Low Level Laser versus Platelet-rich Plasma in Treatment of Alopecia Areata: A Randomized Controlled Intra-patient Comparative Study

Abstract


 Background: Non-scarring alopecia areata (AA) is a disease that is mediated through autoimmunity. Recently, autologous platelet-rich plasma (PRP) and photobiomodulation (PBM), commonly known as low-level laser (or light, LLLT) have been suggested to provide a valuable role in stimulating the growth of hair follicles (HF)
 Aim: Compare between the significance and wellbeing of PRP and LLLT in the management of AA.
 Patients & methodology: Thirty patients, each having three patches of AA participated in the study. Patches were assigned randomly to have one of the two treatments: PRP or LLLT. The third patch served as a control and received placebo treatment. PRP was done once weekly whereas LLLT was done 3 sessions per week for a maximum of 6 weeks. Patients were followed up at one month and three months. The thickness and density of hair were evaluated by the folliscope.
 Results: A noteworthy higher improvement was detected in the thickness and the density of hair in the PRP treated patches as evaluated by the folliscope and patients satisfaction. The obtained outcomes were sustained during the 12 week follow-up period in most of patients.
 Conclusion: PRP and LLLT could be considered as efficacious alternatives for the treatments of AA with the least morbidity in addition to a little cost profit ratio.
 KEYWORDS: Alopecia areata, platelet-rich plasma, folliscope, photobiomodulation, low level laser therapy.

Platelet-rich plasma in alopecia areata and primary cicatricial alopecias: A systematic review

“…Efficacy of PRP in AA has also been compared to topical minoxidil and low-level laser therapy (LLLT). PRP showed superior to 5% topical minoxidil in improving dystrophic hair and had a greater effect on improving hair diameter compared to LLLT ( 34 , 43 ).…”

“…At the full-text stage, 87 full articles met our predefined selection criteria, and we further excluded 55 publications for the following reasons: review articles ( n = 27), conference abstracts ( n = 17), wrong population ( n = 5), wrong intervention ( n = 3), commentary articles ( n = 3), and secondary cicatricial alopecias ( n = 2) ( Figure 1 ). Thirty-two studies were included: 11 randomized controlled trials (RCTs) ( 33 – 43 ), 4 non-randomized studies ( 44 – 47 ), and 17 case series or case reports ( 48 – 64 ). Between 2013 and 2022, 23 AA studies ( 33 – 55 ) and nine PCA studies ( 56 – 64 ) were included, totaling 621 patients with AA and 19 with PCAs.…”

“…The PRP preparation protocols of included studies are demonstrated in Tables 3 , 4 . Regarding the centrifugation method, there were 13 studies using single spin method ( 33 , 34 , 36 , 39 , 43 , 47 , 49 , 52 , 53 , 58 , 60 , 63 , 64 ), 10 using double spin method ( 35 , 37 , 38 , 40 – 42 , 45 , 46 , 51 , 56 ), and eight provided no information ( 44 , 48 , 54 , 55 , 57 , 59 , 61 , 62 ). Several types of PRP activators were used; seven studies used calcium chloride ( 37 , 38 , 41 , 45 , 46 , 49 , 60 ), four used calcium gluconate ( 33 , 34 , 36 , 42 ), one used calcium carbonate ( 52 ), two did not use any activators ( 48 , 53 ), and 17 provided no information ( 35 , 39 , 40 , 43 , 44 , 47 , 51 , 54 – 59 , 61 – 64 ).…”

“…Regarding treatment protocol, most studies used three or four treatment sessions, with 15 using three sessions ( 33 , 34 , 38 , 40 – 42 , 45 , 47 , 50 , 53 , 54 , 56 , 60 , 63 , 64 ), six using four sessions ( 35 , 36 , 39 , 49 , 57 , 59 ), two treated until a satisfactory response was obtained ( 51 , 61 ), and the remaining studies used different number of sessions. Our included studies selected different treatment intervals, with the most common interval being 4 weeks, selected by 17 studies ( 33 , 34 , 36 , 38 , 40 – 42 , 44 , 45 , 47 , 51 , 55 , 56 , 58 , 60 , 62 , 64 ); five studies selected 3 weeks ( 35 , 39 , 50 , 57 , 59 ), four selected 2 weeks ( 37 , 46 , 49 , 52 ), one selected 1 week ( 43 ), and four selected interval of ≥ 6 weeks ( 53 , 54 , 62 , 63 ).…”

“…Most RCTs demonstrate comparable PRP efficacy to intralesional TA with earlier and more persistent responses ( 37 , 39 – 41 , 47 ). PRP also showed superior efficacy compared to 5% topical minoxidil and LLLT ( 34 , 43 ). In contrast to AA, PCAs have fewer studies evaluating the efficacy of PRP, and their treatment endpoint is disease stabilization.…”