A comprehensive review of platelet-rich plasma for the treatment of dermatologic disorders

Figures & data

Table 1. Evaluation of PRP in androgenic alopecia, alopecia areata, and cicatricial alopecia.

Study	Condition assessed	Study country: setting: time period	Study design	Number of patients	Therapies	Outcome measures	Outcomes
Mao et al. (6)	Androgenic alopecia	Studies conducted until January 2019	Meta-analysis of 11 articles	262; 179 males, 83 females	Subcutaneous PRP injection Control: normal saline injection	Hair density (hairs/cm^2) Hair cross-sectional area (hairs/cm^2)	Increased hair density in PRP over control groups: mean difference (MD)=49.78; Heterogeneity (I^2)= 63%, 95% CI 36.25–63.30, p > .00001 from 4 articles. No statistically significant increase in hair cross section in all 4 articles.
Gupta et al. (12)	Androgenic alopecia	N/A	Meta-analysis of 10 articles	165 men	Subcutaneous PRP injection Control: normal saline injection	Hair density (hairs/cm^2)	Increased hair density in PRP over control group: 0.58 (95% confidence interval [CI]: 0.35–0.80) and 0.51 (95% CI:0.23–0.80, p < .0004), in baseline and placebo, respectively.
Giordano et al. (13)	Androgenic alopecia	N/A	Meta-analysis of six studies	177	PRP injection alone PRP + PDRN injections PRP + Dalteparin +  protamine microparticle Control: interfollicular placental extract (dalteparin + protamine microparticles)	Hair density (hairs/cm^2) Hair thickness (cross section hairs/10 ^−4 mm^2)	Increased hair density in PRP group (MD = 17.90, 95%CI 5.84–29.95, p=.004) Increased hair cross-sectional thickness (MD 0.22, 95%CI 0.07–0.38, p = .005) The pooled results did not show statistically significant differences in percentage increase in hair number (MD 24.12%, 95%CI 12.76–60.99, p = .20) and hair thickness (MD 32.63%, 95%–I 16.23–81.48, p = .19) among patients treated with PRP.
Pakhomova et al. (14)	Androgenic alopecia	N/A	RCT	69 men	PRP injections monotherapy 5% minoxidil solution Combination with PRP + 5% minoxidil	Hair density (hairs/cm^2) Average hair diameter (μm) Proportion of vellus hair (%)	The highest increase in hair density occurred in the combination group at 32% (p = .00004), with 16% in the minoxidil group (p = .00073), and 12% in the PRP group (p = .000067). The greatest increase in average hair diameter was 26% in the combination group (p = .00004), followed by 12% in the PRP group ( p = .001947), and 2% in the minoxidil group (p = .338). For vellus hair there was a 17% increase in the PRP group (p = .002225), followed by a 2% increase in the minoxidil group(p = .7647), and a 30% decrease in the combination group (p = .00082).
Gressenberger et al. (15)	Androgenic alopecia	N/A	RCT	30 men	Intracutaneous PRP injections Control: intracutaneous physiological saline	Hair density (hairs/cm^2) Average hair diameter (μm)	The PRP group had a lesser decrease in hair density (6.5 hairs/ cm^2) at 4 weeks post treatment compared to placebo (9 hairs/cm^2, p = .817). Hair diameter measured in micrometers increased by 1.7 in the PRP treated group compared to 1.1 in the placebo group after treatment (p = .523).
Gupta et al. (23)	Alopecia areata	New Delhi, India	Randomized, split-head study	27	PRP injections Control: normal saline injections	Severity of Alopecia Tool (SALT) score, percentage reduction in cytokines	SALT score was reduced by 9.05% in the PRP group compared to 4.99% in the placebo group (p = .049). There was decreased expression of the inflammatory cytokines IFN-λ in the PRP-treated scalp (p = .001) and IL-17 (p = .009), and an increase in the expression of FOXP3, an immune modulating cytokine (p = .011).
Ragab et al. (24)	Alopecia areata	N/A	Randomized clinical trial	60	Intradermal PRP injections Fractional CO2 laser + topical PRP Microneedling followed by topical PRP	SALT score	Patients in all 3 groups improved after treatment, with intradermal PRP injections and fractional CO2 Topical PRP had greater (80%) reduction in SALT score compared to microneedling with topical PRP (70%); no intergroup difference by physicians (p = .268) or patients (p = .147).
Hedge et al. (25)	Alopecia areata	New Delhi, India	Randomized split-scalp study	50	PRP injections Control: triamcinolone acetonide injections	SALT score	There were similar improvements in PRP- and steroid-treated groups with 44% of each showing near complete regrowth compared to placebo (20%). There was a decreased SALT in all compared to baseline (p = .001 for each) with greatest absolute hair growth with intralesional corticosteroids followed by PRP, followed by placebo.
Ozcan et al. (26)	FFA	N/A	Letter to the editor	1 female	PRP injections	Clinical and trichoscopical perifollicular erythema and scaling	All outcomes improved after 1 month of PRP injections.
Dina et al. (20)	CCCA	USA	Letter to the editor	1 female	PRP injections	Subjective evaluation of hair density	Greater than 50% improvement in hair density of scalp vertex.
Dina et al. (20)	LPP	USA	Letter to the editor	1 female	PRP injections	Subjective evaluation of hair density	Normal hair density with only minimal perifollicular erythema and scaling.
Bolanca et al. (27)	LPP	N/A	Case report	1 female	PRP injections	Trichoscopy, subjective symptoms	Complete regression of itching and hair shading, no perifollicular erythema or scaling.

Table 2. Evaluation of PRP in vitiligo.

Study	Condition assessed	Study country: setting: time period	Study design	Number of patients	Therapies	Outcome measures	Outcomes
Khattab et al. (28)	Nonsegmental and symmetrical vitiligo	Egypt, May 2018–May 2019	Prospective comparative study	52	Intradermal PRP injection + excimer laser Control: Excimer laser only	% repigmentation	The combination group had higher repigmentation compared with excimer laser alone, with excellent (75–100%) response in 34.6% of patients compared to 0% in the placebo group, and good (50–75%) response in 50% compared to 34.6% in placebo. (p = 000).
Afify et al. (29)	Nonsegmental vitiligo with ≥6 patches	Ain Shams University Hospital, December 2018–November 2019	Randomized clinical trial	20	Fractional CO2 laser, intradermal PRP injection Combined fractional CO2 with PRP Combined fractional CO2 with NB-UVB Combined fractional CO2 with PRP and NB-UVB Control: no treatment	Surface area as determined by computer-assisted grid (VACAG)	Vitiligo patches in all treatment groups had improved surface area of disease: 1.5% reduction in CO2 laser group, 0.4% in PRP group, 0.2% in CO2 laser with PRP group, 0.4% in CO2 laser with NB-UVB group, and 0.5% reduction in CO2 laser with PRP and NB-UVB group. No difference between the different regimens (p = .122).
Kadry et al. (30)	Stable nonsegmental vitiligo	1 facility in Cairo, June 2014–June 2016	Prospective, randomized, intrapatient, comparative controlled study	30	PRP intradermal injections alone Combined PRP and fractional CO2 CO2 laser alone Control: no treatment	computer-assisted grid (VACAG), mean improvement score by physician (MISP), visual analog scale (VAS), and histopathological evaluation.	The combination CO2 laser and PRP, and PRP alone, had the highest improvement; surface area measured by VACAG was 57.01 in the PRP alone group, 54.22 in the CO2 and PRP combined group, 38.08 in the CO2 laser alone group, and 13.79 in the control group. MISP and VAS were highest in the CO2 and PRP group, and the PRP monotherapy group, with a MISP of 3.20 and 2.97, and VAS of 6.87 and 6.67 in the CO2 and PRP combination and PRP monotherapy groups, respectively (p < .001).
Abdelghani et al. (31)	Stable nonsegmental vitiligo	Cairo, Egypt, January 2016–January 2017	prospective, randomized comparative trial	80	Laser alone PRP intradermal injections alone Combined laser and PRP Combined laser and NB-UVB.	VAS 5 point scale for repigmentation: (grade 1: 1-5%, grade 2: 6–25%, grade 3: 26–50%, grade 4: 51-75%, and grade 5: 76-100%)	Treatment with combination laser and PRP had highest mean percent repigmentation (63.40), followed by 39.70 in laser and NB-UVB, 31.65 in laser alone, and 27.25 in PRP alone. The mean VAS score was highest in combination laser and PRP (61.60), followed by 40.73 in combination laser and NB-UVB, 31.70 in laser alone, and 27.98 in PRP alone (p = .000).
Deng et al. (32)	Localized stable vitiligo	2 Beijing Hospitals	Randomized, prospective, case-control study	60	Combined intradermal PRP injections + 308-nm excimer laser PRP injections alone Laser alone	Vitiligo disease activity (VIDA) score	The laser plus PRP group had an increase in repigmentation with a total effective rate of 80% compared to 25% in the PRP alone group and 35% in the laser alone group (p < .05 for both), but no significant difference between the PRP and laser groups.

Table 3. Evaluation of PRP in melasma.

Study	Condition assessed	Study country: setting: time period	Study design	Number of patients	Therapies	Outcome measures	Outcomes
Mumtaz et al. (37)	Melasma	Rahim Yar Khan, 10/1/ 2019–4/30/ 2020	Nonrandomized, controlled clinical trial	64	Intradermal PRP injections Tranexamic acid	MASI score	The PRP group had improved MASI at weeks 4, 12, and 24 compared to control (p = .01,.0001, and.02, respectively).
Zhao et al. (33)	Melasma	N/A	Meta-analysis of 10 studies	395	Intradermal PRP PRP + tranexamic acid PRP + laser microneedling	MASI score	Of the 9 studies reporting MASI score, the efficacy of PRP alone had a standardized mean reduction in MASI of 1.18 (p = .02), but after sensitivity analysis and subsequent removal of 1 study this was not significant. (p = .492). The most efficacious treatment based on subjective patient and physician satisfaction was combination PRP and microneedling. (p < .05 for all).
Sthalekar et al. (38)	Melasma	N/A	Prospective study	30	Growth factor concentrate (GFC) injections	Modified MASI (mMASI) categorized into ‘mild’ (0–8), ‘moderate’ (8–16), and ‘severe’ (16–24)	Number of patients with severe melasma decreased from 23.1% at the beginning of the study to 7.7% at conclusion. The number of patients with moderate melasma decreased from 23.1% to 19.2%, while the number of patients with mild disease increased from 53.8% to 73.1%. (p < .05 for all) (32).

Table 4. Evaluation of PRP in inflammatory nail disorders.

Study	Condition assessed	Study country: setting: time period	Study design	Number of patients	Therapies	Outcome measures	Outcomes
Rehman et al. (42)	Lichen planus-associated nail dystrophy	N/A	Intra-individual comparable study	26	Combination intramatricial PRP injection and triamcinolone Intramatricial triamcinolone alone	Clinical response: good (>50% improvement), moderate (25–50%), poor (<25%)	Fingernails treated with combination therapy had a good response in 50% of nails, moderate response in 34.6%, and poor response in 15%, compared to the triamcinolone monotherapy group which had good response in 11.5%, moderate in 38.4%, and poor in 50% of nails (p = 0.001). In toenails, treatment with combination therapy had a good response in 48% of nails, moderate response in 16%, and poor response in 36%, compared to the triamcinolone monotherapy group which had good response in 12%, moderate in 24%, and poor in 64% of nails (p = .004).
Kaur et al. (43)	Nail lichen striatus	New Delhi	Case report	1 male	Intramatricial PRP injection	Clinical exam, onychoscopy	Resolution of pretreatment nail changes
Kaur et al. (43)	Idiopathic trachyonychia	New Delhi	Case report	1 female	Intramatricial PRP injection	Clinical exam	Resolution of pretreatment nail changes

Table 5. Evaluation of PRP in psoriasis.

Study	Condition assessed	Study country: setting: time period	Study design	Number of patients	Therapies	Outcome measures	Outcomes
Chakravdhanula et al. (46)	Plaque psoriasis	Single center	Prospective pilot study	21	Combination PRP injection and methotrexate (MTX), or MTX monotherapy	Psoriasis Area Severity Index (PASI) score	Combination group had reduced erythema, induration, and desquamation, with 62.5% achieving PASI75, and 12.5% achieving PASI90, whereas no patient treated with MTX monotherapy achieved PASI50 although they did improve 35–40% from baseline.
Kauhl et al. (47)	Plaque psoriasis	N/A	Prospective uncontrolled trial	30	Subdermal PRP injections	Average lesion size (cm^2)	Average lesion decreased from 8.2 cm^2 to 0.3 cm^2 and 80% of patients achieved complete clearance of skin lesions (PASI100) with the remaining 20% of patients achieving at least PASI70 (p < .00001).

Table 6. Evaluation of PRP in wound healing.

Study	Condition assessed	Study country: setting: time period	Study design	Number of patients	Therapies	Outcome measures	Outcomes
Ucar et al. (52)	Stage II coccygeal pressure ulcers	Patients were enrolled January 10–December 31, 2018	RCT	60	PRP gel and gas dressing Control: serum physiologic dressing	Pressure Ulcer Scale for Healing (PUSH) scale	PRP group was found to have decreased ulcer area (2.83 cm^2), exudate amount (score of 0.93) and tissue type (score of 1.2), compared to the control group (5.00, 1.93, 1.97, respectively). (p = .001 for all measurements).
Saha et al. (53)	Trophic ulcers in leprosy	Single center, August 2016–May 2018	Observer-blind RCT	118	Intra-and peri-lesional PRP injections Control: platelet-poor plasma gel	Surface area of ulcers (cm^2)	The surface area of the ulcers decreased by 91.10% in the PRP injection group compared to 79.77% the control group. (p<.001).
Semenic et al. (54)	Chronic lower leg ulcers	Slovenia	Randomized double-blind trial	60	PRP gel Control: hydrogel	Surface area of ulcers (cm^2)	Wound area in the PRP gel group decreased to 35.1% of the initial area compared to 89.95% in the control group (p = .001) with a similar decrease in wound circumferences (54.62% in experimental group, compared to 91.28% in control group; p = 0.001).
Paposio et al. (55)	Chronic skin ulcers	N/A	RCT	40	PRP injections Control: standard wound care	Closure rate (cm^2/day)	Control and experimental groups had similar healing rates; however, the experimental group had a higher wound closure rate at .2287 cm^2/day compared to the control group which had a rate of 089 cm^2/day (p = .0257)
Sasaki et al. (56)	Autologous fat grafting	February 2015–May 2018	Preliminary, case controlled, clinical trial	10	Equivalent volumes of combined fat: PRP injections Control: equivalent volumes of fat: normal saline	Complex VISIA Investigational Facial Skin Analysis and Facial Vectra XT 3D Volumetric Analysis Imaging Cortex Facial Skin Analysis	Outcomes were assessed at 3, 6, and 12 months, with a higher but statistically nonsignificant increase in mean volume assessment of the fat/PRP sites from baseline (3 D Vectra Analysis).
Mandour et al. (57)	PRP fat grafting in repair of medium-size tympanic membrane perforation	Tanta University, Egypt, December 2016–December 2017	Prospective randomized controlled study	50	Myringoplasty with fat graft enriched with PRP Myringoplasty with cartilage perichondrium graft	Rates of successful closure at 3-month follow-up Mean overall improvement in pure tone average and air-bone gap	PRP group had 92% graft take rate at 1 month and 88% at 3 months, compared to 96% at 1 month and 92% at 3 months for control. Mean overall improvement in pure tone average was 18.08 dB in PRP group and 18.24 dB in control. Air bone gap was 14.12 dB in PRP group and 15.64 dB in control (p > .05).
Nolan et al. (58)	Autologous fat grafting in diabetic foot ulcers	Single center	3-armed RCT	18	Fat grafting Fat grafting with PRP Control: routine podiatry care	Biopsies obtained at weeks 0, 1, and 4 with quantitative histology/immunohistochemistry (H&E, CD31, and Ki67)	Fat grafting group with PRP had increased mean microvessel density at 1 week to 1645 microvessels/mm^2 (p = .035).
Chen et al. (51)	Autologous fat grafting	January 2010–January 2020	Meta-analysis of 36 studies	1697 patients	Control: Fat grafting with cell-assisted lipotransfer (CAL) PRP-assisted lipotransfer	Rate of fat survival	CAL- and PRP-assisted lipotransfer improved the fat survival rate 48–71% for CAL and 40–70% for PRP (p = .0001 for both), but the difference in fat survival rate between CAL and PRP (71% and 70%) was not significant (p = .7175).
Anzarut et al. (59)	Postoperative wound drainage in patients undergoing bilateral reduction mammaplasty	Patients from offices of 11 plastic surgeons recruited between July and December 2004	Blinded, randomized, controlled trial	111	Topical autologous platelet gel applied to 1 breast after hemostasis achieved Control: standard treatment in contralateral breast	Total drainage, mL NRS (numerical rating scale) average pain score	Total drainage was 70.6 in treatment breasts and 72.2 in control (p = .672) Average pain score was 3.3 in treatment breasts and 3.5 in control (p = .163).

Table 7. Evaluation of PRP in repair of acne scars, chronic photoaging, and facial rejuvenation.

Study	Condition assessed	Study country: setting: time period	Study design	Number of patients	Therapies	Outcome measures	Outcomes
Long et al. (61)	Atrophic acne scars	N/A	Meta-analysis of 8 studies	311 patients	Topical PRP + microneedling Intradermal PRP injections + microneedling	Goodman and Baron qualitative scores	Improvement was greater in combination therapy than in microneedling alone (MD −16.48, p<.001), with results favoring intradermal PRP over topical PRP.
Abuaf et al. (60)	Dermal collagen proliferation, facial rejuvenation	Single center in Turkey, September 2013–December 2013	Prospective, open-label, nonrandomized controlled clinical study	20	Intradermal PRP injection Control: intradermal saline	Mean optical density (MOD)	Skin regions treated with PRP had a higher mean optical density (MOD) of collagen (1019) compared to pretreatment (539) and saline injection (787) (p < .001 for PRP side). Patients receiving intradermal PRP treatment had an improvement of 89.05%, compared to a 46.01% improvement in patients in the control group. Improvement ratio from PRP to control was 1.93:1 (p < .001 for both).
Gawdat et al. (62)	Glogau photoaging types II and III	N/A	Randomized, split-face study	20	Intradermal PRP injections Control: intradermal mesotherapy, a readymade growth factor solution	Global Esthetic Improvement Scale (GAIS) Optical coherence tomography (OCT).	No difference between treatment groups according to GAIS at 1 month (p>.05). Evaluation by OCT had an increase in both epidermal and dermal thickness after mesotherapy (182–222.55 μm and 220.75–282.85, respectively) and PRP (173.35–222.60, and 226.10-286.70, respectively) (p<.05 for all). No significant difference between the 2 treatments was found from OCT (p > .05).
Alam et al. (63)	Glogau class II or greater photoaging	Single center, Illinois, August 21, 2012– February 16, 2016	Randomized, masked, split-face clinical trial	27	Intradermal PRP injections Control: intradermal normal saline injections	Photoaging scores	No significant difference between PRP and normal saline in fine lines, mottled pigmentation, skin roughness, or skin sallowness. However, participant self-assessment scores were higher for the PRP-treated side compared with the normal saline side in texture (2.0 vs 1.21 p = 0.02) and wrinkles (1.74 vs 1.21 p = 0.03) 6 months after injections.
Faghihi et al. (64)	Atrophic facial acne scars	N/A	Split-face, randomized clinical trial	16	Combination CO2 laser plus intradermal PRP injections Control: CO2 laser plus intradermal normal saline	Objective dermatologic evaluation on a quartile grading scale	At 1 month, 0% in either group had ‘excellent’ response, 12.5% and 6.3% had ‘good,’ 56.3% and 43.7% had ‘fair’, and 31.2% and 50% had ‘poor’ improvement in the combination group and FCL monotherapy group, respectively. At 6 months, 0% in either group had ‘excellent’ response, 31.2% and 31.2% had ‘good,’ 56.3% and 37.5% had ‘fair,’ and 12.5 and 50.312 had ‘poor’ in the combination group and FCL monotherapy group, respectively. No significant improvement was found via objective dermatologic evaluation at either time point (p = .15, 0.23).

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Data availability statement

This manuscript is not associated with a data set.