What is the guideline for using Platelet-Rich Plasma (PRP) therapy to treat alopecia?

PRP for Alopecia: Clinical Guidelines

Administer PRP as three intradermal scalp injections spaced exactly one month apart, using nonactivated PRP at 5-7 mL per session (0.05-0.1 mL/cm²), combined with topical minoxidil 5% twice daily, followed by maintenance injections every 6 months. 1

Preparation Protocol

• Use manual double-spin method for PRP preparation with target platelet concentration of 1.0-1.5 million platelets per microliter 2
• Do not activate PRP before injection—nonactivated PRP produces 31% greater increases in hair count and total hair density compared to activated PRP 1
• Draw autologous blood and process immediately using standardized centrifugation protocols 2

Treatment Administration

Initial Treatment Phase

• Deliver 3-5 treatment sessions spaced exactly one month apart 2, 1
• Inject 5-7 mL PRP per session using 30-gauge × 4 mm needles 2
• Use point-by-point injection technique at 90-degree angle, 2-4 mm depth 2
• Space injections 1 cm apart across mapped areas of hair loss 2
• Apply pharmaceutical-grade topical anesthetic before injection to minimize pain 2

Concurrent Therapy

• Prescribe topical minoxidil 5% at 1 mL twice daily throughout treatment and beyond—combination therapy significantly outperforms either monotherapy 1, 3
• Consider adding finasteride and multivitamin supplements as background therapy 2

Maintenance Phase

• Administer maintenance PRP injections every 6 months indefinitely—discontinuation results in loss of gains 1
• Evaluate response after one year of treatment 2

Expected Outcomes and Timeline

• Initial improvements visible at 2-3 months, with 25% improvement at 2 months predicting sustained response at 6 months 1
• At 6 months: hair density increases 1.74-fold, hair diameter increases 14.3-fold, telogen phase hair decreases 9.3-fold 1
• Average gain of 22 follicular units per cm² after four sessions 4
• Pull test becomes negative in approximately 80% of patients after completion of initial treatment phase 4

Patient Selection

Best candidates are patients with mild to moderate androgenetic alopecia—more severe grades show variable results 1

Consider PRP for:

• Androgenetic alopecia (male and female pattern hair loss) not responding to 6 months of conventional therapy 4
• Alopecia areata (efficacy ranges 31.7-76%) 5, 6
• Adjuvant therapy during hair transplant surgery 2

Avoid in:

• Patients unable to commit to long-term maintenance therapy 1
• Severe, advanced androgenetic alopecia where response is unpredictable 1

Safety Profile

• Primary adverse effect is injection pain, which resolves after treatment completion 5
• Overall excellent safety profile with minimal serious adverse events 5, 7
• High patient satisfaction rates across multiple studies 4, 5

Critical Clinical Pitfalls

• Activating PRP reduces efficacy by 31%—always use nonactivated PRP 1
• Monotherapy with PRP alone is inferior to combination with minoxidil—always prescribe concurrent topical therapy 1, 3
• Stopping maintenance injections leads to relapse—counsel patients about lifelong commitment 1
• Variable study protocols in literature make evidence interpretation challenging—follow standardized Indian Association of Dermatologists recommendations 2

Emerging Alternative: Platelet-Rich Fibrin (PRF)

• PRF shows promise as potentially superior alternative with theoretical advantages including lower cost and easier preparation 2, 3
• PRF demonstrates clinical efficacy in androgenetic alopecia with similar safety profile to PRP 2
• Consider PRF particularly for mild cases and as adjuvant to hair transplantation 2
• Standardized protocols still needed before widespread adoption 2