. 1,2

A large number of growth factors have been described, among the most important are platelet-derived growth factor, vascular endothelial growth factor, transforming beta growth factor, growth factor similar to insulin types I and II (FCI-I and FCI-II), acidic and basic fibroblast growth factor and epidermal growth factor, among others. 2

The use of platelet rich plasma in dermatology is increasing; the most frequent indications are leg ulcers, photoaging, after laser treatment in acne scars and in alopecia for some years. 1,2,3

Androgenic alopecia is a non-scarring alopecia, it is the most prevalent type of hair loss and manifests itself during the second or beginning of the third decade in the form of gradual hair loss in the frontotemporal region and the vertex, the process begins in any moment after puberty, and the presence of fluff in both temples may be the first sign, the anterior implantation line of the hair recedes on both sides, the forehead is enlarged and raised, the crown can show a total loss of hair. The pathogenesis is centered around the prolongation of the telogen phase and the shortening of the anagen phase of the hair growth cycle, so that the shorter the anagen phase is, the lower the hair growth, in addition to the follicles they shorten and decrease in size, with sclerosis of the dermis and a miniaturization or reduction of the diameter of the remaining hairs. 5,6

Recent studies suggest that the intradermal application of autologous platelet rich plasma in the scalp of patients with androgenetic alopecia promotes the proliferation of dermal papilla cells and protects them from apoptosis by increasing cell survival so they play a key role in hair shaft lengthening; to these effects are added the increase in the thickness of the epithelium, the proliferation of collagen fibers, fibroblasts, elastin and hyaluronic acid, the increase in the number of blood vessels in the periphery of the follicle, improving the cutaneous ischemic conditions and increased vascular structures around the hair follicles. 7

It is proposed that growth factors released from platelets can act on stem cells in the area of bulge protrusion, stimulating the development of new follicles and promoting neovascularization; on the stem cells it produces migration and activation in the bulb area of the follicles, activates the proliferative phase and transdifferentiation of ciliated and stem cells. They have the ability to attract and direct cells to the place where they are needed. Mitosis or cell division to produce new cells and extracellular matrix synthesis prolongs the anagen, a growth stage of the hair follicle, which lasts from 2 to 6 years. 7,8

The main growth factors involved in the establishment of the hair follicle are the vascular endothelial growth factor, epidermal growth factor, insulin-like growth factor type I and fibroblast growth factor. 8)

Dermatoscopy of the scalp has shown in patients with androgenetic alopecia treated with PRP significant hair growth, increased diameter, reduction of yellow spots. 9

This treatment translates clinically into an improvement in hair quality, in the revitalization of the follicle, in the arrest of hair loss, in the activation of the root of the hair, in the increase in the diameter of the hair and its density with this minimally invasive technique. 10,11

Some other studies have demonstrated the effectiveness of autologous platelet rich plasma in causing greater density and increased thickness of transplanted follicular units with positive results. The data demonstrate the clinical, histological efficacy and safety of this treatment. 12,13

Regarding adverse events, there is unanimity in the safety and absence of side effects. Given its autologous nature, PRP is a safe product that lacks the implicit potential risk of diseasing transmission in the use of donor blood material; there are no systemic effects, no risk of coagulopathies or cancer, even if it is biological material obtained from the patient himself some minutes before treatment; only pain, burning and erythema have been described in the treated area that disappears in a few minutes. 14

In the Sancti Spíritus provincial dermatology office from the Center Polyclinic, a high incidence of patients with androgenetic alopecia has been evidenced through the medical record, in Cuba there are no medicines available to treat this disease and those that exist in the world market must be used for a long time and produce adverse events, so it is necessary to conduct controlled experimental studies with platelet rich plasma to assess its effectiveness and safety as a therapeutic modality.

REFERENCIAS BIBLIOGRÁFICAS

1. Fernández Delgado ND, Hernández Ramírez P. Aplicación de las plaquetas con fines regenerativos en Cuba. Rev Cubana Hematol Inmunol Hemoter [Internet]. 2017 [citado 2019 jun 1];33(1):1-10. Disponible en: Disponible en: http://scielo.sld.cu/pdf/hih/v33n1/hih06117.pdfLinks ]

2. Fernández Delgado ND, Hernández Ramírez P, Forrellat Barrios M. Espectro funcional de las plaquetas: de la hemostasia a la medicina regenerativa. Rev Cubana Hematol Inmunol Hemoter [Internet]. 2012 [citado 2019 jun 31];28(3):200-16. Disponible en: Disponible en: http://scielo.sld.cu/pdf/hih/v28n3/hih02312.pdfLinks ]

3. Pérez-Montesinos G, Medina-Bojórquez A, Hernández-Ramírez H, Morales-Sánchez MA, Peralta-Pedrero ML, Jurado-Santa Cruz F. Plasma rico en plaquetas: estudio comparativo de cuatro protocolos para su obtención. Rev Cent Dermatol Pascua [Internet]. 2017 [citado 2019 jun 1];26(2):41-4. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/derma/cd-2017/cd172a.pdfLinks ]

4. Cordero DO. Plasma rico en plaquetas, ¿es útil en dermatología? [Internet]. Med Cutan Iber Lat Am [Internet]. 2015 [citado 2019 jun 1];43(2):87-9. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/cutanea/mc-2015/mc152a.pdfLinks ]

5. Abaroa F, Reyes K, Barrera D, Castelán E, Montemayor B, Izabal G, et al. Hallazgos histopatológicos en las unidades foliculares de sujetos con alopecia androgenética antes y después de la aplicación de plasma rico en plaquetas autólogo. Dermatol Rev Mex [Internet]. 2016 [citado 2019 jun 1];60(2):97-105. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/derrevmex/rmd-2016/rmd162b.pdfLinks ]

6. Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-Rich Plasma for Androgenetic Alopecia: A Pilot Study. Dermatol Surg [Internet]. 2014 [cited 2019 Jun 1];40(9):1010-9. Available from: Available from: https://insights.ovid.com/pubmed?pmid=25111436Links ]

7. Schiavone G, Paradisi A, Ricci F, Abeni D. Injectable Platelet-, Leukocyte-, and Fibrin-Rich Plasma (iL-PRF) in the Management of Androgenetic Alopecia. Dermatol Surg [Internet]. 2018 [cited 2019 jun 1];44(9):1183-90. Available from: Available from: https://insights.ovid.com/pubmed?pmid=30045107Links ]

8. Hausauer AK, Jones DH. Evaluating the Efficacy of Different Platelet-Rich Plasma. Regimens for Management of Androgenetic Alopecia: A Single-Center, Blinded, Randomized Clinical Trial. Dermatol Surg [Internet]. 2018[cited 2019 March 10]:44(9):1191-200. Available from: Available from: https://insights.ovid.com/pubmed?pmid=30141776Links ]

9. Gentile P, Garcovich S, Bielli A, Scioli MG, Orlandi A, Cervelli V. The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial. Stem Cells Transl Med [Internet]. 2015[cited 2019 March 10];4(11):1317-23. Disponible en: Disponible en: http://dx.doi.org/10.5966/sctm.2015-0107Links ]

10. Ferneini EM, Beauvais D, Ferneini MV. Platelet-Rich Plasma in Androgenic Alopecia: Indications, Technique, and Potential Benefits. J Oral Maxillofac Surg [Internet]. 2017 [cited 2018 Dec 7];75(4):788-95. Disponible en: Disponible en: http://dx.doi.org/10.1016/j.joms.2016.10.040 . [ Links ]

11. Jha AK, Udayan UK, Roy PK, Amar AKJ, Chaudhary RKP. Platelet-rich plasma with microneedling in androgenetic alopecia along with dermoscopic pre- and post-treatment evaluation. J Cosmet. Dermatol[Internet]. 2018 [cited 2019 Dec 7];17(3):313-8. Disponible en: Disponible en: http://doi.org/10.1111/jocd.12394 . [ Links ]

12. Ayatollahi A, Hosseini H, Gholami J, Mirminachi B, Firooz FH, Firooz A. Platelet rich plasma for treatment of non-scarring hair loss: systematic review of literature. J Dermatolog Treat[Internet]. 2017[cited 2018 Dec 7];28(7):574-81. Disponible en: Disponible en: http://dx.doi.org/10.1080/09546634.2017.1303571 . [ Links ]

13. Garg S, Manchanda S. Platelet-rich plasma-an 'Elixir' for treatment of alopecia: personal experience on 117 patients with review of literature. Stem Cell Investig[Internet]. 2017[cited 2018 Dec 7];4:64. Disponible en: Disponible en: http://sci.amegroups.com/article/view/15645/15704Links ]

14. Carneiro Marques C, Steiner D, Momente Miquelin G, Tavares Colferai MM, Figueiredo Gatti E. Estudo comparativo e randomizado do Plasma Rico em Plaquetas na Alopecia Androgenética Masculina. Surg Cosmet Dermatol[Internet]. 2016[cited 2018 Dec 7];8(4):336-40. Disponible en: Disponible en: http://www.surgicalcosmetic.org.br/detalhe-artigo/516/Estudo-comparativo-e-randomizado-do-Plasma-Rico-em-Plaquetas-na-Alopecia-Androgenetica-MasculinaLinks ]

Received: June 29, 2019; Accepted: July 08, 2019

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons