Baldness can be embarrassing to the person who has it. Often it runs in families, as there is a genetic factor that can be passed on from mother’s and father’s side. It can even jump one generation. I have reviewed hormonal factors and the treatment with minoxidil under Ref. 1 and 2.
One particularly embarrassing form of baldness is a spotty hair loss (medically known as “alopecia areata”), which can occur spontaneously after a period of severe stress. It is due to an autoimmune phenomenon as explained here.
Recently a randomized trial was published where one half of the head was treated with either platelet rich plasma injections (PRP), corticosteroid injections or placebo injections. Each person of the 45 volunteers got three treatments in monthly intervals and they were followed for 1 year. Only the PRP treatment group had successful regrowth of hair in the bald spots. This study has caught the attention of the media. Images of vampires drinking blood were circulating in the press, but nothing could be further from the truth. Unfortunately a story like this just instills fear in the public, but does nothing to clarify what was done in this clinical trial.
Let me explain what the authors of the above baldness study actually did and why.
PRP has been shown in the past to contain various growth factors that support stem cells. So, in order to stimulate the stem cells in the baldness spots to renew hair growth blood was drawn from the same patient (there are no incompatibility issues with regard to transplant rejection). The blood sample was then placed in a centrifuge to separate the red blood cells, which go to the bottom of the test tube, from the other cells. The portion of the blood just above the red blood cells contains platelets and fibrinogen. This is called PRP or platelet rich plasma (blood without red blood cells is called plasma).
The plasma is enriched more than 4 times from the original concentration of platelets in blood. Platelets are special blood cells, which take part in the clotting process. They also contain a lot of growth factors that are all-important for the survival of the stem cells in the baldness spots. The PRP helps the dormant hair follicles in the bald spots to regrow hair. In the past PRP has been extensively researched for the treatment of musculoskeletal injuries.
With respect to treatment of baldness according to this website PRP injections alone help only in about 30% of patients to slow down hair loss and to rejuvenate hair growth. This link also contains a “before and after” picture of a PRP treated scalp. Note that this patient did not receive a hair transplant, just PRP injections. What happened here is that the PRP injections transferred platelets with growth factors from the patient’s blood. Some of the hair growth was from stimulated dormant hair follicles that were still in the patient’s scalp at the bald spot; however, other hair follicles likely developed from mesenchymal stem cells that were situated in the scalp, but activated by PRP (like grass seeds that would grow grass when put in fertile soil and watered).
Here is a YouTube video, which explains stem cell therapy for thickening of thinned hair with the use of something called Acell and PRP.
In this 2011 paper it was describes that PRP and other factors can stimulate hair growth, in some cases histology proof was even obtained showing that hair follicles had grown to a normal size following the stimulation from PRP and other factors. One important such other growth factor is the so-called Acell, which is a special application of extracellular matrix: With the help of this acellular material that functions as a matrix for hair follicles to grow the success rate of Acell and PRP injections has vastly improved. Estimates are that there are 70% to 80% success rates with this form of treatment (Acell and PRP). Here is a website where this type of treatment is also discussed.
In those cases of baldness where minoxidil and bioidentical testosterone replacements fail, treatment with the patient’s own PRP and augmented by the use of Acell material as a matrix can be an alternative form of treatment. Although so far only one randomized trial has shown good results, other trials from different centers will likely soon confirm this treatment modality.
References regarding hormone aspects (lack of testosterone) of baldness
1. Overview of hair loss: http://www.nethealthbook.com/articles/hairloss.php
2. Testosterone for male menopause: http://www.askdrray.com/testosterone-for-male-menopause-andropause/
3. More info on PRP: http://link.springer.com/article/10.1007/s12178-008-9032-5#page-1
Last edited April 30, 2014