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Platelet-rich plasma (PRP) showed variable and, in some cases, limited efficacy in treating psoriasis and other dermatologic conditions, a literature review has found.

PRP is widely regarded as a safe and potentially effective treatment for hair loss, vitiligo, photoaging, and acne scars, among other conditions, and is one that frequently garners high satisfaction marks from patients. However, according to the review findings, a lack of standardization in preparation protocols and other factors pose an important barrier to interpreting the treatment's true efficacy.

The review, which appears in the , was conducted by researchers at Wake Forest University in North Carolina. The following excerpts were edited for length and clarity.

What was the specific objective of this review?

PRP offers anti-inflammatory and regenerative properties through angiogenesis, cell differentiation, and proliferation. Although studied in many dermatologic conditions, its efficacy is not well understood. The objective of the current review was to gain a clearer picture of the use and effectiveness of PRP for dermatologic conditions.

What were the key findings?

The pathogenesis of psoriasis involves an inflammatory cascade that is not fully understood but is believed to be mediated by NF-jb, which ultimately leads to the epidermal dysregulation. PRP is proposed as a potential treatment for psoriasis through its inhibition of NF-jb via the growth factors released from platelets.

The existing evidence of PRP for plaque psoriasis, however, is minimal and weak, with no randomized controlled trials (RCTs) and other studies that had no control arm or that compared combination therapy of PRP injections and methotrexate to standard methotrexate monotherapy. Nevertheless, data from two prospective clinical studies suggested some benefit from PRP for people with psoriasis.

For inflammatory nail disorders, PRP has been proposed as a treatment based on its anti-inflammatory properties and constituent growth factors. Literature evaluating treatment of these disorders with PRP was limited to an intra-individual comparable study and two case reports. Of these studies, a case report each of nail lichen striatus and idiopathic trachyonychia reported resolution of pretreatment nail changes after PRP; the comparable study found greater improvement in combination PRP and triamcinolone than in triamcinolone alone.

Researchers also identified a total of three meta-analyses and two RCTs that focused on PRP for androgenic alopecia. In the first meta-analysis, there was an increase in hair density in the PRP group but not in cross-sectional thickness, while the second found an increase in hair density. The third meta-analysis initially found an increase in hair density and cross-sectional thickness, but these were not statistically significant in pooled results.

For alopecia areata, a total of three RCTs on PRP use in patients were evaluated. The first study found improved Severity of Alopecia Tool (SALT) scores for the PRP group when compared to placebo. The second found similar improvements between the control and PRP treatment groups after three different treatments with no significant difference from physicians' or patients' assessments. The final study found greatest improvement in the intralesional corticosteroid group followed by the PRP group.

For vitiligo, PRP promotes melanocyte regeneration, anti-inflammatory pathways, and enhancement of intracellular adhesions, and therefore offers potential treatment benefit for this patient population. No meta-analyses were available; four RCTs and an additional comparable study were identified. There was wide variability in both the outcome measures and therapies evaluated, making outcomes difficult to compare among studies. The five vitiligo studies reviewed each used PRP in combination with different laser therapies. In three of these studies, the combination of PRP with laser therapies achieved the biggest improvements, while two of the studies showed no difference or a nonsignificant increase.

What are the current limitations in PRP use and research, particularly in a dermatological context?

There are multiple limitations to the evaluation of PRP studies, which limited the conclusions of the review. Although P-PRP is the primary formulation used in dermatology, preparation protocols are not standardized between institutions and frequently are not reported in the literature. In addition, among studies for many dermatologic conditions, the endpoints vary widely, limiting the ability to compare studies.

Key points

• PRP showed some efficacy in treating psoriasis and other dermatologic conditions, but evidence is weak.
• PRP is still viewed as a safe treatment option that is popular with patients.
• Formulations of PRP are not adequately standardized in dermatology and elsewhere.