Androgenetic alopecia (AGA) is a common condition that affects up to 50 percent of males
and females. It is characterized by progressive loss of terminal hair of the scalp any
time after puberty. It has a very typical distribution in both males and females. In
males, hair loss is mostly on vertex and frontotemporal regions, while in women the
frontal hairline is mostly involved with diffuse hair loss at the crown and top of head.
Currently, FDA approved treatments are topical minoxidil and oral finasteride. But due to
its adverse effects, most patients refuse to take this drug. Platelet rich plasma (PRP)
is currently effective alternate therapy used very commonly. PRP is autologous
concentration of platelets, having multiple growth factors in their alpha granules,
injected intradermally in scalp. There is another emerging treatment modality which is
exosomes. Exosomes are 30-150nm extracellular vesicles (EVs) derived from various
mesenchymal stem cells (MSCs). Exosomes contain various proteins, nucleic acids and
various cell mediators and growth factors. They have same biological properties as that
of their parent derived cell along with advantages of small size, easy penetration of
biological membranes, low immunogenicity, easy storage, and no tumorization. Recently,
exosomes have been genetically modified so that they can exhibit better therapeutic
properties, such as enriched active ingredients, targeted delivery, and physiological
barrier to penetration. Because of their properties they have roll in hair growth.
Exosomes are providing promising results in patients of androgenetic alopecia. Both PRP
and exosome therapy has found to be effective in various studies across the globe. Very
less literature is found on comparison of these two treatment modalities specially in the
world.
Learning Objective is to compare the efficacy and safety of PRP and Exosomes in patients
of Androgenetic alopecia.
It is a randomized clinical trial going on in Dermatology department of Services hospital
Lahore, Pakistan. After getting approval from Ethical Review Board.
Pre-treatment assessment is done by hair pull test, global physician assessment, patient
global assessment and hair density by trichoscopy of the involved areas of scalp. The
patients are randomized into two groups by paper lottery method. After regional nerve
block under aseptic conditions, Group A patients are injected exosomes intradermally at a
strength of 2 to 10 billion particles/5ml, at a dose of 0.1 ml/cm2 of scalp, and group B
patients are injected PRP intradermally in scalp. Exosomes used are GFCCELLTM EXO SCALP
KIT. PRP is prepared under aseptic precautions, around 10ml of blood is collected from
the median cubital vein and is transferred into a sodium citrate tube. Then the tubes are
rotated in a centrifuge machine at 1500 RPM for 10 minutes. This first centrifugation is
called "soft spin," which separates the blood into 2 layers: the lower RBC layer; the
upper acellular plasma layer which is further subdivided into an upper layer which
contains platelet poor plasma and a lower layer which contains platelet rich plasma also
known as the buffy coat. The buffy coat along with the plasma was collected with a
pipette and transferred into another test tube. This tube was again subjected to a second
centrifugation at 4000 RPM for 10 minutes, called "hard spin." This allows the platelets
to settle at the bottom of the tube. Both the upper layer containing platelet poor plasma
and the lower layer of the PRP was collected in another clean tube. The plasma is filled
into insulin syringe and then injected evenly into the affected areas of the scalp.
Multiple PRP injections of 0.1 mL were given at each site in a linear pattern 1 cm apart.
The patients are followed monthly after the first treatment session for 6 months. The
primary efficacy endpoints of this study are increse in hair regrowth assessed by Global
physician assessment and patient global assessment on scale of three ( <25% as
satisfactory, 25-50% as good response, >50% as excellent response) and number of hairs
which are calculated by trichoscopy. Demographic data and pretreatment parameters are
recorded on a predesigned proforma. Data is entered and analyzed using SPSS vs 20.