Intralesional Platelet-Rich Plasma Injection in Patients with Recalcitrant Alopecia Areata

Alopecia areata (AA) is a common, chronic autoimmune disease that causes non-cicatricial hair loss. Its relapsing and remitting nature leads to the search for new, effective treatment options. The study aimed to evaluate the therapeutic efficacy of intralesional platelet-rich plasma (PRP) and intralesional steroid (ILS) injections in patients with AA.

A retrospective chart review was carried out from 2020-2021. A total of 75 patients with AA were included in the study. Thirty-six patients were treated with intralesional PRP, and 39 patients were treated with ILS injections for three sessions. The patients were evaluated with a hair pull test and SALT scores at months 0, 3, and 6.

Of 75 patients, the mean age of the PRP group was 34.33±10.61, and the mean age of the ILS group was 33.82±13.31 years. After three PRP or ILS therapy sessions, at 3. and 6. months, SALT 3 and SALT 6 scores were statistically significantly lower in the PRP group than in the ILS group (p=0.038, p<0.001, respectively). When the treatment response was evaluated at the end of the 6th month in the PRP group, there was no response in 2 (5.5%) patients, partial response in 1 (2.7%) patient, good response in 3 (8.4%) patients, and very good response in 30 (83.4%) patients. Only 2 (5.9%) patients had a clinical relapse in a 6-month period. Side effects were seen in 16 (44.4%) patients in the PRP group and 8 (20.5%) patients in the ILS group, and the frequency of side effects in the PRP group was statistically significantly higher than in the ILS group (p=0.026). However, the side effects of both groups were minor, such as itching, pain, burning, ecchymosis, and folliculitis.

PRP seems to be an effective and safe treatment option for limited patchy alopecia areata, but its superiority over ILS has not been fully demonstrated, making ILS still the first-line treatment.