A randomized blinded retrospective study: the combined use of micro-needling technique, low-level laser therapy and autologous non-activated platelet-rich plasma improves hair re-growth in patients with androgenic alopecia

Abstract

Introduction: Mini-invasive therapies based on autologous non-activated Platelet-Rich Plasma (ANA-PRP), Low-Level Laser Therapy (LLL-T), and Micro-Needling Technique (MN-T) used in combining for hair re-growth need to be standardized. Objectives:The work aims to show in vivo outcomes resulted from retrospective case-series study in which ANA-PRP + MN-T + LLL-T were used in combined in patients affected by Androgenic alopecia. Methods: 23 patients were treated, of which 13 males were classified in stage I-V by the Norwood-Hamilton scale, and 10 females were classified in stage I-III by the Ludwig scale. Assessment of hair re-growth was evaluated with photography, physician's and patient's global assessment scale, and standardized phototrichograms during a follow-up: T0 -baseline, T1 -12 weeks, T2 -23 weeks, T3 -44 weeks, T4 -58 weeks. Results: Interesting outcomes represented by a hair density increase of 81 ± 5 hairs/cm 2 and 57 ± 7 hairs/cm 2 respectively at T1 and T2 compared with baseline (173 ± 5 hairs/cm 2 at T1 and 149 ± 9 hairs/ cm 2 at T2 versus 92 ± 2 hairs/cm 2 at baseline) were observed using computerized trichograms. Expert Opinion: The main limitation in the autologous regenerative therapies and biotechnologies in hair-regrowth is the extreme variability of PRP products used, in the absence of standardized protocols and widely shared. Appropriate PRP preparations have to be pick after carefully thinking about their bio-molecular specifications and intended indications for use in patients. This approach will aid in matching the optimal PRP product to specific patient factors, leading to improved outcomes and the elucidation of the cost-effectiveness of this treatment.The combined use of biotechnologies as the association of PRP with micro-needling and low-level laser therapy may improve the results in terms of hair count and hair density compared with those obtained by alone PRP. All the procedures must be performed in the full respect of international and local rules. Conclusions: The effect of the combined use of MN-T, LLL-T, and ANA-PRP has been demonstrated.

Systematic Review: Adipose-Derived Mesenchymal Stem Cells, Platelet-Rich Plasma and Biomaterials as New Regenerative Strategies in Chronic Skin Wounds and Soft Tissue Defects

“…The role of PRP in wound healing and hair regrowth has been recently reported [52], describing the positive effects of autologous GFs contained in activated and not-activated PRP [53,54,56] in androgenetic alopecia comparing, the results with a micro-needling technique [55], low-level LED therapy [55], micrografting [57], Minoxidil ® , Finasteride ® , and adult stem cell-based therapy [58].…”

“…Alternatively, the use of autologous platelet-derived growth factors, contained in PRP, may represent a valid regenerative strategy for their capacity to promote cell proliferation, differentiation, and neo-angiogenesis, favoring, in vivo, the WH process [52], and hair regrowth (HR) has been reported recently [53][54][55][56][57][58].…”

The new regenerative and innovative strategies in hair loss

“…Although surgical as hair transplant and multiple non-surgical therapeutic methods like topical Minoxidil®, oral Finasteride®, and low-level laser/led therapy (LLLT) had been introduced to the treatment of Female-AGA, further randomized controlled trial treatments must be performed [ 2 , 9 ].…”

“…The use of autologous platelets derived growth factors, contained in PRP, represented by basic fibroblast growth factor, platelet-derived growth factor, vascular endothelial growth factor, epidermal growth factor, transforming growth factor-β, and insulin-like growth factor-1 [ [2] , [3] , [4] , 9 ], may represent a valid regenerative strategies for their capacity to promote cell proliferation, differentiation and neo-angiogenesis, favoring, in vivo , the wound healing process [3] . In vitro , antiapoptotic effects of PRP have been identified as one of the major contributing factors stimulating hair growth (HG) via the Bcl-2 protein's activation (antiapoptotic regulator) and Akt signaling, prolonging the survival of dermal papilla cells during the hair cycle.…”

“…In vitro , antiapoptotic effects of PRP have been identified as one of the major contributing factors stimulating hair growth (HG) via the Bcl-2 protein's activation (antiapoptotic regulator) and Akt signaling, prolonging the survival of dermal papilla cells during the hair cycle. In particular, the up-regulation of fibroblast growth factor-7 (FGF-7)/β-catenin signaling pathways with PRP treatment is suggested to stimulate HG by inducing HF-MSCs differentiation as well as prolonging the anagen phase of the HG cycle [ [2] , [3] , [4] , 9 ].…”