Platelet-rich plasma: Is your practice ready?
EXPERT ANALYSIS FROM ODAC 2019
Dermatology presents a host of uses for PRP. In addition to application after microneedling or resurfacing and injectable aesthetic uses, PRP can also be used to treat melasma, acne scarring, and androgenetic alopecia.
The strongest data for PRP currently are for androgenetic alopecia, said Dr. Hooper, because that’s where most of the work has been done to date. Growth factors in PRP can target the dermal papillae, shortening the anagen phase. “You will improve the anagen:telogen ratio and increase hair density and thickness,” she said.
“When you talk to your hair loss patients, there are drawbacks” with home therapy such as minoxidil and finasteride, said Dr. Hooper. “Compliance is an issue. I’m a firm believer in combination treatment for hair loss.” Studies have shown increased hair thickness and moderately decreased hair loss with PRP. Anecdotally, said Dr. Hooper, hair becomes coarser, feeling fuller and thicker; one study found that about a quarter of patients reported this effect.
Through experience, Dr. Hooper’s learned some pearls for using PRP for androgenetic alopecia. Her male patients appreciate the use of a chilling device to help with pain, especially since Dr. Hooper uses a triple-needle syringe to stamp the scalp as she injects the PRP. Depending on how her patients are tolerating the procedure, she’ll follow up by injecting some platelet-poor plasma as well.
An additional pearl? “Have your patients bring a baseball cap.” Between procedure preparation, some oozing of PRP, and bleeding from injection sites, men don’t leave as well-coiffed as when they entered, she said.
Dr. Hooper has patients return four times over the course of 6 months for androgenetic alopecia, with repeat treatments about every 6 months thereafter.
Several studies have looked at using intradermal PRP for facial rejuvenation, with largely positive results. “Once again, we see consistent efficacy with no side effects,” said Dr. Hooper. She will use PRP either intradermally or topically after microneedling or fractional ablative laser resurfacing.
If it’s being used topically, Dr. Hooper will simply wipe the PRP on after the resurfacing treatment. For microneedling, “As we finish one zone, we topically apply the PRP and move on,” she said, adding that she instructs the patient not to wash her face until bedtime.
“I like injectable delivery for PRP as well,” said Dr. Hooper. She will often use it for crepey skin under the eyes as an add-on to other treatments, she said.
Her patients report that one major upside of post-resurfacing PRP is that they feel they recover more quickly. “Less erythema and less recovery time – that’s something that’s always helpful,” said Dr. Hooper. She uses the same treatment schedule for rejuvenation as for alopecia.
Some studies have shown promise for injected PRP for striae, said Dr. Hooper. She has just begun using injected PRP for striae in her practice and is encouraged by early results she’s seeing. It’s easier for patients than using multiple at-home treatments: “I think it’s just an option, they can pop in 3 times over the next few months” for some added benefit, she said.
Scanning the audience, Dr. Hooper said, “I see a lot of younger faces out there. I would challenge you to do the studies” to build evidence-based protocols for PRP in dermatology, since lack of consensus still hinders both adoption and high-quality research.
Dr. Hooper reported multiple financial relationships with pharmaceutical and cosmetic companies.
SOURCE: Hooper, D. ODAC 2018.
