Platelet Rich Plasma Treatments for Refractory Scarring (CICATRICIAL) Alopecias

To book an appointment with Dr. Donovan, complete our online form as the first step.  You may direct questions via email to our PRP coordinators: prp@donovanmedical.com

 

What are scarring alopecias?

Scarring alopecias (also called cicatricial alopecias) are a group of hair loss conditions whereby the body forms small scars around the hair follicles. These include conditions such as lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), folliculitis decalvans (FD), central centrifugal alopecia (CCCA).

The treatments for these conditions varies, and include topical steroids and steroid injections as well as several pill forms of treatments (hydroxychloroquine, doxycycline, mycophenolate mofetil, finasteride, dutasteride). There treatments are effective (i.e. they 'work' to halt the disease) in a large proportion of patients to halt the disease.

 

What is "refractory" scarring alopecia?

Refractory scarring alopecia refers to scarring alopecia that does not respond to medications in a manner that one would otherwise hope for. Although 50-70% of patients will show benefit from use of these 'traditional' methods, not all patients do. When an individual does not respond to medications, we say that their scarring alopecia is 'refractory' to treatment. 

Our PRP Program is designed to provide new treatment options for those with refractory scarring alopecias.

 

What is Platelet Rich Plasma (PRP) Treatment?

Platelet rich plasma (PRP) therapy, as it relates to hair loss, refers to the use of a patients own platelet cells from their blood to stimulate hair growth. Platelets are a part of our blood cells and they are rich in various growth factors and cytokines that have the 'potential' to stimulate hair growth. PRP is not helpful in all individuals with scarring alopecias,  but is helpful in a proportion. Our data suggests that PRP can induce formation of new blood vessels around hair follicles in scar tissue. This may enhance survival of these hairs.  A short video on PRP (courtesy of Cytomedix) shows the key steps in PRP therapy.

 

 

PRP for Refractory Scarring (Cicatricial) Alopecias

In 2014, we initiated a program at Donovan Medical for treating refractory scarring alopecias using leukocyte poor platelet rich plasma (PRP). This 'off-label' treatment came about after our observations of disease stabilization and sometimes improvement in a cohort of our patients.

Like other hair research groups around the world, including the International Hair Research Foundation, we hope to provide an expanded array of safe options for patients with scarring alopecias who do not respond to traditional treatments. 

 

Am I a candidate for PRP?

We will consider patients for PRP therapy provided an individual has had their disease diagnosis confirmed by a dermatologist and meet the following criteria:

 

a) LICHEN PLANOPILARIS (LPP)

  *** Please NOTE: We do NOT consider PRP a first line step in the treatment of scarring alopecia but is an option when other treatments have not been successful. We strongly advise that use of steroid injections, and doxycycline and hydroxychlorquine be discussed by a physician for all patients with LPP.  Based on our research to date, hair growth in patients with LPP receiving PRP is NOT likely but may help to slow down progression. In fact, hair regrowth does NOT tend to occur with MOST scarring alopecias but stopping the disease is a major goal. It is important to understand the regrowth is not possible for most scarring hair conditions such as LPP. Some changes in disease activity may be possible. We recommend that PRP for patients with LPP be carefully monitored by a dermatologist to follow perifollicular erythema, perifollicular scale and measurements.  

We will consider patients with lichen planopilaris for PRP therapy provided they meet all of the following 5 criteria:

 

1. The patient has been evaluated by a DERMATOLOGIST

2. The patient has used topical steroids or decided they do not wish to use

3. The patient has used steroid injections or decided they do not wish to use

4. The patient has used doxycycline or decided they do not wish to use

5. The patient has used at least one of: hydroxychloroquine pills or mycophenolate mofetil pills

 

 

b) FRONTAL FIBROSING ALOPECIA (FFA)

 *** Please NOTE: We do NOT consider PRP a first line step in the treatment of scarring alopecia but is an option when other treatments have not been successful. We strongly advise that finasteride and dutasteride be discussed by a physician for all post menopausal patients with FFA.    Based on our research to date, hair growth in patients with FFA receiving PRP is NOT likely (less than 5 % -10 % of patients) but may help to slow down progression. In fact, hair growth does NOT tend to occur with MOST scarring alopecias but stopping the disease is a major goal. It is important to understand that regrowth is not possible for most scarring hair conditions such as FFA. The ONLY treatment in the current day and age that has any evidence for prompting regrowth is finasteride and dutasteride and that is why Dr Donovan will ONLY consider PRP after a patient has reviewed these medications with their dermatologist. NO OTHER TREATMENT HAS ANY PROVEN EVIDENCE OF CAUSING REGROWTH. Based on our research to date, hair growth in patients with FFA receiving PRP is NOT likely but it may help slow further spread. Some changes in disease activity may be possible. We recommend that PRP for patients with FFA be carefully monitored by a dermatologist to follow perifollicular erythema, perifollicular scale and measurements. 

We will consider patients with frontal fibrosing alopecia (FFA) for PRP therapy provided they meet ALL of the following 6 criteria:

 

1. The patient has been evaluated by a DERMATOLOGIST 

2. The patient has used topical steroids or decided they do not wish to use

3. The patient has used steroid injections or decided they do not wish to use

4. The patient has used doxycycline or decided they do not wish to use

5. The patient has used at least one of: hydroxychloroquine pills or mycophenolate mofetil pills (or decided they do not wish to use)

6. The patient has used finasteride or dutasteride or decided they do not wish to use  

*** Given the proven benefits of finasteride and dutasteride for treating FFA, we will NOT consider PRP unless patients have seen a dermatologist and discussed the benefits of finasteride and dutasteride.   Since 2014, finasteride and dutasteride have proven to be the most effective in treatment FFA.

 

c) FOLLICULITIS DECALVANS (FD)

 *** Please NOTE: We do NOT consider PRP a first line step in the treatment of scarring alopecia but is an option when other treatments have not been successful. We strongly advise that antibiotics and isotretinoin be discussed by a physician for all patients with FD.  Based on our research to date, hair growth in patients with FD receiving PRP is NOT likely (less than 5 % -10 % of patients) but may help to slow down progression. In fact, hair growth does NOT tend to occur with MOST scarring alopecias but stopping the disease is a major goal. It is important to understand the regrowth is not possible for most scarring hair conditions such as folliculitis decalvans.  Some changes in disease activity may be possible. We recommend that PRP for patients with FD be carefully monitored by a dermatologist to follow perifollicular erythema, scaling, crusting and pustules

We will consider patients with folliculitis decalvans for PRP therapy provided they meet ALL of the following 4 criteria:

 

1. The patient has been evaluated by a DERMATOLOGIST 

2. The patient has used topical antibiotics or decided they do not wish to use

3. The patient has used antibiotic pills or decided they do not wish to use

4. The patient has used isotretinoin or decided they do not wish to use

*** Given the proven benefits of antibiotics and isotretinoin for treating folliculitis decalvans, we will NOT consider PRP unless patients have seen a dermatologist and discussed the benefits of these medications. 

 

d) CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA (CCCA)

 *** Please NOTE: We do NOT consider PRP a first line step in the treatment of scarring alopecia but is an option when other treatments have not been successful. We strongly advise that steroid injections and doxycycline be discussed by a physician for all patients with CCCA.  Based on our research to date, hair growth in patients with CCCA receiving PRP is NOT likely (less than 15 % -18 % of patients) but may help to slow down progression. In fact, hair growth does NOT tend to occur with MOST scarring alopecias but stopping the disease is a major goal. It is important to understand that regrowth is not possible for MOST scarring hair conditions such as CCCA. Some changes in disease activity may be possible. We recommend that PRP for patients with CCCA be carefully monitored by a dermatologist to follow for disease activity. 

We will consider patients with central centrifugal cicatricial alopecia (CCCA) for PRP therapy provided they meet ALL of the following 4 criteria:

 

1. The patient has been evaluated by a DERMATOLOGIST 

2. The patient has used topical steroids or decided they do not wish to use

3. The patient has used steroid injections or decided they do not wish to use

4. The patient has used doxycycline or decided they do not wish to use

 

*** Given the proven benefits of steroid injections and antibiotics such as doxycycline  for treating CCCA, we will NOT consider PRP unless patients have seen a dermatologist and discussed the benefits of steroid injections and doxycycline.   

 

 

 

Treatment Protocol for PRP for Individuals with Scarring Alopecia 

APPOINTMENT ONE: INITIAL CONSULTATION

 

APPOINTMENT TWO:

1. Baseline photographs, dermatoscopic photographs, and disease activity measurements

2. PRP administration with leukocyte poor PRP at a concentration 4 times baseline.

 

APPOINTMENT THREE:

Follow up at month 3 for photographs and repeat measurements. This is the critical appointment to determine if the patient was a responder to PRP therapy. 

There are no fees for the 3 month follow up.

 

APPOINTMENTS  FOUR and BEYOND:

We will repeat PRP treatments ONLY if a positive beneficial response was documented (i.e. reduction in disease activity) at the third appointment. Thereafter, we will repeat PRP sessions every 4-6 months depending on response.  

 

Fees - PRP

 

Consultation: $ 250

Treatments: $ 1500 plus HST per treatment session (avg 3 treatments in first year; 2-3 treatments in subsequent years)

 

Booking an appointment 

To book an appointment to discuss PRP, complete the online form an our office will contact you.




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