Use of autologous platelet-rich plasma in androgenetic alopecia in women: a systematic review and meta-analysis

Figures & data

Figure 1. PICOT question.

Figure 2. Search strategy according to the PRISMA protocol (10).

Table 1. Characteristics of studies included in this systematic review.

Publication details	Study methods	Participants	Interventions	Outcomes	Notes
El-Husseiny et al. (17)	Comparative clinical study with 3 PRP sessions (3 weeks apart), at a single clinic in Egypt, 2018–2019. Patients were followed 6 weeks after the intervention.	15 females aged 23–50 years with FPHL.	Intradermal injection of single-spin prepared PRP in the left half of the scalp compared with double-spin prepared PRP in the right half of the scalp.	Patients’ satisfaction and measurement of terminal hair density.	Funding: none. Conflicts of interest: none.
Puig et al. (19)	Double-blind, multicenter, placebo-controlled pilot study conducted in the USA. Patients were followed for 26 weeks after the intervention.	A randomized sample of 26 women (intervention group, n = 15; placebo group, n = 11), diagnosed with Ludwig II female AGA, aged at least 18 years.	Scalp injections of PRP manufactured from patients own blood using the Angel PRP system in the intervention group, and a normal saline scalp injection in the placebo group.	Hair count, hair mass index, and patient survey.	Funding: Angel PRP and all the soft goods for making the PRP were provided by Cytomedics. Conflicts of interest: none.
Tawfik and Osman (20)	Double-blinded randomized placebo-controlled study, with up to a maximum of 4 weekly sessions, recruited from National Institute of Laser Enhanced Sciences in Egypt. Patients were followed for up to 6 months after the intervention.	30 females aged 20–45 years with FPHL, patients’ scalps with pattern hair loss were randomly assigned to intervention or placebo.	Autologous PRP injection into one area of the scalp and a normal saline injection in the other area.	Effects of the treatment on hair growth, hair density, hair diameter, volume, hair pull test, and patients’ satisfaction.	Funding: not informed. Conflicts of interest: none.
Starace et al. (14)	Pilot, open-label, not randomized, single-group, single center study performed in Italy, 2013–2014. Patients were followed 12 weeks after the intervention.	10 females aged 33–64 years with AGA, not responding to treatment with topical minoxidil and/or oral finasteride.	Interfollicular injection of PRP preparation, every 2 weeks for a total of 4 sessions.	Efficacy of PRP treatment on hair density, hair diameter, vellus hair density, and safety.	Funding: not informed. Conflicts of interest: none.
Lee et al. (18)	Randomized clinical study carried out in Korea. Patients were followed 1 week after the last treatment session.	40 Korean females aged 20–60 years with FPHL were randomized to 2 different interventions. 2 male New Zealand rabbits.	For the patients: single session of PRP injection, followed by 12 sessions of PDRN intra-perifollicular injection or 12 sessions of PDRN injection only, in the scalp at weekly intervals. For the rabbits: 1/2 of the backs of two rabbits was injected with the PRP preparation, and the other 1/2 was injected with phosphate buffered saline as a control.	For the patients: effects of PRP and PDRN or PDRN only on mean hair counts and mean hair thickness. For the rabbits: expression of WNT, PDGF, and FGF9 mRNA after treatment with PRP compared with phosphate buffered saline.	Funding: none. Conflicts of interest: none.
Dubin et al. (16)	Prospective randomized clinical trial conducted at a single center in the USA, 2018. Patients were followed for 24 weeks.	30 women diagnosed with AGA, aged ≥18 years, were randomly assigned to intervention or placebo. Two patients were lost to follow up (1 in each group).	Subdermal scalp injections of Eclipse system PRP at 0, 4 and 8 weeks or saline injection in the placebo group.	Effects of treatment on changes in hair density, hair caliber, and blinded global photographic assessment (improved or not improved) at week 24. Adverse effects were also recorded.	Funding: Supported by Eclipse Esthetics, LLC (Icahn School of Medicine at Mount Sinai Grants and Contracts Office no. 18-1714(0001)). Conflicts of interest: Dr Farberg currently serves on the advisory board of Suneva Medical, Inc.
Bruce et al. (15)	Randomized, controlled crossover pilot trial performed at a single institution in the USA, 2017. Patients were followed for 32 weeks.	20 consecutive female patients with AGA, aged ≥18 years, into a PRP then minoxidil group (arm A) or minoxidil then PRP group (arm B). Two patients were lost to follow up (1 in each arm).	Patients in arm A received PRP injections every 4 weeks for a total of 3 treatments, followed by an 8-week washout; at week 20 they received crossover treatment with minoxidil. Patients randomized to arm B received the same treatment in reverse sequence.	Outcomes of interest were hair count, vellus hair density, terminal hair density, and cumulative thickness. Additional analysis included a 16-item quality-of-life questionnaire. Adverse effects were also assessed.	Funding: not informed. Conflicts of interest: none.

Table 2. Quality assessment of the individual randomized, parallel group trials.

Table 3. Quality assessment of the individual randomized, crossover trial.

Table 4. Quality assessment of non-randomized studies – interventions.

	Pre-intervention		At intervention		Post-intervention			Overall risk of bias
Study	Bias due to confounding	Bias in selection of participants into the study	Bias in classification of interventions	Bias due to deviations from intended interventions	Bias due to missing data	Bias in the selection of reported result	Bias in selection of the reported result	Low/moderate/serious/critical
El-Husseiny et al. (17)	Low	Serious	Low	Low	Low	Low	Low	Serious
Starace et al. (14)	Low	Serious	Low	Low	Low	Moderate	Moderate	Serious

Figure 3. Terminal hair density (count per cm²) outcome: PRP vs. control.

Figure 4. Hair thickness/caliber (mm) outcome: PRP vs. control.

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El-Husseiny RM, Saleh HM, Moustafa AA, 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. Arch Dermatol Res. 2020;313(7):557–566.

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Puig CJ, Reese R, Peters M. Double-blind, placebo-controlled pilot study on the use of platelet-rich plasma in women with female androgenetic alopecia. Dermatol Surg. 2016;42(11):1243–1247.

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Tawfik AA, Osman M. The effect of autologous activated platelet-rich plasma injection on female pattern hair loss: a randomized placebo-controlled study. J Cosmet Dermatol. 2018;17(1):47–53.

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Starace M, Alessandrini A, D'Acunto C, et al. Platelet-rich plasma on female androgenetic alopecia: tested on 10 patients. J Cosmet Dermatol. 2019;18(1):59–64.

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Lee SH, Zheng Z, Kang JS, et al. Therapeutic efficacy of autologous platelet-rich plasma and polydeoxyribonucleotide on female pattern hair loss. Wound Repair Regen. 2015;23(1):30–36.

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Dubin DP, Lin MJ, Leight HM, et al. The effect of platelet-rich plasma on female androgenetic alopecia: a randomized controlled trial. J Am Acad Dermatol. 2020;83(5):1294–1297.

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Bruce AJ, Pincelli TP, Heckman MG, et al. A randomized, controlled pilot trial comparing platelet-rich plasma to topical minoxidil foam for treatment of androgenic alopecia in women. Dermatol Surg. 2020;46(6):826–832.

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