There are many clinical manifestations and subtypes of baldness, among which, creeping baldness involves the occipital and bilateral scalp and is often more difficult to treat than other types of baldness. Recently, Dr. Donovan from Canada reported a case of glucocorticoid-resistant prolapsed pattern baldness with rapid hair regrowth after platelet-rich plasma (PRP) injection, which is described below. The patient suffered from patchy baldness more than 10 years ago, which has worsened in recent years, with creeping baldness appearing 2 years ago. The eyebrows, eyelashes and nails were not involved. Blood tests were normal, with a platelet count of 201 × 109/L, ferritin of 72 μg/L, and thyrotropin of 3.42 mIU/L. Figure 1. Posterior occipital alopecia before PRP treatment The patient had been treated with intradermal tretinoin injections three times, but with poor efficacy and severe mood changes after each injection. Prior treatment also included minoxidil and topical glucocorticoids. The patient did not want to receive systemic therapy or exposure therapy (dithranol).
Autologous PRP was prepared using specialized equipment, with the scalp anesthetized with 1% lidocaine + epinephrine, and 30 minutes later PRP was mixed with platelet-poor plasma to achieve a final platelet concentration of 3.5 times the baseline level. A total of 9 mL of PRP was injected into a 40 cm2 area behind the occiput.
The procedure was well tolerated, with mild pain on the postoperative day, but controlled with acetaminophen. Hair regrowth was observed 1 month after surgery and 2.8 cm at 3 months.
Case Study PRP is a new option for the treatment of patchy baldness with mild side effects. A randomized controlled “half-head” study in 45 patients with patchy baldness also confirmed the efficacy of PRP for the treatment of baldness, which was superior to 2.5 mg/mL tretinoin injection. the mechanism of PRP for baldness is unknown and may be growth stimulating and immunomodulatory. PRP is known to contain more than 20 growth factors that are beneficial for wound healing and hair growth.
Side effects of hormone injections include skin atrophy, capillary dilation, and pigmentation changes. Systemic side effects are rare, but single doses of hormones by non-oral routes have been reported to cause mood changes, such as mania. Mood changes are common with oral hormones, with mania reported in 26% of ophthalmic patients treated with short-term high-dose prednisone and depression in 10%.
Considering the high prevalence of mood disorders such as depressive disorders and anxiety in patients with pemphigus, further evaluation of the benefit of switching to PRP therapy when mood changes occur after hormone injections is warranted.
In summary, this case suggests two things: first, that PRP can be used to treat hormone-resistant baldness; and second, that PRP can be used to treat baldness with side effects after hormone injections.