Treatments: Microneedling and PRP

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© Springer Nature Switzerland AG 2020
A. Tosti et al. (eds.)Hair and Scalp Treatmentshttps://doi.org/10.1007/978-3-030-21555-2_4



4. Regenerative Treatments: Microneedling and PRP



Colombina Vincenzi1  , Benedetta Marisaldi1 and Antonella Tosti2


(1)
Dermatology, Private Hospital Nigrisoli, Bologna, Italy

(2)
Fredric Brandt Endowed Professor of Dermatology, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

 



 

Colombina Vincenzi


Keywords

Hair growthRegenerative treatmentsMicroneedlingGrowth factorsPlatelet-rich plasmaAndrogenetic alopeciaAlopecia areataWNT pathwayβ-CateninCytokines


Microneedling


Introduction


Microneedling is a minimally invasive dermatological procedure, also known as percutaneous collagen induction (PIC), that utilizes multiple fine needles rolled over the skin to create micropunctures. This treatment was first used for cosmetic purposes to promote an increase in collagen and elastin formation and is now used in a wide range of dermatologic conditions, including hair disorders.


How It Works


The mechanism of action of microneedling consists in creating numerous microwounds within the epidermis and papillary dermis in order to initiate the wound-healing response. The microwounds create microinflammation, trigger the response of platelets, which release platelet-derived growth factors, and activate the hair bulge. Increased expression of Wnt pathways, namely Wnt3a and Wnt10b, is also an evident consequence of microneedling. All these processes have been demonstrated to activate dermal papillae stem cells and hair growth (Fig. 4.1).

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Fig. 4.1

How microneedling works


Microneedling may also facilitate transdermal drug delivery through the creation of micropores that reach different levels of the skin depending on the needle size. There are recent studies that show how involving a greater microneedle length increased drug penetration, whereas rollers without microneedles failed [1]. These results suggest that microneedling could be a valid way for increasing the delivery of topical medications.


Microneedling Devices


Microneedling may be performed with non-energy-based and radiofrequency-based devices. The non-energy-based devices are divided into manual and automatic devices.


The manual instrument consists in a cylindrical roller device with stainless steel needles that is rolled back and forth to induce thousands of tiny pores in the papillary dermis. The manual devices are usually preferred for short and more sparse hair (Fig. 4.2).

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Fig. 4.2

Manual non-energy-based device for microneedling


Automatic devices are electronic pen-shaped tools with gauge needles that vibrate and punch vertically into the skin at speeds of up to 25+ times/s (Fig. 4.3). They are preferred for patients with longer hair. If a pen is used, the depth of penetration can be adjusted according to the length of the needles and the pain tolerance on different areas of the scalp. If a manual roller is used, the depth of needles cannot be adjusted during the procedure (Table 4.1). Be sure to use high-quality instruments in order to ensure that needles do not injure the patient’s skin by breaking off.

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Fig. 4.3

Automatic non-energy-based device for microneedling




Table 4.1

Comparison between manual and automatic devices




















Manual

Automatic

Variable needle length and diameter BUT not adjustable during the treatment

Variable needle length and diameter AND adjustable during the treatment


Horizontal rolling that may be less comfortable

Vertical punching that proves more comfortable


Recommended for shorter and more sparse hair

Recommended for patients with longer hair


Radiofrequency microneedling adds the element of radiofrequency energy to the traditional microneedling procedure. The delivery of radiofrequency through a fractional microneedling radiofrequency device causes thermal injury directly to the dermis by generating a current between paired insulated microneedles [2]. Radiofrequency microneedling can offer similar results to ablative laser procedures.


Microneedling Procedure


It is essential that the patient attends the microneedling session with cleaned hair. Topical anesthetic cream should be applied for 45 minutes prior to the session. Once the anesthetic has become effective, the cream should be removed using saline solution or alcohol.


In our experience, we prefer using pen devices. Move the pen over the treatment area in linear passes, up to three times for the same area, using minimal pressure (Fig. 4.4). The endpoint is to achieve pinpoint bleeding or mild erythema in the treated scalp area (Fig. 4.5). At the end of the procedure, wash off the blood with saline solution and apply an antibiotic or antiseptic cream to avoid infections.

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Fig. 4.4

Use of pen during microneedling session


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Fig. 4.5

Pinpoint bleeding after microneedling session


No side effects have been reported in the literature apart from bearable pain, obviously depending on individual pain tolerance.


Efficacy Assessment


Most studies on microneedling in hair diseases focus on the use of this procedure in androgenetic alopecia (AGA). The first study, run by Dhurat et al., compared treatment with twice daily application with 5% minoxidil alone and the same concentration of minoxidil in conjunction with weekly microneedling sessions. After 12 weeks of treatment, the microneedling plus minoxidil group showed a higher hair count than the other group [3]. The same authors evaluated the use of microneedling in four men who were unsuccessfully using minoxidil 5% and oral finasteride. With the addition of microneedling, all patients showed higher improvement than with the medical therapy alone [4].


Another study by Farid et al. involving 40 female AGA patients compared 5% minoxidil monotherapy with microneedling plus platelet-rich plasma (PRP). Both groups showed a significant increase in hair count, but hair growth occurred faster with minoxidil therapy alone. The authors suggested minoxidil as the first-line therapy [5].


A paper by Sasaki studied the effect of the combination of microneedling and PRP in AGA, with a final significant improvement in hair growth [6].


Lee et al. ran a pilot study where the subjects were treated on half the scalp with microneedling plus topical growth factor, and the other half with a saline solution followed by microneedling. The growth factor-treated side of the scalp showed more than a 10% increase of hair count compared to the control side [7].


All these studies suggest a significant role of microneedling in combination with other established therapies such as minoxidil or finasteride.


Only two studies reported the use of microneedling in alopecia areata (AA). Lee et al. used microneedling in combination with photodynamic therapy to enhance the absorption of methyl 5-aminolevulinate acid (MAL), but unsuccessfully [8]. Chandrashekar et al., on the other hand, used microneedling in combination with the topical application of triamcinolone in two patients with AA, obtaining excellent results [9]. We cannot affirm that microneedling has an evident efficacy in the treatment of AA.


Platelet-Rich Plasma


Introduction


Platelet-rich plasma (PRP) is an autologous preparation of plasma with concentrated platelets containing various growth factors (GFs) and cytokines that enhance the body’s inherent capacity to repair and regenerate (Table 4.2).
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Mar 23, 2021 | Posted by in Dermatology | Comments Off on Treatments: Microneedling and PRP

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