Effects of Platelet-Rich Plasma on Hair Growth using Artificial Intelligence-based Trichoscopy and Ki67+ Keratinocytes Analysis: A Randomized Placebo-Controlled Trial

Introduction: Platelet-rich plasma (PRP) therapy is garnering significant attention in the realm of regenerative medicine as a viable treatment option for various conditions, including hair loss. Hair loss, particularly androgenic alopecia (AGA), is a progressive form of hair thinning that significantly impacts an individual's overall quality of life. Recent interest has emerged in utilizing PRP, an autologous blood product enriched with growth factors and other bioactive compounds, as a means to modulate cell signaling and stimulate hair growth while intervening in the progression of AGA. Employing PRP for promoting hair growth has proven to be an effective approach, employing physical therapy techniques to stimulate hair follicles. This study delves into the scientific underpinnings of PRP as a treatment for hair loss, encompassing its methodologies, effectiveness, and future prospects. Methodology: This study was a randomized, placebo-controlled, half-head group study conducted at a tertiary care centre in Bangalore. 35 patients with AGA were enrolled in the study. Baseline photography and hair analysis using the AI (Artificial Intelligence) based app was performed at 4 different scalp areas (frontal, parietal, vertex and occiput). A scalp biopsy for H& E staining for hair density and IHC (Immuno Histo Chemistry) for baseline Ki67 was performed. Monthly PRP was given on one half of the scalp and the other half was treated with normal saline injections (placebo). After 3 sittings of PRP and again after another 3 months patients were evaluated for hair density using the mobile software and the scalp biopsies were obtained from right side and left side of scalp at 3 months and 6 months for H&E staining and IHC with Ki67. Results: 23 (65.7 %) patients were males and rest 12 (34.3%) were females. 13(37.1%) patients were less than 30 years of age and majority 19 (54.3%) were between 30 and 40 years of age. The remaining 3 (8.6%) patients were over 40 years of age. Statistically significant hair growth was detected in the in the PRP procedure side as compared to the placebo side. Hair density on the intervention side was 8.4% more as compared to the baseline after 3 sessions of PRP and 19.1% more after 6 months of starting the intervention. Vertex and frontal region showed the maximum clinical response as compared to the placebo side. On the PRP side, single hair follicular units reduced from 584% to 43.9%, double follicular units changed from 22% to21% and multiple follicular units increased from 19% to 35%after 6 months. Conclusion: PRP side of the scalp showed significant hair growth as compared to the placebo side and this growth was more at 3 months and it further increased at 6 months. The hair fall and reduced hair density on the placebo side continued at the end of 6 months. Percentage of multiple follicular units increased significantly on the intervention side and the single follicular units reduced significantly. Ki67 uptake on IHC categorically emphasizes the growth of anagen hair folloicles following PRP therapy. Platelet-rich plasma (PRP) therapy for hair development has a lot of promise as a minimally invasive, autologous non-surgical treatment for people who are experiencing hair loss. PRP is a viable method for accelerating the growth of hair follicles due to its regenerative features, which include its capacity to increase cell proliferation, angiogenesis, and collagen formation.