Evaluation of Minoxidil Intradermal Injection combined with Autologous Platelet Rich Plasma in the Treatment of Androgenetic Alopecia

Abstract

SUMMARY A ndrogenetic alopecia is progressive miniaturization of hair induced by androgens in genetically susceptible men and women. This condition is also known as male pattern hair loss (MPHL) or common baldness in men. AGA affects approximately 50 % of the male population. The etiology of this condition involves the interaction of genetic and hormonal influences that result in changes in follicular architecture and alterations of hair growth cycle. The influence of androgens and the type II 5 α- reductase enzyme in the pathogenesis of AGA is now well established. 5 α- reductase enzyme converts testosterone to the more active DHT form. Type II isoform of 5 α- reductase enzyme is expressed in androgen-responsive tissues such as the hair follicle while type I isoform of 5 α-reductase is widely expressed in many tissues including sebaceous glands and hair follicles. AGA has an intense emo¬tional effect; it causes disrupted self-image leading to negative 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 folliscope that is one of the non-invasive imaging techniques; that allows the visualization of hair at high magnification and the assessment of different hair structures. Available therapies for AGA include topical minoxidil, oral finasteride, cyproterone and hair transplantation. Minoxidil the only yet approved for treatment of AGA by the FDA promotes hair growth but has both systemic and dermatological adverse effects including lowering blood pressure, headache, increase visibility of body hair in some patients, dryness, scaling, itching and redness of the scalp. Finasteride used systemically is questioned due to the adverse effects in some male patients including decreased libido, erectile and ejaculatory dysfunction and its safety in females is questionable in matters of efficiency and safety. Platelet derived growth factors were proved to be biologically active in many key regenerative steps, such as the development of angiogenesis, the formation of hair matrix and the enhancement of the cell proliferation hence their use in many medical fields including sport medicine, orthopedic, plastic and aesthetic medicine. They aimed at both the delivery of biologically active substances such as growth factors, cytokines, and fibrin that help restoration of a healthy environment for the regenerating tissues. The present study included 90 male patients with androgenetic alopecia, 10 patients dropped out from the study and 80 completed the study period. Patients were divided randomly into 4 groups according to the type of treatment used: the first was injected with PRP, group 2 with minoxidil2%, the third group with combination of both and the forth group served as a placebo control and was injected with saline. Clinical evaluation of patients ’photographs was done by two blinded dermatology experts before and after end of treatment. Evaluators were asked to compare patients’ photos to the standard scale of Norwood-Hamilton. Clinical response was also evaluated in terms of changed caliber, density and hair count using folliscopic examination and computer image analysis before and at the end of sessions.