Platelet-Rich Plasma and Its Utilities in Alopecia: A Systematic Review.

BACKGROUND: The use of platelet-rich plasma is becoming more prevalent in the field of dermatology. Variable preparation techniques and treatment methods have been described with reported success in alopecia. OBJECTIVE: To consolidate the available evidence of platelet-rich plasma and its utility in the treatment of alopecia for the practicing dermatologist. METHODS: Evaluating the available evidence up to May 31, 2018, a search was conducted in the PubMed database for "platelet rich plasma" or "platelet releasate" or "platelet gel" or "PRP" and "dermatology" or "skin" or "hair" or "cutaneous." RESULTS: Nineteen articles met the inclusion criteria for analysis including 3 alopecia areata studies with a total of 71 patients and 16 androgenetic alopecia studies with a total of 389 patients. Although the heterogeneity of the studies prevented direct comparisons and subsequent statistical analysis, the majority demonstrated that platelet-rich plasma produced successful hair growth in androgenetic alopecia and alopecia areata. CONCLUSION: This review advocates for the use of platelet-rich plasma in 3 to 4 monthly sessions for the treatment of alopecia. Future studies should include a detailed description of the platelet-rich plasma isolation process to allow for comparison among studies, provide reproducibility, and generate a standardized treatment protocol.

Platelet-rich plasma and its utility in medical dermatology: A systematic review.

The field of dermatology has seen numerous therapeutic innovations in the past decade with platelet-rich plasma (PRP), recently garnering significant interest in alopecia, acne scarring, and skin rejuvenation. In other conditions of dermatology, such as chronic wounds and vitiligo, PRP has been investigated but has received less attention. The objective of this literature review was to focus on conditions of medical dermatology and to consolidate the available evidence on PRP for the practicing dermatologist. This review evaluates the literature up to October 31, 2018, and a search was conducted in the PubMed database for "platelet-rich plasma," "platelet releasate," "platelet gel," "platelet-rich fibrin" or "PRP" and "dermatology," "skin," "cutaneous," "wound," or "ulcer." In total, 14 articles met the inclusion criteria for this review. In studies representing Levels of Evidence 1b-4 according to the Centre for Evidence-Based Medicine, Oxford, PRP significantly improved wound healing in chronic diabetic ulcers, venous ulcers, pressure ulcers, leprosy ulcers, acute traumatic wounds, and ulcers of multifactorial etiologies. Two studies also documented benefits of adjunctive PRP in stable vitiligo. In chronic wounds of multiple etiologies and vitiligo, PRP warrants further investigation because it represents a potential therapeutic adjunct or alternative with a favorable side effect profile.

Platelet-rich plasma and its utility in the treatment of acne scars: A systematic review.

The field of dermatology has seen numerous therapeutic innovations in the past decade, with platelet-rich plasma recently garnering significant interest in acne scarring. This review consolidates the available evidence on platelet-rich plasma for the practicing dermatologist and evaluates the current evidence up to May 31, 2018. A search was conducted in the PubMed database for the terms platelet-rich plasma or platelet releasate or platelet gel or PRP and dermatology or skin or acne or scar or cutaneous, with 13 articles meeting the inclusion criteria. The quality of each individual study was evaluated, and levels of evidence were assigned according to the Centre for Evidence-Based Medicine, Oxford, United Kingdom. This review reveals that activated, leukocyte- and platelet-rich plasma in combination with fractional ablative laser treatment administered in 2 or 3 sequential sessions 1 month apart improves the appearance of acne scars. The evidence for the use of platelet-rich plasma with microneedling is less supportive. Because of the heterogeneity of the studies and widely variable outcome measures, comparison between platelet-rich plasma treatments and subsequent statistical analysis could not be performed. Although these studies use various subjective and objective evaluation methods, the addition of platelet-rich plasma provides improvements in acne scarring, higher patient satisfaction, and decreased postprocedure downtime.

Major Depression and Long-Term Survival of Patients With Heart Failure.

OBJECTIVES: Previous studies have found that depression predicts all-cause mortality in heart failure (HF), but little is known about its effect on long-term survival. This study examined the effects of depression on long-term survival in patients with HF. METHODS: Patients hospitalized with HF (n = 662) at an urban academic medical center were enrolled in a prospective cohort study between January 1994 and July 1999. Depression was assessed on a structured interview during the index hospitalization and on quarterly interviews for 1 year after discharge. Patients were classified at index as having Diagnostic and Statistical Manual, Fourth Edition major depressive disorder (n = 131), minor depression (n = 106), or no depression (n = 425). Clinical data and the National Death Index were used to identify date of death or last known contact through December 19, 2014, up to 20 years after the index hospitalization. The main outcome was time from enrollment to death from any cause. RESULTS: A total of 617 (94.1%) patients died during the follow-up period. Major depressive disorder was associated with higher all-cause mortality compared with no depression (adjusted hazard ratio = 1.64, 95% confidence interval = 1.27-2.11, p = .0001). This association was stronger than that of any of the established predictors of mortality that were included in the fully adjusted model. Patients with persistent or worsening depressive symptoms during the year after discharge were at greatest risk for death. The association between minor depression and survival was not significant. CONCLUSIONS: Major depression is an independent risk factor for all-cause mortality in patients with HF. Its effect persists for many years after the diagnosis of depression.