| Objectives:Androgenetic Alopecia(AGA)is one of the most common types of hair loss,affecting both men and women,and manifests as miniaturisation of the hair follicles on the crown and forehead,resulting in thinning of the hair in the affected areas and an upward shift of the hairline.AGA has a negative impact on the physical and mental health of patients,and in severe cases even interferes with normal work and life.Topical minoxidil is currently the main form of treatment,but the long period of use and slow onset of action can easily result in poor patient compliance,thus affecting the efficacy of the treatment.Platelet-Rich Plasma(PRP),a highly concentrated platelet concentrate obtained by centrifugation of autologous blood,has been shown to improve the clinical outcome of AGA when combined with minoxidil compared to minoxidil alone.However,the existing studies are heterogeneous and the results are inconsistent.Therefore,this study was designed to systematically evaluate clinical studies of PRP combined with minoxidil therapy for AGA,as well as to conduct a small clinical trial to observe the efficacy and safety of the combination therapy for AGA and to explore potential factors affecting efficacy.Methods:1.Pubmed,Embase,Cochrane,Web of Science,Zhiwang,and Wanfang databases were searched to collect literature on randomized controlled trials of PRP combined with minoxidil compared with minoxidil alone or PRP alone for the treatment of AGA.According to the inclusion and exclusion criteria,the retrieved literature was screened,managed and evaluated by 2investigators respectively.The studies with good homogeneity were further subjected to metaanalysis using Revman 5.4 pairs to synthesize the effectiveness of this combination therapy.2.Healthy volunteers were recruited and PRP was prepared by the PRP preparation all-in-one machine using a secondary centrifugation protocol,and the PRP obtained was measured using a haematology analyser and manual counting method to ensure that the PRP products obtained were homogeneous and stable.3.Patients with AGA attending the outpatient clinic of Jiangsu University Hospital between April 2021 and September 2021 were recruited to conduct a small-scale clinical trial of PRP combined with minoxidil.Patients with AGA were given PRP injections(1 time per month,3 times in total)and minoxidil(1 ml each time,2 times per day)in the alopecia area for a total treatment period of 3 months.The platelet count in each patient’s whole blood and PRP was measured at each treatment,and the number of hairs,hair density and hair diameter at the dye marker sites were measured by the Foto Finder Trichoscale hair analysis system before and after the patients’ treatment,and statistical analysis was performed using SPSS statistical software.Adverse reactions that occurred during the study period in patients were also recorded for safety evaluation.Results:1.5 studies involving a total of 331 patients were finally included in this systematic evaluation through systematic search and screening according to the inclusion and exclusion criteria.2 of the studies were found to have unclear risk of random sequence generation(selection bias)as well as allocation concealment;1 study had high risk of implementation bias and measurement bias;3studies had unclear risk of implementation bias;and 2 studies had unclear risk of measurement bias.unclear.the results of the Meta-analysis showed that PRP combined with minoxidil treatment increased hair density and hair diameter significantly compared to the minoxidil control group alone,with all differences being statistically significant(WMD=28.57,95% CI=15.79-41.35,P<0.0001、WMD=0.01,95%CI=0.00～0.01,P=0.03);PRP combined with minoxidil increased hair density compared to PRP controls alone,but the difference was not statistically significant(WMD=45.77,95% CI=-28.14 to 119.67,P=0.22).Local pain was the main adverse effect of PPR treatment,other rare adverse effects were scalp pruritus,increased facial hair and hyperpigmentation,with no serious adverse effects.2.Ten healthy volunteers were recruited and PRP was prepared using a secondary centrifugation protocol and through an all-in-one preparation machine.The platelet count in the PRP obtained was found to be significantly higher than that of whole blood,approximately 4.9±0.6times higher,by both the haematology analyser and manual counting methods,and there was no statistical difference between the results of the two tests(P=0.84),suggesting that stable homogeneous PRP.3.A total of 12 patients with AGA were recruited for the clinical trial of PRP combined with minoxidil treatment.Hair microscopy and quantitative analysis of the target area before and after treatment revealed a mean increase of 14.1 hairs(P=0.003)and 15.59 hairs/mm2(P=0.003)in the target area after treatment compared to baseline.Correlation analysis was performed between the mean platelet concentration in PRP and the rate of improvement in hair density and the Pearson correlation coefficient was 0.767,suggesting a strong relationship(P=0.010).The most significant adverse effect during treatment was momentary pain during treatment,with no serious adverse effects occurring.Conclusions:1.The results of the systematic evaluation suggest that PRP combined with minoxidil may be more beneficial than minoxidil alone in improving hair density and hair diameter in patients with AGA and is an effective and safe treatment modality;however,due to the small number and high heterogeneity of the existing research literature and the lack of standardised treatment protocols,more high-quality randomised controlled studies with large samples are needed in the future for longer However,due to the paucity of available research literature,high heterogeneity and the lack of standardised treatment protocols,more high-quality randomised controlled studies with large samples and longer follow-up are needed in the future to provide a strong reference for the development of optimal clinical treatment protocols.2.Stable homogeneous PRP can be obtained by two centrifugations using the PRP all-in-one machine at a concentration of 4.9±0.6 times that of whole blood.3.PRP combined with minoxidil treatment for 3 months significantly improves the mean hair count and hair density in AGA patients without serious adverse effects,and is safe and efficient.The number of platelets in PRP may be a potential influencing factor on the efficacy. |
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