Total Regrowth in Chronic Severe Alopecia Areata Treated with

Hair Transplant Forum International
www.ISHRS.org
September/October 2015
Total Regrowth in Chronic Severe Alopecia Areata Treated with
Platelet Rich Plasma: A Case Report and Literature Review
Anastasios Vekris, MD, Dimitra Zafeiratou, MD, Antonia Andriopoulou, and Amalia Tsiatoura Athens, Greece
[email protected]
Introduction
Alopecia areata (AA) is a chronic, autoimmune disease that
causes inflammation of hair follicles. AA may lead to nonscarring hair loss that can affect any hair-bearing area of the
body, and in severe cases it may be recalcitrant to usual treatment options.1 Platelet rich plasma (PRP) therapy is an innovative treatment gaining interest in the field of Dermatology and
Plastic Surgery. PRP activates follicular stem cells, which do
not seem to be targeted by the immune system in cases of AA,
causing prolongation of the anagen phase of the hair cycle and
improvement in the function of the hair follicle.2 We present a
case where the use of PRP in a young patient with chronic, severe
AA resulted in total regrowth of his scalp hair.
Case Report
A 15-year-old boy was referred to our Clinic for massive
hair loss in his scalp, eyebrows, and eyelashes of 5 years’ duration. He first presented loss of a round patch of hair at the back
of his scalp, which rapidly progressed to involve 80% of his
total body hair within
4 months (Figure 1).
The patient’s past medical history was free of
any comorbidities and
a review of systems
was unremarkable. He
had already consulted
with another physician
and was using topical
agents, such as minoxidil 5% and mometasone lotion, twice daily,
at the time he sought
our consultation, but Figure 1. The patient’s scalp hair presenting with a
major hair loss at his first consultation with our Clinic,
without noticing any before the onset of PRP treatments.
improvement.
In this setting, PRP seemed like a promising therapeutic
choice as the patient’s history revealed he had already undergone
almost all standard forms of treatment for AA to no avail. As
a result, he was introduced to a suggested therapeutic plan of 6
PRP treatments with 2-months intervals.
Method
The procedure involved collection of 10mL of blood from the
patient, which was then double centrifuged. The PRP was then
pipetted and activated by 0.05mL of 10% calcium chloride to
each 1mL of PRP. The activated plasma with the concentrated
platelets was finally injected into the patient’s scalp and eyebrows
at the amount of 0.1mL/cm2.
Results
The patient came to the Clinic for evaluation 2 months after
the last treatment. A significant response was then recorded.
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There was no evidence of
hair loss. Hair on the scalp
started to regrow and hair
thickness and density were
also increased (Figure 2).
At 6-month follow-up, total
regrowth of the hair on the
scalp of the patient (Figure
3) was noted, along with
major reappearance of hair
in his eyebrows.
Figure 2. The patient’s scalp hair two months
post last treatment, indicating a significant
improvement.
Discussion
AA treatment approach
varies according to the type
and severity of the disease.
The efficacy of the available
treatments, such as minoxidil
and intralesional triamcinolone injections, has proved
limited, and they may as well
include many adverse effects.3 This can cause people
suffering from AA a lot of
problems in their psychosoFigure 3. The young patient at 6 months’
cial life.
follow-up, presenting with impressive results.
There have been few
references in literature suggesting the use of autologous
PRP injections for AA. Kang et al. studied the clinical use
of CD34+ cell-containing PRP for pattern hair loss, resulting
in significant improvement in mean hair count and thickness
compared with baseline values.4 Singh reported the positive
clinical outcome of a study of 20 patients with chronic AA
with frequent recurrences treated with PRP.1 All patients
tolerated the procedure well, without mentioning any side
effects, and only 1 patient out of 20 presented with a relapse.
Finally, a double-blinded, placebo and active-controlled halfhead study on 45 patients was conducted by Trink et al. to
evaluate the effects of PRP on AA.5 The study pointed out
the safeness and effectiveness of PRP as a treatment option
for AA, but it also underlined the need for more controlled
trials to be completed in order to validate the findings.
In our study, the patient was suffering from chronic, severe
AA and he was treated with PRP injections on the scalp and
the eyebrows, prepared from a small volume of his blood after
being centrifuged and activated. PRP activates antiapoptotic
regulators, such as Bcl-2 protein and Akt signaling, leading
to prolonged survival of dermal papilla cells during the hair
cycle and prolonged anagen phase.2 The overall results of the
use of PRP included a significant increase in thickness and
density, with a remarkable total hair regrowth in 6 months’
time.
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Conclusion
We concluded that the use of PRP represents a very promising
as well as a safe option for the management of AA. It diminishes
hair loss, stimulates hair regrowth, and demonstrates a subjective
improvement in the mean number of hair and mean hair density.
However, further research is needed in order to establish PRP as
an alternative treatment for AA.
References
1.
2.
Singh, S. Role of platelet-rich plasma in chronic alopecia
areata: our centre experience. Indian J Plast Surg. 2015;
48:57-59.
Li, Z.J., et al. Autologous platelet-rich plasma: a potential
therapeutic tool for promoting hair growth. Dermatol Surg.
2012(Jul); 38(7 Pt 1):1040-1046.
3.
4
5.
September/October 2015
Falto-Aizpurua, L., S. Choudhary, and A. Tosti. Emerging
treatments in alopecia. Expert Opin Emerg Drugs. 2014;
19:545-556.
Kang, J.-S., et al. The effect of CD34+ cell-containing
autologous platelet-rich plasma injection on pattern hair
loss: a preliminary study. J Eur Acad Dermatol Venereol.
2014(Jan); 28(1):72-79.
Trink, A., et al. A randomized, double-blind, placebo- and
active-controlled, half-head study to evaluate the effects
of platelet-rich plasma on alopecia areata. Br J Dermatol.
2013(Sep); 169(3):690-694.u
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