Platelet-rich plasma dermatological applications

What is platelet-rich plasma?

Platelet rich plasma (PRP), also termed autologous platelet
gel, plasma rich in growth factors (PRGF), platelet
concentrate (PC), is essentially an increased concentration of
autologous platelets suspended in a small amount of plasma
after centrifugation.
Blood consists of approximately 93% red blood cells (RBC),
1% white blood cells (WBC) and 6% platelets, all suspended
in plasma. In platelet rich plasma, the RBC count is lowered
to 5, since they are less useful in the healing process, while
the platelet count is increased to 94%.
This leads to a plasma super rich in platelets, at a much
higher percentage than would be found in normal blood
concentrations i.e. 1,000,000 platelets/mL of plasma.
PRP is autologous, meaning that it comes from the patient's
own body.
How is PRP collected?
Blood is withdrawn from a patients arm by syringe.
The tubes containing withdrawn blood are placed in a
centrifuge and spun using a carefully determined
protocol.
The speed and duration of centrifugation is very important
to ensure the platelets are not damaged.
Centrifuging separates the red and white blood cells and
platelets and concentrates them at various levels in the
tubes.
Blood plasma that is rich in platelets is drawn off from the
appropriate level for therapeutic use.
An activating agent (e.g. calcium chloride) is added to
activate the platelets and release their content prior to
use.
Predictable and efficient compact systems to develop PRP
that are available commercially (e.g. RegenLab,
Switzerland) can be used in both office and hospital
settings.
Background information
Platelets are probably best known as components of the
blood clotting system. When injury disrupts a blood vessel

and causes bleeding, platelets are activated and help with

the formation of a clot that stems the flow of blood.
In addition, every platelet is also a biochemical storehouse of
regulatory, signalling and growth-factor molecules that
participate in recovery and healing of tissue in response to
injury.
As an autologous preparation, PRP is safer to use than
allogenic or homologous preparations and is free from
concerns over transmissible diseases such as HIV, hepatitis,
West Nile fever, and Creutzfeldt-Jakob disease.
PRP requires no special considerations regarding antibody
formation, effectively preventing the risk of graft vs. host
disease and leading to better acceptance by patients.
Role of platelet rich plasma in wound healing
PRP effects soft tissue healing via growth factors released
after platelet degranulation. These growth factors initiate
and enhance physiological processes that contribute to
tissue recovery and healing after injury.
Growth-factor molecules associated with platelets include:
Platelet-derived growth factor (PDGF)
Transforming growth-factor-beta TGF-b)
Vascular endothelial growth factor (VEGF)
Epidermal growth factor (EGF)
Fibroblast growth factor-2 (FGF-2)
Insulin-like growth factor (IGF)
These growth factors aid healing by:
attracting undifferentiated stem cells into the newly formed
matrix and triggering cell division
suppressing cytokine release and limiting inflammation
attracting macrophages to improve tissue healing and
regeneration
promoting new capillary growth (new blood vessel
formation), and accelerating epithelialisation.
Indications for use of PRP
There is accumulating evidence that PRP can help in the
following skin conditions:
Venous and arterial leg ulcers
Diabetic foot ulcers
Pressure ulcers (bedsores)

Skin graft donor sites

First and second degree thermal burns
Superficial injuries, cuts, abrasions and surgical wounds
Hair loss disorders PRP has been shown to reinvigorate
dormant hair follicles and stimulate new hair growth
Facial rejuvenation PRP injections can treat wrinkles,
photodamage and discoloration in conjunction together
with other treatment modalities
Post-traumatic scars PRP combined with centrifuged fat
tissue and fractional laser resurfacing improve cosmetic
appearance of scars.
Safety, complications and contraindications for PRP
PRP is immunologically neutral and poses no danger of
allergy, hypersensitivity or foreign-body reactions.
Sterile technique must be used at every stage of PRP
preparation and application. Sterile technique is especially
important if a patient has an underlying medical condition
that predisposes to infection.
PRP may be injected intralesionally or perilesionally or mixed
with autologous thrombin at a 9:1 ratio, forming a platelet
gel and used topically.
When administered by intradermal injection, a brief period of
inflammation at wound sites may be experienced. Nerve
trauma is another potential complication.
The following medical conditions are a contraindication for
use of PRP:
Critical thrombocytopaenia (low platelet count)
Hypofibrinogenaemia
Haemodynamic instability (collapse)
Sepsis (infection)
Acute and chronic infections
Chronic liver disease
Anti-coagulation therapy (warfarin, dabigatran, heparin)
What is the evidence to support PRP use in wound
healing?
Available data are largely based on case series. These
studies have demonstrated:
healing of post-traumatic and vascular wounds, diabetic
and chronic ulcers with a combination of PRP and

autologous fat supported by a 3-dimensional matrix of

hyaluronic acid
cosmetic improvement of scars with fat grafts mixed with
PRP, followed by skin resurfacing with nonablative laser
healing of open and chronic wounds of the heel and ankle
with a combination of PRP and hyaluronic acid
healing of dehiscent infected sternal wounds with local
application of PRP.
Case studies conducted in a number of countries have also
shown that for patients who may have moderate wrinkling
due to exposure to sunlight and/or simply due to age can
benefit from PRP treatment.
Results show that when PRP is applied by superficial or
deep dermal injection, skin texture, tone and firmness
can improve within 3 weeks with ongoing
improvements over the next few months.
Areas commonly treated using the PRP for rejuvenation
include cheeks, around the eyes, jawline, back of
hands, neck, knees, elbows, upper arms and postpregnancy stretch marks.
Related information
References:
Cervelli V, De Angelis B, Lucarini L, Spallone D, et al. Tissue
regeneration in loss of substance on the lower limbs
through use of platelet-rich plasma, stem cells from
adipose tissue, and hyaluronic acid Adv Skin Wound
Care. 2010 Jun; 23(6):262-72.
Cervelli V, Nicoli F, Spallone D, et al. Treatment of
traumatic scars using fat grafts mixed with platelet-rich
plasma, and resurfacing of skin with the 1540 nm
nonablative laser. Clin Exp Dermatol. 2012 Jan;
37(1):55-61.
Cervelli V, Lucarini L, Spallone D, et al. Use of platelet rich
plasma and hyaluronic acid on exposed tendons of the
foot and ankle.. J Wound Care. 2010 May; 19(5):188190.
Akhundov K, Pietramaggiori G, Waselle L, et al.
Development of a cost-effective method for plateletrich plasma (PRP) preparation for topical wound

healing. Ann Burns Fire Disasters. 2012 Dec 31;

25(4):207-13.
Park KY, Kim IS, Yeo IK, et al. Treatment of refractory
venous stasis ulcers with autologous platelet-rich
plasma and light-emitting diodes: a pilot study. J
Dermatolog Treat. 2013 Jun 27. [Epub ahead of print]
Salcido RS. Autologous platelet-rich plasma in chronic
wounds. Adv Skin Wound Care. 2013 Jun; 26(6):248.
Shan GQ, Zhang YN, Ma J, et al. Evaluation of the effects of
homologous platelet gel on healing lower extremity
wounds in patients with diabetes. Int J. Low Extrem
Wounds. 2013 Mar; 12(1):22-9.
On DermNet NZ:
Role of growth factors in skin creams
Leg ulcers
Hair loss
Wound healing course
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