Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : WC01 - WC04 Full Version

Clinical Evaluation of Intradermal Platelet Rich Plasma Administration along with Oral Biotin Supplement for the Management of Androgenetic Alopecia in Adult Males: A Randomised Clinical Trial


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57980.17008
Neha Gupta

1. Associate Professor, Department of Dermatology, Venereology and Leprology, NSCB Government Medical College, Jabalpur, Madhya Pradesh, India.

Correspondence Address :
Dr. Neha Gupta,
HIG 13, JDA Colony, Katanga, Jabalpur-482001, Madhya Pradesh, India.
E-mail: dr.neha33@gmail.com

Abstract

Introduction: Androgenetic Alopecia (AA) is characterised by progressive-patterned hair loss from the scalp affecting males and females alike. Miniaturisation of the hair follicle with associated hereditary tendency is one of the major primary causal factors for the pathogenesis of AA. Various treatment modalities have been proposed for the management of AA including minoxidil, finastride, etc.; however, they are associated with known side-effects.

Aim: To evaluate the effect of intradermal Platelet Rich Plasma (PRP) administration, along with oral biotin supplement for the management of AA in males.

Materials and Methods: The present randomised clinical study was conducted at Department of Dermatology, B.J. Medical College and Hospital, Ahmedabad, Gujarat, India from January 2012 to May 2013. A total of 40 healthy adult males of Indian origin, with a history of hair loss, completed the 12 month trial. They were equally randomised into two groups. Subjects enrolled in group A (n=20) received intradermal administration of autologous PRP, every 15 days for three months along with oral biotin tablets, once daily for three months, while those in group B (n=20) received oral biotin tablets, once daily for three months. Hair regrowth was evaluated using a standardised 7-point rating scale at 3, 6, 9 and 12 months intervals, by the same investigator. Chi-square test was used to statistically assess the data. The p-value for significance was established at <0.05.

Results: Individuals in group A had mean age of 32.3±6.1 years and showed statistically significant (p-value <0.05) increase in hair regrowth at 6 months, 9 and 12 months; compared to Group B with mean age of 30.7±5.2 years.

Conclusion: Intradermal administration of PRP along with oral biotin tablet supplementation resulted in a statistically significant increase in hair regrowth, without any remarkable side-effects. PRP is a safe and effective treatment modality in adult males, with AA.

Keywords

Blood products, Hair, Hair growth, Hair loss, Hair regrowth

The AA is typically characterised by progressive patterned hair loss from the scalp. Researchers have tried to understand its pathogenesis and underlying genetic basis (1). It has been established that the miniaturisation of the hair follicle with associated hereditary tendency are the major primary causal factors for the pathogenesis of AA (2). Although the transition of some terminal hairs into vellus hair is a secondary sexual characteristic, it becomes a medical condition when the hair loss is extreme, untimely and distressing (3). This progressive loss of hair also has psychosocial implications for affected individuals, which may lead them develop a negative image of themselves and thereby a reduced quality of life (4).

The polysomal inheritance genetic pattern and the related presence of androgens have been known to be causal agents for male AA (5). AA characteristically presents as patterned hair loss, beginning in the bitemporal region accompanied by a recession of frontal hair, which is followed by reduction over the vertex. The bald patch, so formed enlarges and joins the receding frontal hair line, leaving an island of hair on the frontal scalp. Subsequently this island of hair disappears and only a thin area remains over the parietal and temporal region. The amount of hair loss is not uniform, affected individuals often experience phases of increased hair loss (6). Studies show that, AA usually does not start till puberty and the rate of hair loss is extremely variable. It is also observed that by the age of 30 years, about 30% of men suffer from AA, which may increase to 50% upon completing 50 years of age (6),(7). Also, dark skinned males experience AA lesser than fairer skinned men (7).

Several treatment options have been advocated for the management of AA, ranging from usage of hair wigs to scalp surgery. Of these, the most accepted treatment protocols involve the use of topical minoxidil application and/ or oral finasteride medication (8). Both, minoxidil and finastride are fraught with their respective side-effects such as palpitations, dizziness, allergic reactions and sexual dysfunction, respectively (8),(9).

Hair supplements are a vast and growing industry. Patients often turn to oral supplements to address hair concerns as they are easily accessible over the counter. Nutritional supplements are regulated by the Food Drug Administration (FDA) as foods instead of drugs, meaning, they do not have to prove their efficacy and safety before becoming available to consumers. While, some oral supplements have strong evidence supporting their use for hair growth, many ingredients have not been tested in clinical trials, have only in-vitro evidence for hair growth, or have only been tested in animals (10).

The PRP is proven to be a rich source of growth factors (7). PRP promotes significant changes in monocyte mediated proinflammatory cytokine/chemokine release. The injections should be limited to the region of the superficial papillary dermis (1.5-2 mm) (11). PRP is known to contain Platelet derived Growth Factor (PGDF)-AB, PDGF-BB, transforming growth factor ?-1, Insulin-like growth factor-1 (IGF-1), fibroblast growth factor basic, Epidermal Growth Factor (EGF), Vascular Endothelial Growth Factor (VEGF), interleukin -12, etc. (11) These factors have been proven to increase blood circulation to the Dermal Papilla (DP) cells and also aid in their survival, thereby, leading to hair regrowth.

The present study was conducted to evaluate whether it is advantageous to administer autologous PRP through intradermal injection along with biotin supplementation for the management of AA in males. Also the effect of oral biotin alone on hair regrowth could be assessed. The null hypothesis established was that, there is no significant improvement in the management of AA with intradermal injection of PRP along with oral biotin supplementation as compared to administration of oral biotin also. Although PRP and biotin have been individually investigated for their role in hair regrowth in individuals with AA, the author after a literature search did not find any published data on a combination therapy employing intradermal administration of PRP and oral biotin supplements for the same. Hence, it can be stated that, the present study is a clinical evaluation of a new approach for management of AA.

Material and Methods

This randomised clinical trial was conducted at Department of Dermatology, BJ Medical College and Hospital, Ahmedabad, Gujarat, India. The duration of the present study was one year four months (January 2012 to May 2013). Ethical clearance was obtained from the Institutional Review Board (IRB) (IEC Number BJMC/IEC/2011/245). Informed consent was obtained before patients before being enrolled in the study.

Inclusion criteria: Healthy adult males between the ages of 21-40 years of age, who consecutively presented with mild to moderate vertex male pattern hair loss according to a modified Norwood/ Hamilton classification scale (III vertex, IV, V and VI) (12). All individuals were of Indian ethnicity.

Exclusion criteria: History of surgical correction of scalp hair, topical minoxidil use in the past one year, use of medication with androgenic or antiandrogenic properties, use of finastride, known systemic illnesses (such as endocrine imbalances, hepatic failure, renal failure, amyloidosis, sarcoidosis, hepatitis C, leukaemia, histocytosis X, etc.), were excluded from the study.

A total of 40 individuals were enrolled in the present clinical trial. Sample size was calculated a priori with adequate power (0.80) to detect a defined difference in hair growth between the two treatment groups. The subjects were also advised to avoid hair dyes or change their hairstyle during the course of the present study. The study participants were selected and enrolled, as per a similar study by Dhurat R et al., (12).

The subjects were randomised into two equally distributed groups using “tossing a coin” method (heads=Group A, tails=Group B). The subjects’ hair regrowth was evaluated qualitatively over a period of 12 months at intervals of 3, 6, 9 and 12 months calculated from the date of first PRP injection. Group A (n=20) consisted of subjects who received intradermal administration of autologous PRP every 15 days for three months along with oral biotin tablets (Tablet BTN Ultra, Zydus Liva, India; Manufactured by: Aurochem Pharmaceuticals, Palghar, India) once daily for three months, while those in group B (n=20) received oral biotin tablets (Tablet BTN Ultra, Zydus Liva, India; Manufactured by: Aurochem Pharmaceuticals, Palghar, India) once daily for three months. The flowchart of the study is depicted in (Table/Fig 1). All study participants were informed about the process and its potential side-effects.

Preparation of PRP

Platelet Rich Plasma (PRP) was prepared, as per the method described by Singhal P et al., (13). Twenty mL of fresh blood was collected from the median cubital vein into sodium citrate vacutainers under sterile conditions. The tubes were rotated in a centrifuge machine at 1500 revolutions per minute (rpm) for six minutes. The first centrifugation referred to as “soft spin” separates the blood into three layers, lowermost Red Blood Cell (RBC) layer (55% of total volume), top most acellular plasma layer called Platelet Poor Plasma (PPP, 40% of total volume), and an intermediate PRP layer (5% of total volume) called the “buffy coat.” Buffy coat with PPP is collected with the help of a Finn pipette in another test tube. This tube is again centrifuged at 2500 rpm for 15 minutes called “hard spin.” This allows the platelets (PRP) to settle at the bottom of the tube. The upper layer containing PPP is discarded and the lower layer of PRP is collected in another clean tube. The platelet concentrate is loaded in 1 mL insulin syringes, containing calcium chloride (nine parts of PRP and one part calcium chloride) as an activator and made ready for injections into the regions of interest.

Administration of PRP

Areas where PRP was to be injected were cleaned with surgical spirit and povidone-iodine solution. PRP was injected by the same investigator. PRP was injected using insulin syringes in a linear fashion about 1 cm apart in an aseptic environment. PRP was injected in the frontal, temporal and parietal areas of the scalp. PRP was injected on selected areas of the scalp at the amount of 0.1 mL/cm2, as per a study by Cervelli V et al., (14). About, 3-5 mL of PRP was injected. PRP was injected in a similar manner every 15 days for three months.

Data Collection

Patients (N=40) were randomly assigned to the two treatment groups, group A and group B. Patients were asked to report to the department at 3, 6, 9 and 12 months (hair regrowth was assessed at three month intervals because the hair cycle takes about 90-100 days for new growth and shedding) for standardised photographs using a DSLR Camera of scalp hair for assessment of hair growth. This method was adapted from the investigation by Olsen EA et al., (15) and Canfield D (16). The assessment of hair regrowth was done by the primary investigator at every time point by counting the hairs on the photographs. The assessment was qualitative in nature. Hair regrowth was assessed using a 7-point rating scale compared with baseline (-3 = greatly decreased, -2= moderately decreased, -1= slightly decreased, 0= no change, +1= slightly increased, +2= moderately increased, +3= greatly increased). With -3 being the lowest score accorded, while, +3 was the highest score possible. This scale was adopted, from previously published reports (12),(17).

Statistical Analysis

All statistical analyses were performed using Statistical Package for the Social Sciences for Windows (version 10.0; SPSS, Chicago, Illinois, USA). Comparisons between the groups (intergroup) were made using Chi-square test. In the present study, the level of significance was determined as p<0.05.

Results

Of the 40 patients enrolled in the study, all 40 patients reported for periodic visits, till the end of study period. No patients were lost to follow-up.

The mean age of the population was 31.2±5.39 years of age. Group A had mean±SD of 32.3±6.1 years, group B had mean±SD of 30.7±5.2 years. Patients had hair loss for a mean average of 5.3 years (4-8 years). In the present study, it was observed that there was no statistically significant difference in hair regrowth at three months between groups A and B (Table/Fig 2). However, at six months there was a statistically significant increase in hair growth (p<0.05) in individuals in group A (Table/Fig 2) as compared to group B; this change was progressive at both nine and 12 months. At both 9 and 12 months, there was a highly significant (p<0.001) difference between group A and group B (Table/Fig 2). In the present study, it was observed that upon intradermal administration of PRP and oral supplementation with biotin (group A) there was statistically significant increase in hair regrowth as compared to hair growth after only oral biotin administration. The null hypothesis established at the beginning of the present study, was thus, rejected. Subjects of group A and B at different time intervals, can be seen in (Table/Fig 3),(Table/Fig 4).

Discussion

The PRP contains a variety of growth factors. These are, EGF, IGF, PDGF, Transforming Growth Factors (? & ?) {TGF}, VEGF. Each factor has specific functions, which are as follows, regulation of cell proliferation, differentiation and survival by EGF; key regulator of cell metabolism and growth by IGF; PDGF promotes the synthesis of collagen and proteins and is a major mitogen for connective tissue cells, TGF regulates cell proliferation, differentiation, apoptosis, induction of intimal thickness, and, VEGF regulates angiogenesis (12). These growth factors are vital for the growth and development of the hair follicle in all its stages, from anagen to catagen to telogen. The growth factors contained within the alpha granules of platelets act on stem cells in the bulge area of the hair follicles and stimulate the development of new follicles along with neovascularisation (18). An understanding of the role of the aforementioned growth factors is critical to the successful management of AA. It is the miniaturisation of this hair follicle due to Dihydrotestosterone (DHT) (19), that results in AA.

Apart, from PRP administration and surgical procedures to address Androgenetic Alopecia (AGA), other therapeutic options, include topical minoxidil application and oral finastride. However, potential side-effects have been documented with both (8),(9). Oral finastride is not indicated for females.

The therapeutic effects of PRP in the management of AA can be specifically attributed to the various PDGF aiding in significant improvement in the function of hair follicle and promotion of hair growth. Being autologous in nature, it is potentially free of any adverse effects and is inexpensive and easy to manufacture. In the present study, none of the patients reported with any adverse events, during the study period of 12 months. In the present study, hair regrowth was assessed at three month intervals because the hair cycle takes about 90-100 days for new growth and shedding (20). This was in line with a similar methodology adopted by Schiavone G et al., (21).

Clinical study by Uebel CO et al., where they pretreated follicular units with platelet plasma growth factors before implantation in male patients, observed that there was significant improvement in hair density and hair growth (22). Investigation by Schiavone G et al., demonstrated clinical improvement in males and females with AGA after administration of leucocyte PRP injected three months apart and evaluation was done over a period of 12 months (21). Similar results were reported by Khatu SS et al., wherein they observed significant reduction in hair loss after injection of PRP at the end of an observation period of three months (23). A meta-analysis published by Gupta AK and Carviel JL, showed that PRP injections have a promising role in the treatment of AA (24). Gkini MA et al., evaluated the efficacy of PRP injections over a year and reported a significant reduction in hair loss after three months, and improved over a period of one year (25). A study by Gentile P et al., suggested that PRP may lead to increase in keratinocyte proliferation and perifollicular angiogenesis (26). However, a study by Ayatollahi A et al., using PRP in AGA patients did not find any difference in hair count or density (27).

It can be concluded from this study that PRP injection leads to a statistically progressive increase in hair regrowth. Future studies with greater number of participants and well-designed clinical trials could yield more evidence into application of intradermal PRP injections in the successful management of AA. Also, long-term studies on the survival rate of the hair regrowth obtained after PRP administration should be conducted to analyse the cost to benefit ratio of this modality. Clinically, the administration of PRP and oral biotin supplementation could be a viable treatment approach for males. Similar investigations can be planned for female population with alopecia, also.

Limitation(s)

The small sample size was one of the limitation of the study. The study did not record survival rate of the hair regrowth after a period of 12 months. Also, the present study, was conducted on male population, and the findings cannot be extrapolated to females in a direct manner. PRP injection and oral biotin supplementation is an inexpensive and safe alternative, compared to other modalities of treatment for AGA.

Conclusion

The intradermal administration PRP with oral biotin supplementation yields statistically significant increase in hair regrowth compared to only oral biotin supplementation at 6, 9 and 12 months. This is a safe, non allergenic, relatively inexpensive and reliable treatment modality for individuals, who don’t respond to other modes of treatment or are contraindicated for them.

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DOI and Others

DOI: 10.7860/JCDR/2022/57980.17008

Date of Submission: May 24, 2022
Date of Peer Review: Jul 09, 2022
Date of Acceptance: Oct 05, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 16, 2022
• Manual Googling: Sep 24, 2022
• iThenticate Software: Oct 01, 2022 (23%)

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