Advancing Dermatology: Integrating Platelet-Rich Plasma with Technical Precision and Clinical Insight

The final presentation from Dermatology Week was hosted by Amelia Hausauer, MD, FAAD, who focused on understanding the integration of platelet-rich plasma (PRP) into dermatology practices, exploring its technical, clinical, and mechanistic underpinnings. She delved into how PRP can be optimized for treating androgenetic alopecia, enhancing wound healing, smoothing acne scars, and rejuvenating the skin. Despite the growing literature on PRP, she noted the inconsistency in study quality, highlighting the need for rigorous and comparative research to refine its application.

PRP is defined as an autologous solution derived from a patient’s blood, concentrating platelets in a small plasma volume. This solution typically achieves a platelet concentration of 1.5 to 6 times the concentration found in normal blood, with preparation relying on US Food and Drug Administration-cleared devices. The therapeutic action of PRP is traditionally attributed to the release of growth factors from platelets, but its efficacy extends beyond this, involving signaling molecules such as exosomes that stimulate gene signaling and protein transcription. Over 300 active substances, including fibrin, are present in PRP, emphasizing its complex biologic role.

Dr Hausauer underscored the importance of proper preparation and technical considerations. Homemade PRP systems using nonsterile tubes are discouraged due to safety and efficacy concerns. Approved systems fall into 2 categories: double-spin systems, which involve 2 centrifugation steps for higher platelet concentrations, and single-spin systems, which yield purer solutions with fewer white and red cells. These technical distinctions affect PRP composition and applicability, emphasizing the need to match the preparation method to specific clinical goals.

The role of leukocytes in PRP remains a contentious issue. Leukocyte-rich PRP can provide antimicrobial benefits in wound healing but may also produce catabolic factors like TGF-beta, which can hinder hair growth. Conversely, leukocyte-poor PRP may reduce inflammatory responses in hair follicle applications. Despite theoretical models suggesting when leukocytes may be beneficial or detrimental, the literature offers insufficient head-to-head studies to conclusively guide practice.

She shared that activation of PRP is another critical aspect. Early studies favored activated PRP for efficacy, but recent evidence suggests nonactivated PRP may be superior in hair restoration, allowing gradual activation and sustained biologic effects. Activators, whether exogenous like calcium chloride or endogenous through microneedling, can vary PRP's therapeutic impact. Centrifugation parameters, such as spin speed, duration, and angle, also influence PRP quality. Horizontal spins provide cleaner cell separation, while excessively high centrifugal forces may compromise platelet viability.

Next, Dr Hausauer presented the clinical application of PRP, which extends beyond preparation to patient management, treatment frequency, and injection technique. She emphasized the need for induction therapy, recommending monthly treatments over 3 months for optimal results in androgenetic alopecia. This approach increases both hair density and shaft thickness compared to less frequent regimens. Pain management during injections is addressed, with subdermal delivery and fine needles minimizing discomfort.

Mechanistically, PRP promotes hair follicle health by prolonging the anagen (growth) phase, reducing inflammation, and enhancing vascular support. This involves various gene cascades and signaling pathways, including the Wnt/β-catenin pathway. Although PRP consistently improves hair growth and skin healing, patient selection is critical. Early-stage hair loss responds more robustly, while advanced cases may yield less cosmetically significant results. Combining PRP with other treatments, such as minoxidil, demonstrates superior outcomes, showcasing the potential for synergistic therapies.

Dr Hausauer also touched on gaps in PRP research. While multiple randomized controlled trials and meta-analyses support its use, the variability in PRP formulations and treatment protocols complicates comparisons. Future studies must address these inconsistencies and explore optimal cell concentrations, activation methods, and combination therapies.

Overall, PRP represents a versatile tool in regenerative dermatology, offering promising applications for hair restoration, scar improvement, and skin rejuvenation. Its integration into clinical practice requires a nuanced understanding of its biologic mechanisms, preparation methods, and patient-specific factors. Continued research will refine its efficacy and expand its role in dermatologic care.

Reference
Hausauer A. Platelet-rich plasma in dermatology. Presented at: Dermatology Week; November 13–16, 2024; Virtual.