Combination of a non-ablative 1,927 nm thulium fiber fractional laser and autologous platelet-rich plasma in treatment of male androgenetic alopecia: A pilot study
Keywords:
Androgenetic alopecia, platelet-rich plasma, fractional laserAbstract
Background: Platelet-rich plasma (PRP) is composed of multiple essential growth factors which can stimulate hair growth by promoting cell proliferation, prolonging cell survival and the anagen phase of hair follicles. Fractional laser can create proper wounding which results in subsequent platelet activation and might promote hair growth. Nevertheless, clinical trials related to the efficacy and safety of the combination of fractional laser and PRP have not been established.
Objectives: To investigate the efficacy and safety of the combination of non-ablative fractional laser and platelet-rich plasma for the treatment of male androgenetic alopecia (AGA).
Methods: A total of nine men were recruited for a pre- and post- treatment study. Three sessions of fractional 1,927 nm Thulium-doped fiber laser (Lasemd, Lutronic Inc, South Korea) followed by PRP injections on the affected area were performed at 1-month intervals. Non-activated PRP was prepared using a Ycellbio-kit (Ycellbio Medical Co., Ltd., South Korea). Hair growth was evaluated by using: (i) standardized global photographs; (ii) hair mass index (Hair check system); (iii) target area hair counts (Trichoscale, Fotofinder); and, (iv) patient selfassessment questionnaires at baseline, then 3 and 6 months after the last treatment.
Results: Nine men with Norwood-Hamilton classification of grade II-IV, and a mean age of 41.3 years old (range 32 - 55) completed the study. At 6 months after completing the three treatment sessions, the terminal hair density significantly increased from baseline by 28.1% (99.1 to 127 = 27.9 hairs/cm2, P = 0.011). The increased percentage of total hair density was 9.7% (149.7 to 164.2 = 14.5 hairs/cm2, P = 0.015). The hair mass index was increased from baseline by 26.4% (16 to 20.2, P = 0.024). The global photography showed improvement in almost all patients: 3 moderate (41 - 70%); 4 slight improvement (1 - 40%) and 2 no change as compared to baseline. The treatment was fair tolerated and the mean visual analog scale (VAS) for pain was 0.8 (0 - 2) and 4.2 (2 - 6) for laser treatment and PRP injections, respectively. Adverse effects were transient erythema and a mild burning sensation on the treated areas.
Conclusion: A combination of a 1,927 nm fractional Thulium-doped fiber laser and PRP is considered safe, and an effective strategy for the treatment of male AGA. However, to determine the efficacy of this combination therapy, larger sample sizes and longer follow-up durations, randomized, placebo-controlled trials are suggested.
Downloads
References
Olsen EA, Messenger AG, Shapiro J, Bergfeld WF, Hordinsky MK, Roberts JL, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol 2005;52:301-11.
https://doi.org/10.1016/j.jaad.2004.04.008
Pathomvanich D, Pongratananukul S, Thienthaworn P, Manoshai S. A random study of Asian male androgenetic alopecia in Bangkok, Thailand. Dermatol Surg 2002;28:804-7.
https://doi.org/10.1046/j.1524-4725.2002.02036.x
Adil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. J Am Acad Dermatol 2017;77:136-41. https://doi.org/10.1016/j.jaad.2017.02.054
Gentile P, Cole JP, Cole MA, Garcovich S, Bielli A, Scioli MG, et al. Evaluation of not-activated and activated PRP in hair loss treatment: role of growth factor and cytokine concentrations obtained by different collection systems. Int J Mol Sci 2017;18: pii: E408. https://doi.org/10.3390/ijms18020408
Martinez-Zapata MJ, Marti-Carvajal A, Solà I, Bolibar I,Angel Expósito J, Rodriguez L, et al. Efficacy and safety of the use of autologous plasma rich in platelets for tissue regeneration: a systematic review. Transfusion 2009;49:44-56. https://doi.org/10.1111/j.1537-2995.2008.01945.x
Hamilton BH, Best TM. Platelet-enriched plasma and muscle strain injuries: challenges imposed by the burden of proof. Clin J Sport Med 2011;21:31-6. https://doi.org/10.1097/JSM.0b013e318205a658
Cho JW, Kim SA, Lee KS. Platelet-rich plasma induces increased expression of G1 cell cycle regulators, type I collagen, and matrix metalloproteinase-1 in human skin fibroblasts. Int J Mol Med 2012;29:32-6.
Cervelli V, Palla L, Pascali M, De Angelis B, Curcio BC, Gentile P. Autologous platelet-rich plasma mixed with purified fat graft in aesthetic plastic surgery. Aesthetic Plast Surg 2009;33:716-21.
https://doi.org/10.1007/s00266-009-9386-0
Sclafani AP. Applications of platelet-rich fibrin matrix in facial plastic surgery. Facial Plast Surg 2009;25:270-6. https://doi.org/10.1055/s-0029-1242033
Na JI, Choi JW, Choi HR, Jeong JB, Park KC, Youn SW, et al. Rapid healing and reduced erythema after ablative fractional carbon dioxide laser resurfacing combined with the application of autologous plateletrich plasma. Dermatol Surg 2011;37:463-8. https://doi.org/10.1111/j.1524-4725.2011.01916.x
Li ZJ, Choi HI, Choi DK, Sohn KC, Im M, Seo YJ, et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg 2012;38:1040-6.
https://doi.org/10.1111/j.1524-4725.2012.02394.x
Rastegar H, Ahmadi AH, Aghaei M, Ehsani A, Barikbin B. Combination of herbal extracts and plateletrich plasma induced dermal papilla cell proliferation: involvement of ERK and Akt pathways. J Cosmet Dermatol 2013;12:116-22. https://doi.org/10.1111/jocd.12033
Perper M, Aldahan AS, Fayne RA, Emerson CP, Nouri K. Efficacy of fractional lasers in treating alopecia: a literature review. Lasers Med Sci 2017;32:1919-25. https://doi.org/10.1007/s10103-017-2306-7
Cho SB, Goo BL, Zheng Z, Yoo KH, Kang JS, Kim H. Therapeutic efficacy and safety of a 1927-nm fractionated thulium laser on pattern hair loss: an evaluator-blinded, split-scalp study. Lasers Med Sci 2018;33:851-9. https://doi.org/10.1007/s10103-018-2437-5
Picard F, Hersant B, Niddam J, Meningaud JP. Injections of platelet-rich plasma for androgenic alopecia: A systematic review. J Stomatol Oral Maxillofac Surg 2017;118:291-7.
https://doi.org/10.1016/j.jormas.2017.06.011
Fukaya M, Ito A. A new economic method for preparing platelet-rich plasma. Plast Reconstr Surg Glob Open 2014;2:e162. https://doi.org/10.1097/GOX.0000000000000109
Castillo TN, Pouliot MA, Kim HJ, Dragoo JL. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med 2011;39:266-71.
https://doi.org/10.1177/0363546510387517
Kobayashi Y, Saita Y, Nishio H, Ikeda H, Takazawa Y, Nagao M, et al. Leukocyte concentration and composition in platelet-rich plasma (PRP) influences the growth factor and protease concentrations. J Orthop Sci 2016;21:683-9. https://doi.org/10.1016/j.jos.2016.07.009
Valles J, Santos MT, Marcus AJ, Safier LB, Broekman MJ, Islam N, et al. Downregulation of human platelet reactivity by neutrophils. Participation of lipoxygenase derivatives and adhesive proteins. J Clin Invest 1993;92:1357-65. https://doi.org/10.1172/JCI116709
Orliac S, Serfaty JM, Perozziello A, Zurlinden O, Louedec L, Dallaudiere B. Efficacy of subcutaneous injection of platelet-rich plasma in alopecia: A clinical and histological pilot study on a rat model with a sixmonth long-term follow-up experience. J Cosmet Dermatol 2018;17:214-9.
https://doi.org/10.1111/jocd.12425
Cervelli V, Gentile P, Scioli MG, Grimaldi M, Casciani CU, Spagnoli LG, et al. Application of platelet-rich plasma in plastic surgery: clinical and in vitro evaluation. Tissue Eng Part C Methods 2009;15:625-34.
https://doi.org/10.1089/ten.tec.2008.0518
Alves R, Grimalt R. Randomized placebo-controlled, double-blind, half-head study to assess the efficacy of platelet-rich plasma on the treatment of androgenetic alopecia. Dermatol Surg 2016;42:491-7.
https://doi.org/10.1097/DSS.0000000000000665
Kim WS, Lee HI, Lee JW, Lim YY, Lee SJ, Kim BJ, et al. Fractional photothermolysis laser treatment of male pattern hair loss. Dermatol Surg 2011;37:41-51. https://doi.org/10.1111/j.1524-4725.2010.01833.x
Bae JM, Jung HM, Goo B, Park YM. Hair regrowth through wound healing process after ablative fractional laser treatment in a murine model. Lasers Surg Med 2015;47:433-40.
https://doi.org/10.1002/lsm.22358
Ansell DM, Kloepper JE, Thomason HA, Paus R, Hardman MJ. Exploring the "hair growth-wound healing connection": anagen phase promotes wound re-epithelialization. J Invest Dermatol 2011;131:518-28. https://doi.org/10.1038/jid.2010.291
Chuong CM. Regenerative biology: new hair from healing wounds. Nature 2007;447:265-6.
https://doi.org/10.1038/447265a
Fertig RM, Gamret AC, Cervantes J, Tosti A. Microneedling for the treatment of hair loss? J Eur Acad Dermatol Venereol 2018;32:564-9. https://doi.org/10.1111/jdv.14722
Jha AK, Udayan UK, Roy PK, Amar AKJ, Chaudhary RKP. Original article: Platelet-rich plasma with microneedling in androgenetic alopecia along with dermoscopic pre- and post-treatment evaluation. J Cosmet Dermatol 2017 Aug 3. doi: 10.1111/jocd.12394. https://doi.org/10.1111/jocd.12394
Strazzulla LC, Avila L, Lo SK, Shapiro J. An overview of the biology of platelet-rich plasma and microneedling as potential treatments for alopecia areata. J Invest Dermatol 2017 Nov 3. pii: S0022- 202X(17)32751-3. https://doi.org/10.1016/j.jid.2017.07.827
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Chulalongkorn Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
