Platelet-rich plasma (plasmolifting) to improve hair growth. Part 1

Medicinal hair loss treatments such as minoxidil lotion, fenasteride, or oral cyproterone acetate may prevent hair loss.

However, in recent years it has been discovered that platelet-rich plasma can also be injected into the scalp to combat hair loss.

There are three main questions in this article:

• how growth factors affect the hair growth cycle,
• a review of the literature describing the treatment of hair loss (in particular the use of platelet-rich plasma),
• as well as referrals for further treatment evaluations.

Interest in the treatment of baldness has increased due to the accurate classification by factors of each patient, which helps to effectively treat male and female androgenetic alopecia in selected patients. Dihydrotestosterone is a special hormone responsible for bald patches in men and women as a result of metabolic changes.

In normal hair loss, the 100 hairs that fall out every day are replaced by new thick hairs. In the development of female and male bald patches, new hair is thin and sparse (medium or reduced hair). Baldness in men and women tends to develop in a certain order.

A phototrichogram taken with a digital camera makes it possible to objectively assess hair growth parameters, such as density, the number of reduced and/or terminal hairs, as well as the intensity of hair growth in the selected and tattooed area.

The most studied and most published medical treatment for male pattern baldness is Minoxidil Lotion 5% and 2% for the treatment of female pattern baldness. The first signs of improvement generally appear 3 months after the start of treatment. Side effects of minoxidil are minimal and include itching, eczema, and hypertrichosis (the latter most commonly seen in women).

In men with alopecia, finasteride, taken orally (1 mg) daily, prevents the formation of dihydrotestosterone by 5α-reductase. Reduced DHT levels allow some medium sized follicles to enlarge and grow normal long hair. Side effects may include decreased libido.

Cyproterone acetate (in Europe) can effectively block the elevated levels of male hormones that cause hair loss in some women. Spirolactone (in the US) is a competitive dihydrotestosterone receptor binding inhibitor. New interest in the prevention of hair loss and baldness has been generated by cell therapy with damage and then the injection of platelet-rich plasma into the scalp, which normalizes hair loss after the first session, and also reverses hair loss in men and women after the second session.

Plasmolifting to improve hair growth: The importance of growth factors

Over the years, the expectations of physicians and patients have been focused on medical and surgical procedures, improving their accuracy, obtaining satisfactory results and simplifying treatment. As a result, the procedure using platelet-rich plasma has taken one of the leading places in this regard. The process consists of using the patient's own platelets as a cell repair product.

The restorative qualities of platelets have been well known since the 1970s. They are used in various fields such as plastic surgery, rheumatology, dentistry and orthopedics. Being an autogenous product, platelets are well tolerated and do not lead to serious side effects.

However, for their use in surgery (against baldness), the main task is still to evaluate the results using objective parameters. To evaluate the effect of platelet-rich plasma on the skin, two studies were conducted, one of which used biometric parameters (ie, anisotropy, hydration, transepidermal water loss, and other human histological parameters). Most clinical assessments are based on subjective assessment, patient satisfaction, and before and after pictures. Such publications that offer objective assessments have parameters based on human biometrology or histology. For this reason, future studies aiming to use platelet-rich plasma for the treatment of alopecia should consider objective parameters.

The process begins with a blood sample drawn through an anticoagulated tube with or without filter gel. The tubes are then centrifuged for approximately 5 minutes at 600 G (speed and time will depend on the collection protocol). As a result of their density, the red blood cells sink into the tube, and plasma and platelets collect at the top of the tube. Platelet-rich plasma is usually called platelet-rich plasma when its concentration is 3-5 times higher than usual. After injection into the skin layer, platelets are activated. They are expanding and growth factors are being released.

The most important growth factors for using platelet-rich plasma for hair growth are:

Platelet Growth Factor (PGF);
Vascular endothelial growth factor (VEGF);
Epidermal growth factor (EGF);
Insulin-like growth factor 1 (IGF-1);
Fibroblast growth factor (FGF);
Nerve Growth Factor (NGF).

TGF stimulates the growth of the skin mesoderm. TGF signals are involved in the interaction of the epidermis and follicles, as well as the mesoderm of the skin, required for the formation of the hair channel and the growth of the skin mesoderm.

VEGF is a powerful growth factor that acts on mitotic cells and endothelial cells of blood vessels and increases vascular permeability. The hair follicle is an avascular structure whose growth depends on the vessels and capillaries that form the choroid plexuses in the dermal ridge. Clearly and others have identified VEGF as an important mediator of hair follicle growth, providing the first direct evidence that improved follicle vascularization promotes hair growth and follicle enlargement and hair size. In a trial of 104 hair transplant patients, Rinaldi et al showed using confocal microscopy that stimulation of VEGF via adenosine receptors involves significant changes in the mean diameter of the perifollicular vessels of the scalp compared to placebo. as well as the lengthening of transplanted follicles in the anagen phase. Further research has shown that adenosine receptor stimulation improves hair growth by directly stimulating VEGF production from dermal ridges.

EGF stimulates mitosis on epithelial cells and fibroblasts, improves anagen. EGF prevents entry into the catagen phase, increasing the duration of the anagen phase. EGF signals control the direction and elongation of the follicle, probably through their action on the proliferation of basal keratinocytes and cells that make up the outer sheath of the hair root. High doses of EGF may reduce follicle regression. As suggested by Kingston et al., EGF serves as a biological switch to enter and exit the anagen phase. IGF slows down apoptosis.

IGF-1 acts as a signal in various mitotic cell lines and protects cells from apoptosis. IGF-1 may prevent cell death.

FGF stimulates the proliferation and differentiation of keranocytes and endothelial cells. It is more pronounced in the anagen phase, and then decreases from anagen stage VI.

NFR significantly stimulates hair fasting and slows down apoptosis. NGF has a modulating effect on the hair depending on the receptor with which it interacts: at the level of the outer root sheath, the complex NGF TrkA stimulates keratinocyte proliferation, and NGFj p75NTR stimulates apoptosis, repression of the follicle and prevents hair growth.

During the transition from the anagen phase to the catagen phase, increased neuroimmunity leads to perifollicular neurogenic inflammation, apoptosis in the hair follicles, and premature catagen development. Not only norepinephrine, an important signaling molecule in the sympathetic stress response, but also NRFs have been found to act as stress mediators. Undoubtedly, this is one of the best ways to explain the connection between stress and hair loss.

According to Prime magazine.

You can see the stages of the scalp prazmolifting procedure in this video: