Comparison of the efficacy of platelet-rich plasma with topical minoxidil in treating patients with androgenetic alopecia: a systematic review of clinical trials.

Androgenetic alopecia (AGA) is a very common cause of noncicatricial alopecia, which negatively affects a person's wellbeing. Although Food and Drug Administration (FDA)-approved drugs such as topical minoxidil result in an apparent improvement in this hair condition in a period of 4-6 months and have been used commonly as the first-line treatment of choice, another treatment modality that has gained popularity over the years is platelet-rich plasma (PRP) therapy. PRP is minimally invasive but much more cost-effective than restoration surgery. The FDA has not approved PRP as a treatment modality for AGA. We systematically reviewed the existing literature from Embase, Web of Science, CENTRAL and PubMed from inception to 2024, and included six clinical trials that compared these two commonly practised dermatological therapies for the treatment of AGA. Most studies used global photographic assessment of hair changes based on the investigator's examination, which demonstrated statistically significant changes in hair density, terminal hair count and hair pull test. A few studies used subjective quantitative measures of hair parameters, such as patient satisfaction scores and improvement in hair quality. Topical minoxidil showed more improvement in terminal hair count and proportion of anagen hair. PRP showed more improvement in hair density and a negative hair pull test. All of the selected studies suggested that the efficacy of PRP is nearly comparable to that of topical minoxidil, with minimal adverse effects on long-term follow-up. Thus, PRP is a valuable treatment option either adjuvant to topical minoxidil or as a second-line treatment option for AGA.