A Case Study on PRP Treatment and its Successful Results for Treating Alopecia Areata Barbae

ABSTRACT

Alopecia Areata (AA) is a common autoimmune disorder in which inflammatory cells attack the hair follicles. Here I share a successful case study of a 27-year-old male suffering from Alopecia Areata Barbae (AAB), which is Alopecia of the beard, who responded to eight PRP treatments performed in combination with oral vitamin supplementation.

Case presentation.

A patient visiting my clinic has reported progressing Alopecia Areata Barbae (AAB) for more than a year. There is currently no guidance established on treating AAB. 

Management and Outcome.

The examination has confirmed patchy AAB and thinning crown hair. AAB can be associated with autoimmune disorders which have been excluded during examination therefore the decision on implementing PRP treatment has been agreed upon with the patient. 

Discussion.

PRP is a natural, safe, and effective treatment provided the patient’s blood cells are rich in necessary micronutrients, and a required level of growth hormone is delivered, while potentially harmful agents are eliminated.

INTRODUCTION

AA is a frequent autoimmune disorder caused by inflammatory cells attacking the hair follicles on the scalp. AAB is well known as Alopecia Areata Barbae which affects the beard area in men. AA can be associated with autoimmune disorders like Psoriasis, Atopic Dermatitis, Vitiligo, Incipient Diabetes Mellitus, Hypothyroidism. Treatment options include corticosteroid therapy (intralesional or topical),  immunotherapy, Janus kinase (JAK) inhibitors, lasers, photodynamic therapy, and treatment of an underlying Helicobacter Pylori infection. All of the above conditions have been excluded during the consultation process. 

Furthermore, it is well known that Alopecia Areata is a common clinical finding in patients with vitamin D deficiency [1]. Any hair-bearing skin can be involved, but it most commonly affects the scalp or beard, less frequently, the eyebrows and eyelashes [2]. “Hair follicles are highly sensitive to hormones” [3]. Vitamin D is a hormone that plays an important role in calcium homeostasis, immune regulation, cell growth, and differentiation.

It has been found that RBC folate is significantly lower in patients with Alopecia Areata and in patients with more extensive and more severe forms of disease [4]. A deficiency of a few vitamins from the B group has been proven to be one of the factors that are correlated to Alopecia, malabsorption, and low mood [5]. Ascorbic Acid (Vitamin C) is well known for its antioxidative function [6]. 

Lidocaine demonstrates a 100% kill ratio on telomerase-positive stem cells [7].

All these factors have been taken into consideration and an improvement of the condition has been noticed a month after the second treatment with PRP. 

This presented case is focused on effective vitamin supplementation contributing to strong blood cells and eliminating cell harming factors, both primarily contributing to successful PRP treatments. 

CASE REPORT

A 27-year-old male, skin type IV, with a noticeably small amount of body fat has visited my clinic expressing his wish to be treated for AAB with PRP treatment. 

During the consultation, he has shared with me that his current situation is stressful due to his job plus he is not happy in a relationship which suggested the oxidative stress factor. He confirmed progressing patchy AAB for over a year. Crown hair area was thinning. Eyelashes, eyebrows, and nails were unaffected.

Patient has reported AA in family history. Apart from AAB the patient did not suffer from any diseases and did not take any medication except for protein shakes containing Dihydrotestosteron (DHT). DHT seems to play an extremely important role in the pathogenesis of androgenetic alopecia [8]. Patient was advised to stop DHT shakes and was educated on the importance of implementing vitamin supplements including; Niacin (Vitamin B3), Riboflavin (Vitamin B2), Pantothenic Acid (B5), and Biotin (B7). These vitamins show a significant role in hair growth itself, however, evidence suggests that “supplementation with the entire B group of vitamins is a more rational approach than selecting one, two or three compounds from this sub-group of vitamins”, (Kennedy, January 2016)

Therefore B Complex, Silica, and Vitamin C have been implemented into the diet two weeks prior to the treatment and are ongoing. Vitamin D3 and C accordingly, acknowledging that most of the population in the UK has a low level of vitamin D in the blood and that a skin type IV requires regular sun exposure to keep vitamin D levels at norm [9]. The biological actions of vitamin D3 derivatives include regulation of epidermal cell proliferation and differentiation and modulation of Cytokine production [10].

The patient was reluctant to the blood-taking procedure declaring he “jumps when the needle is introduced to his skin”. After reassurance and making the patient feel comfortable two PRP treatments have been performed four weeks apart. No improvement has been noted on the second appointment. However, the patient returned after eight weeks and showed minimal improvement of the condition where minimal hair regrowth was noted and was willing to undergo further treatments. Another six autologous plasma treatments (PRP) were administered at intervals of four weeks. He has confirmed regularly taking vitamin supplements as advised earlier. 

For each treatment 20 ml of blood has been drawn from the patient with a 21G needle into two separate 10ml tubes (T-lab PRP kit). Directly after that, the blood samples have been centrifuged at 4000 speed for 15 minutes. In each tube, the PRP and PPP (Platelet Poor Plasma), approximately 5 ml,  settled in the upper third of the tube and was transferred within a closed system with the sterile cannula into a smaller tube. PRP and PPP have been drawn into a 2,5 ml syringe. Following disinfection of the treatment area without the use of numbing agents containing Lidocaine, but just using ice. Approximately 7ml has been injected into the AAB area and 3ml into the thinning hair crown area. Injections were performed approximately 0,7cm apart in the depth of approximately 1-2mm with a 31G needle. The patient has tolerated the procedure well. I’ve coordinated the injection speed with the patient’s breathing tempo which helped in managing the discomfort level. Additionally, during the last four treatments I’ve used 1ml TIGF (Cytokine stimulation of natural growth factors), a mesotherapy product injected with nappage technique to ensure a high level of growth factor produced. On top, post-treatment a natural hair-growth spray containing ginseng extract has been applied leaving a pleasant smell and protective sheath. 

Patient was advised on home and aftercare which included: lowering the stress level meaning gentle lifestyle change, washing hair and face in low warm water not often, then, every 2-3 days using organic shampoo or at least with no sulfates included, avoiding blow drying and styling of the hair plus ongoing vitamin supplementation. 

Stabilisation of the condition was noted after the third treatment and full regrowth at one-year follow-up continuously until today. The patient has gained a healthy body mass and moved on from lifestyle-inducing oxidative stress. He now lives happily in a different country surrounded by many new and good friends confidently sharing his pictures on social media.

DISCUSSION

PRP treatment has always been controversial in terms of results, especially in aesthetics. Patients are often treated as clients only, receiving the treatment without further consideration of factors contributing to the problem, like lifestyle and diet, resulting in less effective treatment. Would it be possible to achieve the above-mentioned outcome without educating the patient on these subjects and his compliance?

This case represents several features that should be considered helpful for other medical health practitioners to achieve the best possible results. These include:

• The PRP kit is explicitly designed for PRP treatment which guarantees the appropriate volume of harvested platelets – not every IVD tube is suitable for PRP treatment;

• Ensuring patient’s blood is nourished in necessary micronutrients – 75% of the UK population’s blood plasma is lacking Vitamin D, according to Kift and Rhodes (01/08/2018).

• Eliminating potentially harmful agents;

• Achieving patient compliance;

• Reducing oxidative stress.

PRP treatment requires a holistic approach to be successful. When treating clients with PRP, I refer to them as patients and consider their lifestyle and overall well-being, which assures the most effective outcome.

Nonetheless, the need for further research in the micronutrients area is paramount, given that the current body of literature primarily consists of small case studies and reports concluding the role of vitamin supplementation in Alopecia Areata (AA).

Kornelia Hauck RN INP Holistic Practitioner

6 Hermit Place,
London, NW6 4BZ

TEL. +44 7861772863

info@angry-boyd.213-175-201-39.plesk.page

The patient’s consent was obtained to share his case.  
London 11/01/2022