PRP is not helpful for all patients with hair loss, but is helpful in a proportion of individuals with hair thinning.
Alopecia areata is an autoimmune condition that affects about 2 % of the world in their lifetime. The condition is associated with inflammation that accumulates at the bottom of hairs deep under the scalp. This inflammation makes it difficult for hair to grow properly. Some hairs don’t grow on account of the inflammation and just fall out of the scalp. Some hairs grow for a bit but then simply snap off producing black dots. Other hairs are able to grow despite that fact that the manufactured hair fiber is so weak. Such fibers often show kinks and bends and may be referred to as “elbow hairs.”
Up close examination of the scalp via dermoscopy allows the registered professional to confirm the suspected type of hair loss and also evaluate how active the condition is at the present time. There are many known “dermatoscopic” features of alopecia areata and we will review five common ones here: 1. Yellow dots (red arrow) represent empty hair follicle openings (pores) and are very common. The more severe of a disease a patient has, the more yellow dots are seen all over the scalp. 2. Vellus hairs (white arrow) are short and thin regrowing hairs and are also common in patients with alopecia areata. 3. Black dots (black arrow) represent hair follicles broken at the surface and indicate an active disease state. 4. Tapered hairs (blue arrow) are long hairs that become quite thin as the are about to enter the scalp. They too represent active disease. 5. Exclamation mark hairs (green arrow) are short 4 mm hairs that are actually broken hairs. They are wider at the top compared to the bottom and are found in patients with active disease.
Exclamation mark hairs were clearly noted at the perimeter. Monthly steroid injections with triamcinolone acetonide lead to complete regrowth in a matter of months and may be of more value than PRP treatments in these cases.
Active Disease in AA
Trichoscopy of active alopecia areata in a well formed patch of hair loss. Black dots (asterisk *) and exclamation mark hairs (arrow) are signs of activity. Without treatment this patch is likely to enlarge. Treatments for patch stage alopecia areata generally start with topical steroids, steroid injections, and possibly minoxidil. A variety of other options are also possible.
Regrowth in AA: Vellus Hairs
Regrowth in alopecia areata can either be spontaneous regrowth whereby hair grows even without treatment or can be regrowth directly attributed to a treatment that was used. This photo shows regrowth from steroid injections in a patient with alopecia areata. Exclamation mark hairs (arrow) are still present indicating that some some amount of growth inhibitory disease activity is still present. This may prevent full regrowth of this patch or the activity may diminish over time on account of the treatment that was given.
Many patients with AA develop one or more so called “patches” of hair loss which may be circular or oval. Some patients develop a single patch whereas others develop many patches. A characteristic feature of patches of alopecia is that are often devoid of hair and are therefore quite smooth and bare. At the perimeter of the patches, characteristic “exclamation” mark hairs can often be seen. These are short 4 mm hairs which are essentially broken hairs. This photo shows a relatively large patch of alopecia areata.
Information from Dr. Jeff Donovan who is a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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