INTRODUCTION
Platelet-rich plasma (PRP) is an autologous concentration of plasma from a patient’s blood containing platelets up to 7 times higher than normal plasma.1 Originally indicated to improve connective tissue regeneration in orthopedic surgery, PRP has also proven to be advantageous in the treatment of androgenic alopecia (AGA), alopecia areata (AA), and other forms of non-scarring alopecia.2,3 While the mechanism of PRP in alopecia remains unclear, PRP has a demonstrated role in multiple key aspects of the wound healing process, resulting in reduced inflammation, remodeled scar tissue, fibroblast proliferation, collagen, and elastin synthesis, and enhancement of the extracellular matrix.1,2 While there is evidence in the literature of the clinical benefit of PRP in non-scarring alopecia, there are few published reports highlighting PRP's potential to treat cicatricial (scarring) forms of alopecia.
CASE
A 48-year-old female with a history of systemic lupus erythematosus (SLE) treated with hydroxychloroquine and discoid lupus erythematosus (DLE) presented with several dyspigmented plaques and significant scarring alopecia of the scalp. The patient experienced improvement in her hair loss initially and was stable using topical corticosteroids and subsequently intralesional Triamcinolone injections. After being lost to follow up for over a year, she reverted to worsening of her DLE with increased areas of scarring alopecia. Examination at that time revealed several smooth, hyperpigmented, atrophic and irregular patches of alopecia more significant on the left than right parietal scalp and on the frontal scalp. A few areas showed decreased follicles with overlying adherent scale on the hyperpigmented patches (Figure 1). The patient, co-managed by rheumatology, declined any additional systemic medications for her hair loss and flaring DLE due to other health co-morbidities (previous history of breast carcinoma). Although rheumatology recommended treatment with belimumab, the patient was unable to tolerate this medication in the past and instead elected to try PRP.
22 mL of the patient's blood was obtained using the Eclipse PRP patient kit. The PRP was prepared using the standardized Eclipse protocol (Eclipse Aesthetics, LLC, Dallas, TX). The blood was centrifuged at 3500 revolutions per minute for 10 minutes and yielded a red blood cell precipitate and plasma supernatant. The platelet poor plasma or upper portion of the supernatant was then removed while the PRP portion of the blood remained for use. After cleaning and prepping the site, the patient's areas of scarring alopecia on the scalp were injected subcutaneously using a 30-gauge needle with a total volume of approximately 7 mL of PRP.
After three treatment sessions of PRP injections (spaced 3 months apart given patient scheduling constraints), significant regrowth was noted overall via global photography, with improvement seen even within the areas of scarring alopecia (Figure 2).
22 mL of the patient's blood was obtained using the Eclipse PRP patient kit. The PRP was prepared using the standardized Eclipse protocol (Eclipse Aesthetics, LLC, Dallas, TX). The blood was centrifuged at 3500 revolutions per minute for 10 minutes and yielded a red blood cell precipitate and plasma supernatant. The platelet poor plasma or upper portion of the supernatant was then removed while the PRP portion of the blood remained for use. After cleaning and prepping the site, the patient's areas of scarring alopecia on the scalp were injected subcutaneously using a 30-gauge needle with a total volume of approximately 7 mL of PRP.
After three treatment sessions of PRP injections (spaced 3 months apart given patient scheduling constraints), significant regrowth was noted overall via global photography, with improvement seen even within the areas of scarring alopecia (Figure 2).
