Post on 13-Feb-2017
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MASTER MEDICINA
ESTETICA
PRP USE IN THE TREATMENT OF ALOPECIA
Dr. Drampa ChristinaMedical Biopathologist
Definition Alopecia is the general medical
term for hair loss
Divided into: non scarring scarring
Non scarring androgenetic alopecia alopecia areata anagen effluvium telogen effluvium traumatic alopecia trichotillomania
Genes involved in androgenetic alopecia
The high frequency of androgenetic alopecia has complicated attempts to establish a mode of inheritance
Rapresents a complex polygenic trait The Androgen Receptor gene is
located on the X chromosome
Lifestyle factors (health habits)
Dietary habits and alcohol abuse Stressful life events Sexual risk behavior and drug abuse Cigarette smoking UV exposure
Clinical Investigations •Date of onset of the hair loss problem• Periodicity of hair loss• Rate of progression• Previous investigations and treatments• Present and past health status (Medications, incl. hormonal treatments)• Dietary behavior• Associated symptoms relating to the
condition of the scalp
The most frequent causes
Iron deficiency Thyroid disorder Lupus erythematosus Intake of drugs or of hormones
(oral contraceptives, replacement therapies that possess androgenic activity)
Biochemical Investigations
Serum ferritin Fe + Ht Vitamin B12 TSH +FT4 Estradiol Progesterone DHT Testosterone Prolactin
Biochemical Ranges1. Serum ferritin
( mg/L) 2. Vitamin B12
(ng/L) 3. Serum folic acid
(nmol/L) 4. Estradiol (day 21)
(pmol/L) 5. Progesterone (day
21) (nmol/L)
1. >402. 300-10003. 5-404. >300
5. >30
Since high levels of serum ferritin are
engendered by inflammation independently
of iron stores, it is important to simultaneously
determine C-reactive protein (CRP)levels
Importance of sexual hormonesClinical evidence for the role of estrogens
for hair growth is observations of the effectsof pregnancy, hormonal treatments that
affect estrogen metabolism, and menopauseon the condition of the hair
But…which one is the most important?
Dihydrotestosterone (DHT) is the
specific hormone responsible for male
and female pattern baldness as a
result of changes in its metabolism
Therapy Male baldness: 5% minoxidil lotion,
finasteride taken orally and daily (1 mg) works by inhibiting the 5α-reductase from forming DHT
Female baldness: 2% minoxidil lotion, cyproterone
Coadjuvant Amino acids
(cysteine, lysine, arginine)
Iron supplements in absence of deficiency
Silic acid Marine extract and
silicea Trace elements
(zinc, copper)
Vitamins (biotin) Ginkgo biloba Aloe vera Ginseng Bergamot Melatonin Retinoids
THERAPY
New interest in preventing hair-loss
and baldness has been stimulated
by cellular therapy
infusing PRP into the scalp
PRP The process consists of using autologous platelet extracts as a cell-repairing product
MICROSCOPΕ
Platelets: 150.000 – 400.000 mm³
Average time llife:5-9 days
What is PRP?Platelet Rich Plasma is blood plasma that
has been enriched with plateletsPRP contains and releases through
degranulation several different growth factors and other cytokines that
stimulate healing of bone and soft tissue
How growth factors interfere with the hair
cycle?Androgenetic alopecia involves a process
of premature termination of anagen associated
with premature entry into catagen
THE MOST IMPORTANT GROWTH FACTORS
■ Platelet-derived growth factor (PDGF)■ Vascular endothelial growth factor (VEGF) ■ Epidermal growth factor (EGF)■ Insulin-like growth factor 1 (IGF-1)■ Fibroblast growth factor (FGF) ■ Nerve growth factor (NGF)
Blood vessel formation & Growth of dermal
mesenchyme
PDGF
Taking a blood sample through an anticoagulated tube
ANTICOAGULATED TUBES
Ratio volumeBLOOD: 9
COAGULATE:SODIO CITRATE 1
CENTRIFUGATION
Different kind of measurements:tubes are centrifuged for approximately 5-10 minutes at 600 G
INJECTIONS
SYRINGE 1ml
NEEDLE4mm30G
ANESTHESIA
1ml of lidocaine 1% injected into the following points:
1) 1,5 cm over the supraorbital foramen, deep in the periosteum, in the internal third of the eyebrows (supraorbital nerve) 2) 1,5 cm medially of the first point (supratrochlear nerve)
3) 1,5 cm in front of the upper part of the ear helix subdermally (auriculo-temporal nerve)
ANESTHESIA
Light massage is necessary to spread the anestheticBlock starts in 60 secMaximum action in 10 minutes Time duration is three hours and more
The process
Personal experience10 patients with androgenetic alopecia: 7 of them were male 3 of them female
Were treated with PRP one session every
month for three months
Before & after 8 months
Before & after 8 months
Before & after 8 months
Ευχαριστώ
Grazie
Thank you