Alopecia-Drampa Christina

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