Platelet-Rich Plasma (PRP) in Dermatology: Cellular and Molecular Mechanisms of Action

Abstract

Platelet-rich plasma (PRP) therapy has gained attention in the scientific field due to its potential regenerative effects and great benefit–risk ratio. This review extensively explores the most studied mechanisms of this therapy according to the etiopathogenesis of skin diseases: cellular proliferation, matrix formation, regulation of inflammation, angiogenesis, collagen synthesis, and the remodeling of new tissue. Moreover, it draws on newly reported and lesser-known effects of PRP: its anti-apoptotic effects, immunological suppression, decrease in melanin synthesis, anti-microbial effects, overexpression of miR-155, antioxidant effects, and their involved pathways. This work aims to provide a complete update for understanding PRP’s benefits and clinical relevance in wound healing, alopecia, pigmentary disorders, scars, rejuvenation, lichen sclerosus, and other inflammatory dermatoses, based on the current evidence. Furthermore, recent reports with novel indications for PRP therapy are highlighted, and new potential pathways correlated with the pathogenesis of skin diseases are explored.

The Use of Platelet-Rich Plasma in the Treatment of Alopecia - A Review of the Literature

“…A one-year randomized double-blind study by Trink et al [40] examined the effect of platelet-rich plasma (PRP) in 45 patients with chronic alopecia areata AA. Compared to the control group, a significant increase in hair regrowth was observed, at the same time there was a decrease in the number of dystrophic hairs and a significant increase in the level of Ki-67 (40,41), an indicator of cellular proliferation [31].…”

“…Platelet-rich plasma contains high concentrations of growth factors (GFs) [26,27,28,29,30,31], released from α-granules of platelets by degranulation [29,31,32]. Growth factors released from platelets include platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF), transforming growth factor (TGF-β) and insulin-like growth factor 1 (IGF-1) [21,26,27,28,29,30,31]. The effectiveness of PRP therapy in alopecia is due to the synergistic action of multiple growth factors.…”

“…In addition, they promote the process of angiogenesis, which results in increased vascularization of the hair follicle, while promoting the delivery of nutrients and oxygen to the area [21,26,34,35]. PRP growth factors, through activation of the ERK/Akt and Wnt/B-catenin signaling pathway, influence the induction and prolongation of the anagen phase of the hair growth cycle [21,27,29,31,34,35,36]. Activation of the Akt signaling pathway counteracts the degradation of Bcl-2 protein, which exhibits anti-apoptotic properties [21,29,31,36].…”

“…PRP growth factors, through activation of the ERK/Akt and Wnt/B-catenin signaling pathway, influence the induction and prolongation of the anagen phase of the hair growth cycle [21,27,29,31,34,35,36]. Activation of the Akt signaling pathway counteracts the degradation of Bcl-2 protein, which exhibits anti-apoptotic properties [21,29,31,36].…”

“…In contrast, activation of the Wnt signaling pathway leads to the accumulation of B-catenin, which promotes proliferation and differentiation of hair follicle stem cells and angiogenesis [21,26,31].…”