Is autologous platelet-rich plasma capable of increasing hair density in patients with androgenic alopecia? A systematic review and meta-analysis of randomized clinical trials

Fundamentals: Platelet-rich plasma (PRP) has been progressively more used in androgenetic alopecia (AGA). Objectives: The authors aimed to evaluate PRP efficacy compared to placebo in AGA. Methods: A comprehensive search was conducted across seven databases, until 01/04/2023. Randomized clinical trials focusing on AGA and PRP use to increase hair density were included. Patients aged between 15 and 63 years, diagnosed with AGA characterized by Norwood I-VII and Ludwig I-III scales, were included. Studies with a sample size <10, lacking PRP processing method, focusing on complementary therapies or other alopecias, were excluded. The authors conducted subgroup analysis for activator, spin method, study design, risk of bias, and gender. Meta-regression was conducted for activator, spin method, design, and gender. The authors used GRADEpro to assess evidence certainty and the RoB-2 tool for risk of bias. Asymmetry was measured through a Funnel plot followed by Egger's test. The protocol was registered at PROSPERO (CRD42023407334). Results: The authors screened 555 registers and included fourteen studies involving 431 patients for qualitative synthesis, with 13 studies included in the meta-analysis. Meta-analysis demonstrated a mean difference of 27.55 hairs/cm(2) and 95% CI (14.04; 41.06), I-2 = 95.99%, p < 0.05. Hair diameter meta-analysis presented a mean difference of 2.02 mu m, 95% CI (-0.85 mu m; 4.88 mu m), and I-2 = 77.11% (p = 0.02). That is, low quality evidence. Study limitations: Studies were highly heterogeneous, of low quality, and presented evident publication bias. Conclusions: Highly heterogeneous studies with publication bias suggest PRP effectively increases hair density in AGA, so further high-quality randomized clinical trials are recommended to strengthen the evidence. (c) 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).