Platelet-Rich Plasma in Alopecia Areata—A Steroid-Free Treatment Modality: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Background: Alopecia areata (AA) is a chronic autoimmune condition that can lead to a serious deterioration in patients’ quality of life. The first line of treatment in patchy AA is triamcinolone acetonide (TrA); however, the efficacy of the treatment varies greatly. Our aim was to investigate the therapeutic effects of platelet-rich plasma (PRP) in the treatment of AA. Method: We performed a systematic literature search in four databases. Randomized clinical trials (RCT) reporting on patients with AA treated with PRP were included, comparing PRP with TrA or a placebo. The primary outcome was the Severity of Alopecia Tool (SALT) score. Results: Our systematic search provided a total of 2747 articles. We identified four studies eligible for quantitative analysis. The pooled mean differences from the four studies did not exhibit a significant difference in the mean change in the SALT score when PRP and TrA groups were compared (MD =−2.04, CI: −4.72–0.65; I2 = 80.4%, p = 0.14). Conclusions: PRP is a promising topical, steroid-free treatment modality in the therapy of AA. No significant difference was found between PRP and TrA treatment; however, further high-quality RCTs are needed to further assess the efficacy of PRP treatment and strengthen the quality of evidence.

[1]  H. M. Saleh,et al.  A Split Scalp Study of Single versus Double Spin Platelet-rich plasma Injections in Treatment of Female Pattern Hair Loss: Clinical Effect and Relation to Vascular Endothelial Growth Factor in PRP , 2021, The Quarterly journal of medicine.

[2]  A. Cline,et al.  Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions , 2021, American Journal of Clinical Dermatology.

[3]  Zhen Wang,et al.  The Effectiveness and Safety of Platelet-Rich Plasma for Chronic Wounds: A Systematic Review and Meta-analysis. , 2021, Mayo Clinic proceedings.

[4]  E. Mayo-Wilson,et al.  The PRISMA 2020 statement: an updated guideline for reporting systematic reviews , 2021, BMJ.

[5]  T. Fukumoto,et al.  Treatments for alopecia areata: A systematic review and network meta‐analysis , 2021, Dermatologic therapy.

[6]  D. Hegab,et al.  Platelet-rich plasma in alopecia areata: intradermal injection versus topical application with transepidermal delivery via either fractional carbon dioxide laser or microneedling. , 2020, Acta dermatovenerologica Alpina, Pannonica, et Adriatica.

[7]  P. Kumar-M,et al.  Identification of novel step‐up regimen of intralesional triamcinolone acetonide in scalp alopecia areata based on a double‐blind randomized controlled trial , 2020, Dermatologic therapy.

[8]  V. Garg,et al.  A randomized, placebo and active controlled, split scalp study to evaluate the efficacy of platelet‐rich plasma in patchy alopecia areata of the scalp , 2020, Dermatologic therapy.

[9]  F. Mohammed,et al.  Trichoscopy as an evaluation method for alopecia areata treatment: A comparative study , 2020, Journal of cosmetic dermatology.

[10]  R. Sridharan,et al.  A Comparative Study of Therapeutic Response to Intralesional Injections of Platelet-Rich Plasma Versus Triamcinolone Acetonide in Alopecia Areata , 2020, Indian dermatology online journal.

[11]  H. M. Saleh,et al.  Comparison between single- versus double-spin prepared platelet-rich plasma injection in treatment of female pattern hair loss: clinical effect and relation to vascular endothelial growth factor , 2020, Archives of Dermatological Research.

[12]  R. Paus,et al.  Hair follicle immune privilege and its collapse in alopecia areata , 2020, Experimental dermatology.

[13]  Sumir Kumar,et al.  Comparative Evaluation of Therapeutic Efficacy of Intralesional Injection of Triamcinolone Acetonide versus Intralesional Autologous Platelet-rich Plasma Injection in Alopecia Areata , 2020, Journal of cutaneous and aesthetic surgery.

[14]  H. Pototschnig,et al.  Successful Treatment of Alopecia Areata Barbae with Platelet-rich Plasma , 2020, Cureus.

[15]  R. Grimalt,et al.  The Alopecia Areata Consensus of Experts (ACE) Study: Results of an International Expert Opinion on Treatments for Alopecia Areata. , 2020, Journal of the American Academy of Dermatology.

[16]  D. West,et al.  A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging , 2019, Archives of Dermatological Research.

[17]  John P. Cole,et al.  Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia. , 2019, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[18]  G. Guyatt,et al.  Completing ‘Summary of findings’ tables and grading the certainty of the evidence , 2019, Cochrane Handbook for Systematic Reviews of Interventions.

[19]  Natalie S Blencowe,et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials , 2019, BMJ.

[20]  M. Hesseler,et al.  Platelet-rich plasma and its utility in the treatment of acne scars: A systematic review. , 2019, Journal of the American Academy of Dermatology.

[21]  H. Ebrahim,et al.  Evaluation of platelet‐rich plasma vs intralesional steroid in treatment of alopecia areata , 2019, Journal of cosmetic dermatology.

[22]  J. Shapiro,et al.  Objective outcome measures: Collecting meaningful data on alopecia areata , 2017, Journal of the American Academy of Dermatology.

[23]  M. Péntek,et al.  Alopecia areata and health‐related quality of life: a systematic review and meta‐analysis , 2016, The British journal of dermatology.

[24]  N. Laird,et al.  Meta-analysis in clinical trials revisited. , 2015, Contemporary clinical trials.

[25]  J. Shapiro,et al.  Benefit of different concentrations of intralesional triamcinolone acetonide in alopecia areata: An intrasubject pilot study. , 2015, Journal of the American Academy of Dermatology.

[26]  S. Hopewell,et al.  Cochrane methods - twenty years experience in developing systematic review methods , 2013, Systematic Reviews.

[27]  Y. Ramot,et al.  A randomized, double‐blind, placebo‐ and active‐controlled, half‐head study to evaluate the effects of platelet‐rich plasma on alopecia areata , 2013, The British journal of dermatology.

[28]  Jeung-Hoon Lee,et al.  Autologous Platelet‐Rich Plasma: A Potential Therapeutic Tool for Promoting Hair Growth , 2012, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[29]  A. McDonagh,et al.  British Association of Dermatologists’ guidelines for the management of alopecia areata 2012 , 2012, The British journal of dermatology.

[30]  A.G. Messenger,et al.  Guidelines Guidelines for the management of alopecia areata , 2003 .

[31]  C. Lortie Doing Meta-Analysis with R - A Hands-On Guide , 2022, J. Stat. Softw..

[32]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[33]  J. M. Weitzner Alopecia areata. , 1990, American family physician.