Response to “Variables affecting the potential efficacy of platelet-rich plasma in dermatology”

Abstract

To the Editor: We read with great interest Sharun and Pawde's response1Sharun K. Pawde A.M. Variables affecting the potential efficacy of platelet-rich plasma in dermatology.J Am Acad Dermatol. 2021; 84: e47-e48Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar to our research letter “Use of platelet-rich plasma in lichen planopilaris and its variants: A retrospective case series demonstrating treatment tolerability without koebnerization.”2Svigos K. Yin L. Shaw K. et al.Use of platelet-rich plasma in lichen planopilaris and its variants: a retrospective case series demonstrating treatment tolerability without koebnerization.J Am Acad Dermatol. 2020; https://doi.org/10.1016/j.jaad.2020.06.026Abstract Full Text Full Text PDF Scopus (5) Google Scholar We would like to thank them for their comments. We absolutely agree that platelet-rich plasma (PRP) procedures differ because of interpatient variability and PRP preparation and application methods, as outlined by Sharun and Pawde. Therefore, we would like to provide additional details regarding the PRP protocols used in our clinics. To begin, we typically obtain approximately 8 to 16 mL of whole blood from a patient. These specimens are then centrifuged by using the Drucker 642 VFD Plus (Regen Lab, Le Mont-sur-Lausanne, Switzerland), which has a relative centrifugal force of 1500g. This yields roughly 5 to 10 mL of usable PRP. A 27-gauge, 0.5-inch needle is then used to penetrate the scalp to a depth of about 0.25 inches, delivering 0.1 mL PRP per injection. Each injection is spaced 1 cm apart across the affected scalp for a total of 50 to 100 injections. We agree that fully evaluating the efficacy of PRP treatment requires accounting for factors that may contribute to variability in PRP procedures. The main conclusion of our research letter was that despite the potential risk of koebnerization, it was not observed in our cohort of patients with lichen planopilaris and its variants. We did not find a significant response to PRP injection therapy and do not suggest or recommend its use as monotherapy for these conditions. A randomized controlled trial will be necessary to truly demonstrate the efficacy and safety of PRP injections in LPP and its variants. Current randomized controlled trials studying the use of PRP injections in alopecia are mostly limited to the diagnosis of androgenetic alopecia, and those studying PRP in cicatricial alopecia are much needed.3Shapiro J. Ho A. Sukhdeo K. Yin L. Lo Sicco K. Evaluation of platelet-rich plasma as a treatment for androgenetic alopecia: a randomized controlled trial.J Am Acad Dermatol. 2020; https://doi.org/10.1016/j.jaad.2020.07.006Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 4Gentile P. Garcovich S. Systematic review of platelet-rich plasma use in androgenetic alopecia compared with minoxidil, finasteride, and adult stem cell-based therapy.Int J Mol Sci. 2020; 21: 2702Crossref Scopus (36) Google Scholar, 5Giordano S. Romeo M. di Summa P. Salval A. Lankinen P. A meta-analysis on evidence of platelet-rich plasma for androgenetic alopecia.Int J Trichology. 2018; 10: 1-10Crossref PubMed Scopus (20) Google Scholar Variables affecting the potential efficacy of platelet-rich plasma in dermatologyJournal of the American Academy of DermatologyVol. 84Issue 1PreviewTo the Editor: We read with great interest the recently published article by Svigos et al1 on the possible clinical benefits of platelet-rich plasma (PRP) in lichen planopilaris. The current literature on platelet concentrate–based biological therapy is limited by the extreme variability of final PRP products used.2 In addition to this, the majority of the clinical trials lack critical data on the biological properties of the PRP. The therapeutic benefits associated with PRP therapy are not solely dependent on the platelet concentration alone. Full-Text PDF