Comparative Study Between Platelet Rich Plasma and Minoxidil in The Treatment of Alopecia Totalis

Abstract

A lopecia totalis is a type of alopecia areata, a non scarring autoimmune disease in which 100% of scalp hair is lost.It is an autoimmune disease in which immune system target the hair follicle. This disease is important because of the intense emo-tional distress, it causes by disrupting self image leading to overwhelming effects on the patient's quality of life. Diagnosis and therapy of hair and scalp diseases were in the last years subject to significant progress. One of the major developments was employing imaging techniques, including hair and scalp dermoscope. Although dermoscopy is one of the non-invasive imaging techniques, it allows the visualization of hair at high magnification and the measurement of relevant trichologic structures. Platelet-rich plasma is defined as autologous blood with a concentration of platelets above baseline values. Growth factors released by platelets have proliferative and anti-inflammatory effects on hair follicle. Minoxidil is FDA approved drug in treatment of andrgenetic alopecia and it is also used in alopecia areata as topical sprays or foams, mechanism of action in promoting hair growth is not fully understood. Vasodilatation, angiogenesis, enhanced cell proliferation, and potassium channel opening have all been proposed. The aim of this study was to evaluate the efficacy of both PRP and intradermal minoxidil 2 % injections in patients with alopecia totalis. The current study included 20 subjects divided randomly into 10 patients of group A with PRP and 10 patients of group B with intradermal minoxidil 2 % injection treatment. All patients were photo documented before and after treatment. Group A were injected with PRP and dermoscopic images were taken at 3 fixed points and then an average is taken.The same was done to group B. Dermoscopic parameters (yellow dots, black dots, broken hair, tapering hair, vellus hair and terminal hair) were documented and analyzed in excel sheet.SALT score is assessed before and after treatment for clinical evaluation. Our results revealed that most of the change in dermoscopic parameters specifically yellow dots and black dots decreased in both group A and B but this decrease was statistically higher after PRP injection compared to minoxidil group. There was no significant change in results between PRP and minoxidil as regard clinical improvement assessed by SALT score. In conclusion, our results showed no significant clinical improvement with PRP treatment,however dermoscopic features showed significantly improvement after PRP compared to minoxidil so we suggest that PRP treatment in alopecia totalis could be of benefit as adjuvant therapy in addition to the main treatment of alopecia totalis. We highly recommend using dermoscope as an advanced aid in clinical dermatological diagnosis and a great follow up tool. Further studies are still recommended on a large number of patients in a trial to identify more uses of dermoscope and more medications to treat alopecia totalis.