Comprehensive Analysis of Platelet-Rich Plasma for the Treatment of Female Pattern Hair Loss: A Subgroup-Based Review of Clinical Evidence

Comprehensive Analysis of Platelet-Rich Plasma for the Treatment of Female Pattern Hair Loss: A Subgroup-Based Review of Clinical Evidence | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comprehensive Analysis of Platelet-Rich Plasma for the Treatment of Female Pattern Hair Loss: A Subgroup-Based Review of Clinical Evidence Xieling Peng, xueqing zhou, Kun Qian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8638974/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Objective: To evaluate the efficacy and safety of platelet-rich plasma (PRP) for female pattern hair loss (FPHL) and to explore how preparation and application parameters modify outcomes. Methods: We systematically searched PubMed, Springer and EMBASE from 2015–2025 for randomized and non-randomized controlled studies in FPHL. Two reviewers screened records, extracted data, and assessed risk of bias (ROB 2/ROBINS-I). Primary outcome was change in hair density. Heterogeneity precluded meta-analysis; findings were synthesized narratively with predefined subgroups (including spin method, activation, platelet concentration, delivery method and topical anesthesia.). Results: 10 studies (256 participants) met inclusion criteria. Across placebo-controlled trials, PRP sometimes improved hair density at 12–24 weeks, but effect sizes varied and certainty was low-to-moderate due to heterogeneity and risk of bias. Key findings indicate that double-centrifugation , non-activated PRP, platelet concentrations of 1000–1500×10⁹/L (2–5× baseline)and subdermal injection (3–5 mm depth, 0.1–0.3 mL/cm², 3–4 sessions/month) yield optimal outcomes. Adverse events were mainly mild; no serious events were reported. Conclusions: PRP may offer short-term benefits for FPHL, but standardized protocols and higher-quality trials are needed to define optimal preparation, dosing, and durability. Future studies should predefine outcomes, use sham controls, and report patient-important measures and safety systematically PRP female pattern hair loss FPHL Figures Figure 1 Figure 2 1. Introduction Female pattern hair loss (FPHL), the most prevalent form of alopecia in women, demonstrates an age-dependent prevalence pattern, affecting approximately 55% of women aged 70 years or older [1] . This condition manifests as progressive hair thinning in the frontal and vertex scalp regions, characterized by follicular miniaturization - a process marked by the gradual replacement of terminal hairs with shorter, finer vellus hairs [2] . The diagnostic evaluation of FPHL requires a comprehensive approach incorporating clinical history assessment, trichoscopic examination, hair wash tests, trichogram analysis, and laboratory investigations to exclude endocrine abnormalities, with particular emphasis on androgen profiling [3] . Beyond its physical manifestations, FPHL carries significant psychosocial consequences, including diminished self-esteem, impaired social functioning, and reduced quality of life [4] . Current therapeutic strategies remain suboptimal, highlighting the critical need for developing effective and well-tolerated treatment modalities. Notably, emerging interventions such as autologous platelet-rich plasma administration, stromal vascular fraction (SVF),low-level laser therapy [5] , dermal sheath cup (DSC) cells [6] and combination regimens show promising clinical potential. PRP represents an autologous biological product obtained through differential centrifugation of peripheral blood, characterized by platelet concentrations exceeding baseline levels by 4-7 fold [7] . Upon activation, platelets undergo degranulation releasing α-granules containing pleiotropic growth factors such as transforming growth factor-β (TGF-β), epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and insulin-like growth factor-1 (IGF-1) [8, 9] . These bioactive molecules collectively exert mitogenic, angiogenic, and anti-apoptotic effects through synergistic modulation of hair follicle stem cell niches [10] . The therapeutic potential of PRP has been demonstrated across diverse clinical domains including chronic wound healing, diabetic ulcer management, and musculoskeletal regeneration [11] . In dermatological applications, PRP creates a pro-regenerative microenvironment through upregulation of Wnt/β-catenin signaling, prolongation of anagen phase duration, and enhancement of dermal papilla cell proliferation - key mechanisms underlying its efficacy in androgenetic alopecia (AGA) treatment [12] . Notably, no grade 3/4 adverse events or long-term complications have been documented in AGA treatment cohorts [13] . By synthesizing evidence from controlled trials conducted over the past decade, we provides actionable guidelines for protocol optimization. 2. Materials and Methods 2.1 Search methodology Literature searches were performed across PubMed, EMBASE and Springer databases (2015–2025) using keywords including（"female alopecia" OR "female androgenetic alopecia" OR "female hair loss" OR "female pattern hair loss") AND("platelet-rich plasma" OR "PRP" OR "platelet rich plasma" OR "autologous platelet concentrate"). Additionally, we manually reviewed the reference lists of the identified articles to find further relevant studies. 2.2 Inclusion Criteria This study followed the PICO framework; Participants were female individuals aged≥18 experiencing FPHL; The intervention involved administering autologous PRP; Only English-language articles were included. 2.3 Subgroup analysis Subgroup analyses were conducted based on predetermined criteria, including spin method, activation, platelet concentration, delivery method, treatment course and topical anesthesia. 2.4 Assessment of Risk of Bias and Quality of Evidence Two independent reviewers (PXL and ZXQ) rigorously assessed the risk of bias of all included studies. For randomized controlled trials (RCTs), the Cochrane Risk of Bias Tool 2.0 (ROB 2) was used to evaluate bias. For non-randomized controlled studies, the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) was applied. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the evidence quality of primary outcomes. 3. Results 3.1 Study selection Our systematic search identified 652 potentially relevant records (PubMed:117; EMBASE:439; Springer: 96). Following removal of 519 non-research articles, two independent reviewers screened titles and abstracts of 133 records. 25 articles underwent full-text evaluation, with 10 studies ultimately meeting the predefined inclusion criteria (see PRISMA flowchart in Fig. 1 ). 3.2 Study Characters The included studies (n = 10), published between 2015–2024, Collectively, these investigations enrolled 256 participants with FPHL. Studies designs comprised: RCTs:6 studies; uncontrolled clinical trials (UCTs): 2 prospective self-controlled trials and 2 single-arm pilot studies. 3.3 Risk of bias assessment and Quality Most RCTs demonstrated a low risk of bias in key domains, including randomization, outcome measurement, and selection of reported results. However, some concerns were raised regarding deviations from the intended intervention and missing data, with two studies being assessed as having a high risk of bias (Fig. 2 ). Among non-randomized controlled studies, there was a higher risk of bias related to participant selection and confounding, while biases arising from missing data, outcome measurement, and intervention classification were generally low, with only one study rated as high risk. In terms of the certainty of evidence for the outcomes, the results for hair density and side effects were relatively complete. For hair diameter, four studies did not report results. Overall, the certainty of the evidence was moderate, although the evidence for hair density in one study was rated as very low, and three studies were rated as low, primarily due to a high risk of bias and small sample sizes . 3.4 Subgroup Classification and Result ( Subgroup details are presented in the Table 1 ) This analysis categorized 10 studies into subgroups based on four key intervention variables (centrifugation technique, activation method, platelet concentration, delivery method, Topical Anesthesia AND Treatment Course). Table 1 Relevant subgroup details for each study:" Only cases in which activators (e.g., calcium gluconate) are explicitly mentioned as added or "activated PRP" is labeled in the literature shall be included; cases without explicit activation steps or only mentioning "centrifugation preparation" shall be classified as non-activated groups, and subjective inference shall be avoided.​Extract "centrifugation times + specific parameters" from the literature, such as "single centrifugation, "double centrifugation ", and "systematic standardized centrifugation ". Vague descriptions that only mention "centrifugation" without specific parameters shall be excluded.​Prioritize extracting "specific concentration values, followed by "concentration multiples ". Cases that only mention "high concentration" without numerical values/multiples shall be classified as medium-low concentration groups, and shall not be subjectively determined as "high concentration".​Extract descriptions of "anesthesia type"or "explicitly stated 'no anesthesia'" from the literature; cases without any mention of anesthesia measures shall be default classified as "no anesthesia used group". Study PRP Extraction Method & Platelet Concentration Injection Method Anesthesia Method Treatment Regimen Primary Outcomes Adverse Events Patient Satisfaction 2024Peng et al Apheresis with whole blood separator (Non-activated, High platelet, Low leukocyte) Subcutaneous Topical surface anesthesia (type unspecified) 3 sessions, once monthly Hair density increased by 19 hairs/cm²; follicle density increased by 15 follicles/cm²; 67% of patients showed improved appearance 86.7% had mild pain; 3 cases with intolerable pain; 1 case with headache 4.2/5 points; 80% recognized acceptable comfort 2021Moftah et al 4 groups:- Group I: Single centrifugation- Group II: Double centrifugation - Group III: Double centrifugation - Group IV: Single centrifugation ;Medium-Low platelet Intradermal None 3 sessions, once monthly, Group IV: Hair density increased by 11.54%; other groups: 9.8%-10.2% increase 100% had mild pain; 1 case with pain lasting > 48 h; 2 cases with dandruff No specific score; Group IV showed slightly higher recognition for outcome stability 2016Puig et al Angel PRP system, Medium-Low platelet Subcutaneous Circular block anesthesia 1 injection 13.3% of patients reported subjective hair loss reduction Mild tenderness (no inter-group difference) 13.3% had significant improvement; 26.7% felt thicker hair 2023Ezz et al Group 1: Single centrifugation, high platelet; Group 2: Single centrifugation, Medium-Low platelet Intradermal Lidocaine spray 4 sessions, once monthly Group 1: Forehead density increased by 55.6%; Group 2: 52.1% increase (both P < 0.001) 1 case with headache in Group 1; 100% had mild pain ≥ 7/10 points; significantly higher than placebo group 2015 Lee et al SmartPReP®2 system, High platelet Subcutaneous 2% lidocaine injection + (-10℃) cold air cooling 1 PRP injection + 12 PDRN (Polydeoxyribonucleotide) injections, once weekly Hair count increased by 23.2%; hair thickness increased by 16.8% (both P < 0.001, superior to PDRN alone) 90% tolerated mild pain; 20% had edema; 10% had pruritus and desquamation Higher recognition in combined group vs. single PDRN group; no dissatisfaction 2017Tawfik et al Double centrifugation + calcium gluconate activation, Medium-Low platelet Intradermal None 4 sessions, once weekly Hair density increased by 77.28 hairs/cm²; hair thickness increased by 0.11 mm (both P < 0.005, superior to placebo) 100% had mild pain and petechiae; resolved within 24 h 7.0/10 points; 83% felt significant improvement 2020Dubin et al Eclipse system, Medium-Low platelet Subcutaneous None 3 sessions (at week 0, 4, 8) Hair density increased by 105.9 hairs/cm² (P < 0.01, superior to placebo) 50% had headache; 50% had scalp tightness; 29% had swelling; resolved within 24 h 57% satisfaction; higher recognition than placebo group 2019Bruce et al Double centrifugation, High platelet Subcutaneous (-10℃) cold air cooling 3 PRP sessions, once monthly, followed by 12-week minoxidil foam treatment Hair count increased (P = 0.002); vellus hair density increased 21.1% had pain/ecchymosis 11 items of Quality of Life questionnaire improved (P < 0.05); better convenience than minoxidil group 2020El-Husseiny et al Right side: Double centrifugation; Left side: Single centrifugation; both activated with calcium gluconate, Medium-Low platelet Intradermal None 3 sessions, once every 3 week Right side: Terminal hair density increased by 400% (P = 0.001); Left side: No significant change (P = 0.140) 100% had mild pain; 73.3% had headache Mean score 6.6/10 points; 66.7% felt increased hair density 2018 Starace et al My Cells system, Medium-Low platelet Interfollicular injection Anesthetic cream 4 sessions, once every 2 weeks Forehead density increased; hair diameter increased by 14.6% (P < 0.05) Mild pain (alleviated by anesthesia) High recognition for thicker hair and reduced hair loss 3.4.1Centrifugation Technique In Bruce et al.'s study, involving double centrifugation and subcutaneous injection, resulted in a statistically significant increase in hair count (p = 0.002) [14] . Similarly, El-Husseiny et al, whose the method used is intradermal injection, with a single or double centrifugation approach on both sides of the scalp, reported that the right-side treatment area under double centrifugation exhibited a median terminal hair density of 480 hairs/cm² (range: 135–798), representing a statistically significant improvement from baseline (p = 0.001). Furthermore, both the Ludwig grade (p = 0.017) and Sinclair grade (p = 0.047) demonstrated significant enhancements [15] . In contrast, Moftah et al found that single-spin centrifugation yielded only an 11.54% increase in hair density, which did not reach statistical significance (p = 0.117) [16] . 3.4.2Activation Method Both studies employed a single centrifugation intervention with medium-to-low platelet concentration and intradermal injection. In the study by Starace et al, non-activated PRP was used, and the results showed that the hair diameter on the forehead continued to increase significantly (relative rate of change: 14.6%, p < 0.05), vellus hair density on the vertex decreased (by 6.6%), hair density showed positive growth in all regions and clinical photographs revealed improvements in hair density and quality [17] . In El-Husseiny et al’s study, activated PRP was adopted, and the results indicated that the median terminal hair density was 444 hairs/cm² (range: 64–798), with no significant increase compared with the baseline (p = 0.140)and no significant improvement was observed (Ludwig scale: p = 0.089; Sinclair scale: p = 0.289) [15] . 3.4.3Platelet Concentration In all clinical studies on high-concentration platelet-rich plasma (PRP), the injection depth of PRP is in the subcutaneous layer. Peng et al reported that hair density increased by 19 hairs/cm² [18] .Ezz El-Dawla et al investigated the efficacy differences between two different PRP kits, with the main distinction being platelet concentration. In the high-concentration group (Group 1), the results showed that frontal hair density increased from 1076.4 hairs/cm² to 1675.38 hairs/cm² (p < 0.001), temporal hair density increased from 1015.7 hairs/cm² to 1770.85 hairs/cm² (p < 0.001), and vertex hair density increased from 1093.8 hairs/cm² to 1666.7 hairs/cm² (p < 0.001). Clinical photographs demonstrated improvements in both hair density and quality. However, Group 2 showed a comparable efficacy trend, with no statistical significance observed between the two groups [19] . Bruce et al found that hair count increased significantly compared to the baseline (median 145 hairs/0.65cm², p = 0.002), and vellus hair density also increased significantly (median 53.1 hairs/cm², p = 0.009).Puig et al observed no significant differences in hair count (t = 0.680, p = 0.503) or hair mass index (HMI) (t = 1.258, p = 0.220) between the PRP group and the placebo group [14] . 3.4.4 Delivery Method Both studies used non-activated platelet-rich plasma (PRP) with medium-to-low concentration, which was obtained via single centrifugation. A consistent treatment regimen was adopted in both studies: once a month for a total of three sessions. Among the results, the subcutaneous injection showed that hair density increased by 105.9 hairs/cm² (P < 0.01, superior to placebo) [20] , while the intradermal injection resulted in hair density increases of 3.67% and 11.54% [16] , respectively. 3.4.5Topical Anesthesia Local anesthesia [14, 17, 18, 21, 22] : Anesthetic creams or cold air cooling mainly alleviate the “dull pain” caused by deep injections, with a pain tolerability rate exceeding 80%. No local anesthesia [20] : Although subcutaneous injections are less painful than intradermal injections, 50% of patients still reported scalp tightness and discomfort. 4. Disscussion The 10 studies on the efficacy of PRP in FPHL paint a complex and nuanced picture. Some studies show significant improvements in hair density and other parameters in the PRP group, while others find no statistically significant difference, despite some subjective improvement in PRP-treated subjects. This discrepancy can be attributed to differences in study design, highlighting the influence of factors like platelet concentration in PRP, injection technique, and individual patient characteristics [23, 24] . Double centrifugation is more advantageous in improving hair density and the proportion of terminal hairs, which may be associated with higher platelet concentration and more thorough leukocyte removal. Non-activated PRP exhibits more stable efficacy and avoids the loss of growth factors that may be caused by exogenous activators, making it more suitable for the long-term treatment of FPHL. A platelet concentration > 1000×10⁹/L is a critical threshold for ensuring efficacy, as it can effectively promote terminal hair transformation and hair shaft thickening. In contrast, medium-to-low platelet concentrations are only applicable for mild hair loss or adjuvant treatment. Subcutaneous injection is more conducive to the growth factors in PRP acting on hair follicles, and its efficacy is superior to that of intradermal injection. This approach is particularly suitable for moderate-to-severe hair loss with significant follicular atrophy. High-concentration PRP must be combined with subcutaneous injection to fully exert its effects; insufficient injection depth will limit the efficacy of high-concentration PRP. The combination of non-activated PRP and subcutaneous injection is more optimal, possibly because non-activated PRP can release growth factors slowly in the subcutaneous environment, avoiding rapid metabolism in the intradermal space. Double centrifugation and high-concentration platelets exhibit a synergistic effect: double centrifugation is a key technique for obtaining high-concentration PRP, and their combination can maximize therapeutic efficacy. In PRP treatment for FPHL, local anesthesia can significantly reduce the incidence of severe pain (from 3.3%-30% to 0%- 20%) and shorten the duration of pain, without affecting treatment adherence. For optimized pain management, intradermal injection requires the combination of local anesthesia more than subcutaneous injection. Regarding the treatment course, there is a lack of long-course study results on FPHL treated with PRP alone. Currently, the commonly used treatment course is generally once every 2 to 4 weeks for a total of 3 sessions. In this analysis, all clinical studies involving long treatment courses were based on results combined with other medications, thus lacking reference value.。 Regarding special populations, including those with alopecia areata, polycystic ovary syndrome-related hair loss, and lichen planopilaris, PRP also shows promise but requires further validation through larger-scale studies with longer follow-up periods [25–27] . 5. Limitation First, the sample sizes are generally small and non-randomized controlled studies carry a higher risk of bias, with lower levels of evidence for their results. Second, no meta-analysis was performed in this systematic review, primarily due to three key reasons: the included studies showed significant heterogeneity in study design; intervention parameters (e.g., dose, duration, and delivery mode of the intervention) varied substantially across studies; outcome indicators and their measurement tools were inconsistent, there is high heterogeneity within subgroups, leading to inability to pool quantitative data effectively. Third, the follow-up periods are relatively short, with the longest follow-up duration in existing studies being only six months, which prevents effective assessment of long-term efficacy. 6. Conclusion This narrative analysis demonstrates that a double-centrifugation, non-activated, high-concentration, subcutaneously injected PRP intervention protocol yields the most favorable outcomes in the treatment of female pattern hair loss. Abbreviations AGA: Androgenetic Alopecia bFGF: Basic Fibroblast Growth Factor DSC: Dermal Sheath Cup EGF: Epidermal Growth Factor FPHL: Female Pattern Hair Loss GRADE: Grading of Recommendations Assessment, Development and Evaluation HMI: Hair Mass Index IGF-1: Insulin-like Growth Factor-1 PDGF: Platelet-Derived Growth Factor PRP: Platelet-Rich Plasma RCT: Randomized Controlled Trial ROB: Risk of Bias SVF: Stromal Vascular Fraction TGF-β: Transforming Growth Factor-β VEGF: Vascular Endothelial Growth Factor Declarations Ethics approval and consent to participate Not applicable. This is a review article and does not involve new studies with human participants or animals by the authors. Consent for publication Not applicable. Availability of data and materials All data analyzed in this review are derived from published literature, which is cited in the reference list. Competing Interests The authors declare that they have no competing interests. Funding This work was supported by the special funds for clinical research from the Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University. Authors' contributions PXL and ZXQ conceived the study, performed the literature search, data extraction, and analysis, and drafted the manuscript. Kun Qian supervised the project, provided critical revisions, and is the corresponding author. All authors read and approved the final manuscript. Acknowledgements Not applicable References Vano-Galvan S, Saceda-Corralo D, Blume-Peytavi U, et al. Frequency of the Types of Alopecia at Twenty-Two Specialist Hair Clinics: A Multicenter Study[J]. Skin Appendage Disord, 2019,5(5):309-315. Vujovic A, Del M V. The female pattern hair loss: review of etiopathogenesis and diagnosis[J]. Biomed Res Int, 2014,2014:767628. Camacho-Martinez F M. Hair loss in women[J]. Semin Cutan Med Surg, 2009,28(1):19-32. van Zuuren E J, Fedorowicz Z, Carter B. Evidence-based treatments for female pattern hair loss: a summary of a Cochrane systematic review[J]. Br J Dermatol, 2012,167(5):995-1010. Liu K H, Liu D, Chen Y T, et al. Comparative effectiveness of low-level laser therapy for adult androgenic alopecia: a system review and meta-analysis of randomized controlled trials[J]. Lasers Med Sci, 2019,34(6):1063-1069. Tsuboi R, Niiyama S, Irisawa R, et al. Autologous cell-based therapy for male and female pattern hair loss using dermal sheath cup cells: A randomized placebo-controlled double-blinded dose-finding clinical study[J]. J Am Acad Dermatol, 2020,83(1):109-116. Wu P I, Diaz R, Borg-Stein J. Platelet-Rich Plasma[J]. Phys Med Rehabil Clin N Am, 2016,27(4):825-853. Lubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP and their applicability in medicine[J]. J Biol Regul Homeost Agents, 2012,26(2 Suppl 1):3S-22S. Weibrich G, Kleis W K, Hafner G, et al. Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count[J]. J Craniomaxillofac Surg, 2002,30(2):97-102. Mercuri S R, Vollono L, Paolino G. The Usefulness of Platelet-Rich Plasma (PRP) for the Treatment of Vitiligo: State of the Art and Review[J]. Drug Des Devel Ther, 2020,14:1749-1755. Won C H, Yoo H G, Kwon O S, et al. Hair growth promoting effects of adipose tissue-derived stem cells[J]. J Dermatol Sci, 2010,57(2):134-137. Ayatollahi A, Hosseini H, Gholami J, et al. Platelet rich plasma for treatment of non-scarring hair loss: systematic review of literature[J]. J Dermatolog Treat, 2017,28(7):574-581. Cervantes J, Perper M, Wong L L, et al. Effectiveness of Platelet-Rich Plasma for Androgenetic Alopecia: A Review of the Literature[J]. Skin Appendage Disord, 2018,4(1):1-11. Bruce A J, Pincelli T P, Heckman M G, et al. A Randomized, Controlled Pilot Trial Comparing Platelet-Rich Plasma to Topical Minoxidil Foam for Treatment of Androgenic Alopecia in Women[J]. Dermatol Surg, 2020,46(6):826-832. El-Husseiny R M, Saleh H M, Moustafa A A, et al. Comparison between single- versus double-spin prepared platelet-rich plasma injection in treatment of female pattern hair loss: clinical effect and relation to vascular endothelial growth factor[J]. Arch Dermatol Res, 2021,313(7):557-566. Moftah N H, Taha N E, Alhabibi A M, et al. Different platelet-rich plasma preparation protocols in Female pattern hair loss: Does it affect the outcome? A pilot study[J]. J Cosmet Dermatol, 2022,21(8):3316-3326. Starace M, Alessandrini A, D'Acunto C, et al. Platelet-rich plasma on female androgenetic alopecia: Tested on 10 patients[J]. J Cosmet Dermatol, 2019,18(1):59-64. Peng X L, Li S W, Zhou X Q, et al. A Prospective Self-controlled Clinical Trial of Nonactivated Low Leukocyte PRP in Female Pattern Hair Loss Patients of Childbearing Age: Erratum[J]. Dermatol Surg, 2025,51(8):e44. El-Dawla R E, Abdelhaleem M, Abdelhamed A. Evaluation of the safety and efficacy of platelet-rich plasma in the treatment of female patients with chronic telogen effluvium: A randomised, controlled, double-blind, pilot clinical trial[J]. Indian J Dermatol Venereol Leprol, 2023,89(2):195-203. Dubin D P, Lin M J, Leight H M, et al. The effect of platelet-rich plasma on female androgenetic alopecia: A randomized controlled trial[J]. J Am Acad Dermatol, 2020,83(5):1294-1297. Lee S H, Zheng Z, Kang J S, et al. Therapeutic efficacy of autologous platelet-rich plasma and polydeoxyribonucleotide on female pattern hair loss[J]. Wound Repair Regen, 2015,23(1):30-36. Puig C J, Reese R, Peters M. Double-Blind, Placebo-Controlled Pilot Study on the Use of Platelet-Rich Plasma in Women With Female Androgenetic Alopecia[J]. Dermatol Surg, 2016,42(11):1243-1247. Sasaki G H. The Effects of Lower vs Higher Cell Number of Platelet-Rich Plasma (PRP) on Hair Density and Diameter in Androgenetic Alopecia (AGA): A Randomized, Double-Blinded, Placebo, Parallel-Group Half-Scalp IRB-Approved Study[J]. Aesthet Surg J, 2021,41(11):NP1659-NP1672. Ramadan W M, Hassan A M, Ismail M A, et al. Evaluation of adding platelet-rich plasma to combined medical therapy in androgenetic alopecia[J]. J Cosmet Dermatol, 2021,20(5):1427-1434. Xue P, Guo L, Dang E, et al. A Prospective and Comparative Study to Explore the Effects of Platelet-Rich Plasma in Hair Transplantation for Patients With Androgenetic Alopecia[J]. J Cosmet Dermatol, 2025,24(2):e16665. Janaani P, Vinay K, Mehta H, et al. Analysing efficacy of low-dose oral minoxidil, topical minoxidil, and platelet-rich plasma with topical minoxidil combination in patients with androgenetic alopecia: a randomized controlled observer blinded trial[J]. Arch Dermatol Res, 2025,317(1):421. Behrangi E, Akbarzadehpasha A, Dehghani A, et al. Platelet-rich plasma as a new and successful treatment for lichen planopilaris: A controlled blinded randomized clinical trial[J]. J Cosmet Dermatol, 2024,23(8):2547-2555. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviews received at journal 11 Apr, 2026 Reviewers agreed at journal 13 Mar, 2026 Reviews received at journal 13 Mar, 2026 Reviewers agreed at journal 13 Mar, 2026 Reviewers invited by journal 13 Mar, 2026 Editor invited by journal 04 Mar, 2026 Editor assigned by journal 09 Feb, 2026 Submission checks completed at journal 06 Feb, 2026 First submitted to journal 06 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8638974","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":606352602,"identity":"66d545bc-43f3-4426-8ef6-bfe67e09299f","order_by":0,"name":"Xieling Peng","email":"","orcid":"","institution":"Qingyuan People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xieling","middleName":"","lastName":"Peng","suffix":""},{"id":606352603,"identity":"885bc782-6001-4d86-a677-fece79b6541b","order_by":1,"name":"xueqing zhou","email":"","orcid":"","institution":"The People's Hospital of Pingshan Shenzhen","correspondingAuthor":false,"prefix":"","firstName":"xueqing","middleName":"","lastName":"zhou","suffix":""},{"id":606352604,"identity":"15feb887-56ef-48d7-b1da-28820da4262d","order_by":2,"name":"Kun Qian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBAC+/nvPz74UGEjx9jeQKQWA4YEY8MZZ9KMmXsOEK/FTJqz5XBi+4wEIrWYMxxIk2ZsYE7snfl44w2GGptoglosGxsOWxfuYDOeOTut2ILhWFpuA0E9hxkbb888wyO7cXaOmQRjw2EitBxjZpDmbZNg3H/zDJFaDM6wMQG1GCg2zuAhUovkDB5mYCAnGDP2AP2SQIxf+CV4GIFR+R8YlYc33vhQY0OEX5AdKZFAinKIFlJ1jIJRMApGwcgAAMhaQqT6Cl4IAAAAAElFTkSuQmCC","orcid":"","institution":"Qingyuan People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Kun","middleName":"","lastName":"Qian","suffix":""}],"badges":[],"createdAt":"2026-01-19 11:38:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8638974/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8638974/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105727616,"identity":"0184badf-2907-43e7-b385-ad7a736fe200","added_by":"auto","created_at":"2026-03-30 10:55:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":63917,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA flowchart of selected studies.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8638974/v1/b12c7edb91aff4b1f7a32a1d.png"},{"id":104834734,"identity":"bc782edd-8341-479b-88c3-40876644c252","added_by":"auto","created_at":"2026-03-17 17:30:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":144987,"visible":true,"origin":"","legend":"\u003cp\u003eThe risk of bias results for RCTs.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8638974/v1/2f0fe24a2131aa599103b747.png"},{"id":106092596,"identity":"55316b33-66ff-465f-8374-c07a6f02f8c1","added_by":"auto","created_at":"2026-04-03 11:22:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1033751,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8638974/v1/f3dc17b8-42b8-4f20-a669-bf266afeaabe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comprehensive Analysis of Platelet-Rich Plasma for the Treatment of Female Pattern Hair Loss: A Subgroup-Based Review of Clinical Evidence","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eFemale pattern hair loss (FPHL), the most prevalent form of alopecia in women, demonstrates an age-dependent prevalence pattern, affecting approximately 55% of women aged 70 years or older\u003csup\u003e[1]\u003c/sup\u003e. This condition manifests as progressive hair thinning in the frontal and vertex scalp regions, characterized by follicular miniaturization - a process marked by the gradual replacement of terminal hairs with shorter, finer vellus hairs\u003csup\u003e[2]\u003c/sup\u003e. The diagnostic evaluation of FPHL requires a comprehensive approach incorporating clinical history assessment, trichoscopic examination, hair wash tests, trichogram analysis, and laboratory investigations to exclude endocrine abnormalities, with particular emphasis on androgen profiling\u003csup\u003e[3]\u003c/sup\u003e. Beyond its physical manifestations, FPHL carries significant psychosocial consequences, including diminished self-esteem, impaired social functioning, and reduced quality of life\u003csup\u003e[4]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCurrent therapeutic strategies remain suboptimal, highlighting the critical need for developing effective and well-tolerated treatment modalities. Notably, emerging interventions such as autologous platelet-rich plasma administration, stromal vascular fraction (SVF),low-level laser therapy\u003csup\u003e[5]\u003c/sup\u003e, dermal sheath cup (DSC) cells\u003csup\u003e[6]\u003c/sup\u003e and combination regimens show promising clinical potential.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePRP represents an autologous biological product obtained through differential centrifugation of peripheral blood, characterized by platelet concentrations exceeding baseline levels by 4-7 fold\u003csup\u003e[7]\u003c/sup\u003e. Upon activation, platelets undergo degranulation releasing\u0026nbsp;α-granules containing pleiotropic growth factors such as transforming growth factor-β\u0026nbsp;(TGF-β), epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and insulin-like growth factor-1 (IGF-1)\u003csup\u003e[8, 9]\u003c/sup\u003e. These bioactive molecules collectively exert mitogenic, angiogenic, and anti-apoptotic effects through synergistic modulation of hair follicle stem cell niches\u003csup\u003e[10]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe therapeutic potential of PRP has been demonstrated across diverse clinical domains including chronic wound healing, diabetic ulcer management, and musculoskeletal regeneration\u003csup\u003e[11]\u003c/sup\u003e. In dermatological applications, PRP creates a pro-regenerative microenvironment through upregulation of Wnt/β-catenin signaling, prolongation of anagen phase duration, and enhancement of dermal papilla cell proliferation - key mechanisms underlying its efficacy in androgenetic alopecia (AGA) treatment\u003csup\u003e[12]\u003c/sup\u003e. Notably, no grade 3/4 adverse events or long-term complications have been documented in AGA treatment cohorts\u003csup\u003e[13]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBy synthesizing evidence from controlled trials conducted over the past decade, we provides actionable guidelines for protocol optimization.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1\u003c/strong\u003e \u003cstrong\u003eSearch methodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiterature searches were performed across PubMed, EMBASE and Springer databases (2015–2025) using keywords including（\"female alopecia\" OR \"female androgenetic alopecia\" OR \"female hair loss\" OR \"female pattern hair loss\") AND(\"platelet-rich plasma\" OR \"PRP\" OR \"platelet rich plasma\" OR \"autologous platelet concentrate\").\u0026nbsp;Additionally, we manually reviewed the reference lists of the identified articles to find further relevant studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Inclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study followed the PICO framework; Participants were female individuals aged≥18 experiencing FPHL; The intervention involved administering autologous PRP; Only English-language articles were included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Subgroup analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubgroup analyses were conducted based on predetermined criteria, including spin method, activation, platelet concentration, delivery method, treatment course and topical anesthesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Assessment of Risk of Bias and Quality of Evidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo independent reviewers (PXL and ZXQ) rigorously assessed the risk of bias of all included studies. For randomized controlled trials (RCTs), the Cochrane Risk of Bias Tool 2.0 (ROB 2) was used to evaluate bias. For non-randomized controlled studies, the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) was applied. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the evidence quality of primary outcomes.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e3.1 Study selection\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eOur systematic search identified 652 potentially relevant records (PubMed:117; EMBASE:439; Springer: 96). Following removal of 519 non-research articles, two independent reviewers screened titles and abstracts of 133 records. 25 articles underwent full-text evaluation, with 10 studies ultimately meeting the predefined inclusion criteria (see PRISMA flowchart in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e3.2 Study Characters\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe included studies (n\u0026thinsp;=\u0026thinsp;10), published between 2015\u0026ndash;2024, Collectively, these investigations enrolled 256 participants with FPHL. Studies designs comprised: RCTs:6 studies; uncontrolled clinical trials (UCTs): 2 prospective self-controlled trials and 2 single-arm pilot studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Risk of bias assessment and Quality\u003c/h2\u003e \u003cp\u003eMost RCTs demonstrated a low risk of bias in key domains, including randomization, outcome measurement, and selection of reported results. However, some concerns were raised regarding deviations from the intended intervention and missing data, with two studies being assessed as having a high risk of bias (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among non-randomized controlled studies, there was a higher risk of bias related to participant selection and confounding, while biases arising from missing data, outcome measurement, and intervention classification were generally low, with only one study rated as high risk. In terms of the certainty of evidence for the outcomes, the results for hair density and side effects were relatively complete. For hair diameter, four studies did not report results. Overall, the certainty of the evidence was moderate, although the evidence for hair density in one study was rated as very low, and three studies were rated as low, primarily due to a high risk of bias and small sample sizes .\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e3.4 Subgroup Classification and Result (\u003c/b\u003eSubgroup details are presented in the Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThis analysis categorized 10 studies into subgroups based on four key intervention variables (centrifugation technique, activation method, platelet concentration, delivery method, Topical Anesthesia AND Treatment Course).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelevant subgroup details for each study:\" Only cases in which activators (e.g., calcium gluconate) are explicitly mentioned as added or \"activated PRP\" is labeled in the literature shall be included; cases without explicit activation steps or only mentioning \"centrifugation preparation\" shall be classified as non-activated groups, and subjective inference shall be avoided.​Extract \"centrifugation times\u0026thinsp;+\u0026thinsp;specific parameters\" from the literature, such as \"single centrifugation, \"double centrifugation \", and \"systematic standardized centrifugation \". Vague descriptions that only mention \"centrifugation\" without specific parameters shall be excluded.​Prioritize extracting \"specific concentration values, followed by \"concentration multiples \". Cases that only mention \"high concentration\" without numerical values/multiples shall be classified as medium-low concentration groups, and shall not be subjectively determined as \"high concentration\".​Extract descriptions of \"anesthesia type\"or \"explicitly stated 'no anesthesia'\" from the literature; cases without any mention of anesthesia measures shall be default classified as \"no anesthesia used group\".\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePRP Extraction Method \u0026amp; Platelet Concentration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInjection Method\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnesthesia Method\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTreatment Regimen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePrimary Outcomes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdverse Events\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePatient Satisfaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2024Peng et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApheresis with whole blood separator (Non-activated, High platelet, Low leukocyte)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubcutaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTopical surface anesthesia (type unspecified)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 sessions, once monthly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair density increased by 19 hairs/cm\u0026sup2;; follicle density increased by 15 follicles/cm\u0026sup2;; 67% of patients showed improved appearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e86.7% had mild pain; 3 cases with intolerable pain; 1 case with headache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.2/5 points; 80% recognized acceptable comfort\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2021Moftah et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 groups:- Group I: Single centrifugation- Group II: Double centrifugation - Group III: Double centrifugation - Group IV: Single centrifugation ;Medium-Low platelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntradermal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 sessions, once monthly,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup IV: Hair density increased by 11.54%; other groups: 9.8%-10.2% increase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100% had mild pain; 1 case with pain lasting\u0026thinsp;\u0026gt;\u0026thinsp;48 h; 2 cases with dandruff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo specific score; Group IV showed slightly higher recognition for outcome stability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2016Puig et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAngel PRP system, Medium-Low platelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubcutaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCircular block anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.3% of patients reported subjective hair loss reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMild tenderness (no inter-group difference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.3% had significant improvement; 26.7% felt thicker hair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2023Ezz et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1: Single centrifugation, high platelet; Group 2: Single centrifugation, Medium-Low platelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntradermal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLidocaine spray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 sessions, once monthly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup 1: Forehead density increased by 55.6%; Group 2: 52.1% increase (both P\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 case with headache in Group 1; 100% had mild pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;7/10 points; significantly higher than placebo group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2015 Lee et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmartPReP\u0026reg;2 system, High platelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubcutaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2% lidocaine injection + (-10℃) cold air cooling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 PRP injection\u0026thinsp;+\u0026thinsp;12 PDRN (Polydeoxyribonucleotide) injections, once weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair count increased by 23.2%; hair thickness increased by 16.8% (both P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, superior to PDRN alone)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90% tolerated mild pain; 20% had edema; 10% had pruritus and desquamation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHigher recognition in combined group vs. single PDRN group; no dissatisfaction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2017Tawfik et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDouble centrifugation\u0026thinsp;+\u0026thinsp;calcium gluconate activation, Medium-Low platelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntradermal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 sessions, once weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair density increased by 77.28 hairs/cm\u0026sup2;; hair thickness increased by 0.11 mm (both P\u0026thinsp;\u0026lt;\u0026thinsp;0.005, superior to placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100% had mild pain and petechiae; resolved within 24 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.0/10 points; 83% felt significant improvement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2020Dubin et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEclipse system, Medium-Low platelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubcutaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 sessions (at week 0, 4, 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair density increased by 105.9 hairs/cm\u0026sup2; (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, superior to placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50% had headache; 50% had scalp tightness; 29% had swelling; resolved within 24 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57% satisfaction; higher recognition than placebo group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2019Bruce et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDouble centrifugation, High platelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubcutaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-10℃) cold air cooling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 PRP sessions, once monthly, followed by 12-week minoxidil foam treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair count increased (P\u0026thinsp;=\u0026thinsp;0.002); vellus hair density increased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.1% had pain/ecchymosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11 items of Quality of Life questionnaire improved (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); better convenience than minoxidil group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2020El-Husseiny et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight side: Double centrifugation; Left side: Single centrifugation; both activated with calcium gluconate, Medium-Low platelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntradermal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 sessions, once every 3 week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRight side: Terminal hair density increased by 400% (P\u0026thinsp;=\u0026thinsp;0.001); Left side: No significant change (P\u0026thinsp;=\u0026thinsp;0.140)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100% had mild pain; 73.3% had headache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean score 6.6/10 points; 66.7% felt increased hair density\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2018 Starace et al\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMy Cells system, Medium-Low platelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterfollicular injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnesthetic cream\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 sessions, once every 2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eForehead density increased; hair diameter increased by 14.6% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMild pain (alleviated by anesthesia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHigh recognition for thicker hair and reduced hair loss\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1Centrifugation Technique\u003c/h2\u003e \u003cp\u003eIn Bruce et al.'s study, involving double centrifugation and subcutaneous injection, resulted in a statistically significant increase in hair count (p\u0026thinsp;=\u0026thinsp;0.002)\u003csup\u003e[14]\u003c/sup\u003e. Similarly, El-Husseiny et al, whose the method used is intradermal injection, with a single or double centrifugation approach on both sides of the scalp, reported that the right-side treatment area under double centrifugation exhibited a median terminal hair density of 480 hairs/cm\u0026sup2; (range: 135\u0026ndash;798), representing a statistically significant improvement from baseline (p\u0026thinsp;=\u0026thinsp;0.001). Furthermore, both the Ludwig grade (p\u0026thinsp;=\u0026thinsp;0.017) and Sinclair grade (p\u0026thinsp;=\u0026thinsp;0.047) demonstrated significant enhancements\u003csup\u003e[15]\u003c/sup\u003e. In contrast, Moftah et al found that single-spin centrifugation yielded only an 11.54% increase in hair density, which did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.117)\u003csup\u003e[16]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2Activation Method\u003c/h2\u003e \u003cp\u003eBoth studies employed a single centrifugation intervention with medium-to-low platelet concentration and intradermal injection. In the study by Starace et al, non-activated PRP was used, and the results showed that the hair diameter on the forehead continued to increase significantly (relative rate of change: 14.6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), vellus hair density on the vertex decreased (by 6.6%), hair density showed positive growth in all regions and clinical photographs revealed improvements in hair density and quality\u003csup\u003e[17]\u003c/sup\u003e. In El-Husseiny et al\u0026rsquo;s study, activated PRP was adopted, and the results indicated that the median terminal hair density was 444 hairs/cm\u0026sup2; (range: 64\u0026ndash;798), with no significant increase compared with the baseline (p\u0026thinsp;=\u0026thinsp;0.140)and no significant improvement was observed (Ludwig scale: p\u0026thinsp;=\u0026thinsp;0.089; Sinclair scale: p\u0026thinsp;=\u0026thinsp;0.289)\u003csup\u003e[15]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.4.3Platelet Concentration\u003c/h2\u003e \u003cp\u003eIn all clinical studies on high-concentration platelet-rich plasma (PRP), the injection depth of PRP is in the subcutaneous layer. Peng et al reported that hair density increased by 19 hairs/cm\u0026sup2;\u003csup\u003e[18]\u003c/sup\u003e.Ezz El-Dawla et al investigated the efficacy differences between two different PRP kits, with the main distinction being platelet concentration. In the high-concentration group (Group 1), the results showed that frontal hair density increased from 1076.4 hairs/cm\u0026sup2; to 1675.38 hairs/cm\u0026sup2; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), temporal hair density increased from 1015.7 hairs/cm\u0026sup2; to 1770.85 hairs/cm\u0026sup2; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and vertex hair density increased from 1093.8 hairs/cm\u0026sup2; to 1666.7 hairs/cm\u0026sup2; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Clinical photographs demonstrated improvements in both hair density and quality. However, Group 2 showed a comparable efficacy trend, with no statistical significance observed between the two groups\u003csup\u003e[19]\u003c/sup\u003e. Bruce et al found that hair count increased significantly compared to the baseline (median 145 hairs/0.65cm\u0026sup2;, p\u0026thinsp;=\u0026thinsp;0.002), and vellus hair density also increased significantly (median 53.1 hairs/cm\u0026sup2;, p\u0026thinsp;=\u0026thinsp;0.009).Puig et al observed no significant differences in hair count (t\u0026thinsp;=\u0026thinsp;0.680, p\u0026thinsp;=\u0026thinsp;0.503) or hair mass index (HMI) (t\u0026thinsp;=\u0026thinsp;1.258, p\u0026thinsp;=\u0026thinsp;0.220) between the PRP group and the placebo group\u003csup\u003e[14]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.4.4 Delivery Method\u003c/h2\u003e \u003cp\u003eBoth studies used non-activated platelet-rich plasma (PRP) with medium-to-low concentration, which was obtained via single centrifugation. A consistent treatment regimen was adopted in both studies: once a month for a total of three sessions. Among the results, the subcutaneous injection showed that hair density increased by 105.9 hairs/cm\u0026sup2; (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, superior to placebo)\u003csup\u003e[20]\u003c/sup\u003e, while the intradermal injection resulted in hair density increases of 3.67% and 11.54%\u003csup\u003e[16]\u003c/sup\u003e, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.4.5Topical Anesthesia\u003c/h2\u003e \u003cp\u003eLocal anesthesia \u003csup\u003e[14, 17, 18, 21, 22]\u003c/sup\u003e: Anesthetic creams or cold air cooling mainly alleviate the \u0026ldquo;dull pain\u0026rdquo; caused by deep injections, with a pain tolerability rate exceeding 80%. No local anesthesia\u003csup\u003e[20]\u003c/sup\u003e: Although subcutaneous injections are less painful than intradermal injections, 50% of patients still reported scalp tightness and discomfort.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Disscussion","content":"\u003cp\u003eThe 10 studies on the efficacy of PRP in FPHL paint a complex and nuanced picture. Some studies show significant improvements in hair density and other parameters in the PRP group, while others find no statistically significant difference, despite some subjective improvement in PRP-treated subjects. This discrepancy can be attributed to differences in study design, highlighting the influence of factors like platelet concentration in PRP, injection technique, and individual patient characteristics\u003csup\u003e[23, 24]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDouble centrifugation is more advantageous in improving hair density and the proportion of terminal hairs, which may be associated with higher platelet concentration and more thorough leukocyte removal. Non-activated PRP exhibits more stable efficacy and avoids the loss of growth factors that may be caused by exogenous activators, making it more suitable for the long-term treatment of FPHL.\u003c/p\u003e \u003cp\u003eA platelet concentration\u0026thinsp;\u0026gt;\u0026thinsp;1000\u0026times;10⁹/L is a critical threshold for ensuring efficacy, as it can effectively promote terminal hair transformation and hair shaft thickening. In contrast, medium-to-low platelet concentrations are only applicable for mild hair loss or adjuvant treatment. Subcutaneous injection is more conducive to the growth factors in PRP acting on hair follicles, and its efficacy is superior to that of intradermal injection. This approach is particularly suitable for moderate-to-severe hair loss with significant follicular atrophy. High-concentration PRP must be combined with subcutaneous injection to fully exert its effects; insufficient injection depth will limit the efficacy of high-concentration PRP.\u003c/p\u003e \u003cp\u003eThe combination of non-activated PRP and subcutaneous injection is more optimal, possibly because non-activated PRP can release growth factors slowly in the subcutaneous environment, avoiding rapid metabolism in the intradermal space. Double centrifugation and high-concentration platelets exhibit a synergistic effect: double centrifugation is a key technique for obtaining high-concentration PRP, and their combination can maximize therapeutic efficacy.\u003c/p\u003e \u003cp\u003eIn PRP treatment for FPHL, local anesthesia can significantly reduce the incidence of severe pain (from 3.3%-30% to 0%- 20%) and shorten the duration of pain, without affecting treatment adherence. For optimized pain management, intradermal injection requires the combination of local anesthesia more than subcutaneous injection.\u003c/p\u003e \u003cp\u003eRegarding the treatment course, there is a lack of long-course study results on FPHL treated with PRP alone. Currently, the commonly used treatment course is generally once every 2 to 4 weeks for a total of 3 sessions. In this analysis, all clinical studies involving long treatment courses were based on results combined with other medications, thus lacking reference value.。\u003c/p\u003e \u003cp\u003eRegarding special populations, including those with alopecia areata, polycystic ovary syndrome-related hair loss, and lichen planopilaris, PRP also shows promise but requires further validation through larger-scale studies with longer follow-up periods \u003csup\u003e[25\u0026ndash;27]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"5. Limitation","content":"\u003cp\u003eFirst, the sample sizes are generally small and non-randomized controlled studies carry a higher risk of bias, with lower levels of evidence for their results. Second, no meta-analysis was performed in this systematic review, primarily due to three key reasons: the included studies showed significant heterogeneity in study design; intervention parameters (e.g., dose, duration, and delivery mode of the intervention) varied substantially across studies; outcome indicators and their measurement tools were inconsistent, there is high heterogeneity within subgroups, leading to inability to pool quantitative data effectively. Third, the follow-up periods are relatively short, with the longest follow-up duration in existing studies being only six months, which prevents effective assessment of long-term efficacy.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis narrative analysis demonstrates that a double-centrifugation, non-activated, high-concentration, subcutaneously injected PRP intervention protocol yields the most favorable outcomes in the treatment of female pattern hair loss.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAGA: Androgenetic Alopecia\u003c/p\u003e\n\u003cp\u003ebFGF: Basic Fibroblast Growth Factor\u003c/p\u003e\n\u003cp\u003eDSC: Dermal Sheath Cup\u003c/p\u003e\n\u003cp\u003eEGF: Epidermal Growth Factor\u003c/p\u003e\n\u003cp\u003eFPHL: Female Pattern Hair Loss\u003c/p\u003e\n\u003cp\u003eGRADE: Grading of Recommendations Assessment, Development and Evaluation\u003c/p\u003e\n\u003cp\u003eHMI: Hair Mass Index\u003c/p\u003e\n\u003cp\u003eIGF-1: Insulin-like Growth Factor-1\u003c/p\u003e\n\u003cp\u003ePDGF: Platelet-Derived Growth Factor\u003c/p\u003e\n\u003cp\u003ePRP: Platelet-Rich Plasma\u003c/p\u003e\n\u003cp\u003eRCT: Randomized Controlled Trial\u003c/p\u003e\n\u003cp\u003eROB: Risk of Bias\u003c/p\u003e\n\u003cp\u003eSVF: Stromal Vascular Fraction\u003c/p\u003e\n\u003cp\u003eTGF-β: Transforming Growth Factor-β\u003c/p\u003e\n\u003cp\u003eVEGF: Vascular Endothelial Growth Factor\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This is a review article and does not involve new studies with human participants or animals by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data analyzed in this review are derived from published literature, which is cited in the reference list.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the special funds for clinical research from the Affiliated Qingyuan Hospital (Qingyuan People\u0026apos;s Hospital), Guangzhou Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePXL and ZXQ conceived the study, performed the literature search, data extraction, and analysis, and drafted the manuscript. Kun Qian supervised the project, provided critical revisions, and is the corresponding author. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eVano-Galvan S, Saceda-Corralo D, Blume-Peytavi U, et al. Frequency of the Types of Alopecia at Twenty-Two Specialist Hair Clinics: A Multicenter Study[J]. Skin Appendage Disord, 2019,5(5):309-315.\u003c/li\u003e\n \u003cli\u003eVujovic A, Del M V. The female pattern hair loss: review of etiopathogenesis and diagnosis[J]. Biomed Res Int, 2014,2014:767628.\u003c/li\u003e\n \u003cli\u003eCamacho-Martinez F M. Hair loss in women[J]. Semin Cutan Med Surg, 2009,28(1):19-32.\u003c/li\u003e\n \u003cli\u003evan Zuuren E J, Fedorowicz Z, Carter B. Evidence-based treatments for female pattern hair loss: a summary of a Cochrane systematic review[J]. Br J Dermatol, 2012,167(5):995-1010.\u003c/li\u003e\n \u003cli\u003eLiu K H, Liu D, Chen Y T, et al. Comparative effectiveness of low-level laser therapy for adult androgenic alopecia: a system review and meta-analysis of randomized controlled trials[J]. Lasers Med Sci, 2019,34(6):1063-1069.\u003c/li\u003e\n \u003cli\u003eTsuboi R, Niiyama S, Irisawa R, et al. Autologous cell-based therapy for male and female pattern hair loss using dermal sheath cup cells: A randomized placebo-controlled double-blinded dose-finding clinical study[J]. J Am Acad Dermatol, 2020,83(1):109-116.\u003c/li\u003e\n \u003cli\u003eWu P I, Diaz R, Borg-Stein J. Platelet-Rich Plasma[J]. Phys Med Rehabil Clin N Am, 2016,27(4):825-853.\u003c/li\u003e\n \u003cli\u003eLubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP and their applicability in medicine[J]. J Biol Regul Homeost Agents, 2012,26(2 Suppl 1):3S-22S.\u003c/li\u003e\n \u003cli\u003eWeibrich G, Kleis W K, Hafner G, et al. Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count[J]. J Craniomaxillofac Surg, 2002,30(2):97-102.\u003c/li\u003e\n \u003cli\u003eMercuri S R, Vollono L, Paolino G. The Usefulness of Platelet-Rich Plasma (PRP) for the Treatment of Vitiligo: State of the Art and Review[J]. Drug Des Devel Ther, 2020,14:1749-1755.\u003c/li\u003e\n \u003cli\u003eWon C H, Yoo H G, Kwon O S, et al. Hair growth promoting effects of adipose tissue-derived stem cells[J]. J Dermatol Sci, 2010,57(2):134-137.\u003c/li\u003e\n \u003cli\u003eAyatollahi A, Hosseini H, Gholami J, et al. Platelet rich plasma for treatment of non-scarring hair loss: systematic review of literature[J]. J Dermatolog Treat, 2017,28(7):574-581.\u003c/li\u003e\n \u003cli\u003eCervantes J, Perper M, Wong L L, et al. Effectiveness of Platelet-Rich Plasma for Androgenetic Alopecia: A Review of the Literature[J]. Skin Appendage Disord, 2018,4(1):1-11.\u003c/li\u003e\n \u003cli\u003eBruce A J, Pincelli T P, Heckman M G, et al. A Randomized, Controlled Pilot Trial Comparing Platelet-Rich Plasma to Topical Minoxidil Foam for Treatment of Androgenic Alopecia in Women[J]. Dermatol Surg, 2020,46(6):826-832.\u003c/li\u003e\n \u003cli\u003eEl-Husseiny R M, Saleh H M, Moustafa A A, et al. Comparison between single- versus double-spin prepared platelet-rich plasma injection in treatment of female pattern hair loss: clinical effect and relation to vascular endothelial growth factor[J]. Arch Dermatol Res, 2021,313(7):557-566.\u003c/li\u003e\n \u003cli\u003eMoftah N H, Taha N E, Alhabibi A M, et al. Different platelet-rich plasma preparation protocols in Female pattern hair loss: Does it affect the outcome? A pilot study[J]. J Cosmet Dermatol, 2022,21(8):3316-3326.\u003c/li\u003e\n \u003cli\u003eStarace M, Alessandrini A, D'Acunto C, et al. Platelet-rich plasma on female androgenetic alopecia: Tested on 10 patients[J]. J Cosmet Dermatol, 2019,18(1):59-64.\u003c/li\u003e\n \u003cli\u003ePeng X L, Li S W, Zhou X Q, et al. A Prospective Self-controlled Clinical Trial of Nonactivated Low Leukocyte PRP in Female Pattern Hair Loss Patients of Childbearing Age: Erratum[J]. Dermatol Surg, 2025,51(8):e44.\u003c/li\u003e\n \u003cli\u003eEl-Dawla R E, Abdelhaleem M, Abdelhamed A. Evaluation of the safety and efficacy of platelet-rich plasma in the treatment of female patients with chronic telogen effluvium: A randomised, controlled, double-blind, pilot clinical trial[J]. Indian J Dermatol Venereol Leprol, 2023,89(2):195-203.\u003c/li\u003e\n \u003cli\u003eDubin D P, Lin M J, Leight H M, et al. The effect of platelet-rich plasma on female androgenetic alopecia: A randomized controlled trial[J]. J Am Acad Dermatol, 2020,83(5):1294-1297.\u003c/li\u003e\n \u003cli\u003eLee S H, Zheng Z, Kang J S, et al. Therapeutic efficacy of autologous platelet-rich plasma and polydeoxyribonucleotide on female pattern hair loss[J]. Wound Repair Regen, 2015,23(1):30-36.\u003c/li\u003e\n \u003cli\u003ePuig C J, Reese R, Peters M. Double-Blind, Placebo-Controlled Pilot Study on the Use of Platelet-Rich Plasma in Women With Female Androgenetic Alopecia[J]. Dermatol Surg, 2016,42(11):1243-1247.\u003c/li\u003e\n \u003cli\u003eSasaki G H. The Effects of Lower vs Higher Cell Number of Platelet-Rich Plasma (PRP) on Hair Density and Diameter in Androgenetic Alopecia (AGA): A Randomized, Double-Blinded, Placebo, Parallel-Group Half-Scalp IRB-Approved Study[J]. Aesthet Surg J, 2021,41(11):NP1659-NP1672.\u003c/li\u003e\n \u003cli\u003eRamadan W M, Hassan A M, Ismail M A, et al. Evaluation of adding platelet-rich plasma to combined medical therapy in androgenetic alopecia[J]. J Cosmet Dermatol, 2021,20(5):1427-1434.\u003c/li\u003e\n \u003cli\u003eXue P, Guo L, Dang E, et al. A Prospective and Comparative Study to Explore the Effects of Platelet-Rich Plasma in Hair Transplantation for Patients With Androgenetic Alopecia[J]. J Cosmet Dermatol, 2025,24(2):e16665.\u003c/li\u003e\n \u003cli\u003eJanaani P, Vinay K, Mehta H, et al. Analysing efficacy of low-dose oral minoxidil, topical minoxidil, and platelet-rich plasma with topical minoxidil combination in patients with androgenetic alopecia: a randomized controlled observer blinded trial[J]. Arch Dermatol Res, 2025,317(1):421.\u003c/li\u003e\n \u003cli\u003eBehrangi E, Akbarzadehpasha A, Dehghani A, et al. Platelet-rich plasma as a new and successful treatment for lichen planopilaris: A controlled blinded randomized clinical trial[J]. J Cosmet Dermatol, 2024,23(8):2547-2555.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"PRP female pattern hair loss FPHL","lastPublishedDoi":"10.21203/rs.3.rs-8638974/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8638974/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003cem\u003e \u003c/em\u003eTo evaluate the efficacy and safety of platelet-rich plasma (PRP) for female pattern hair loss (FPHL) and to explore how preparation and application parameters modify\u003c/p\u003e\n\u003cp\u003eoutcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe systematically searched PubMed, Springer and EMBASE from 2015–2025 for randomized and non-randomized controlled studies in FPHL. Two reviewers screened records, extracted data, and assessed risk of bias (ROB 2/ROBINS-I). Primary outcome was change in hair density. Heterogeneity precluded meta-analysis; findings were synthesized narratively with predefined subgroups (including spin method, activation, platelet concentration, delivery method and topical anesthesia.).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 10 studies (256 participants) met inclusion criteria. Across placebo-controlled trials, PRP sometimes improved hair density at 12–24 weeks, but effect sizes varied and certainty was low-to-moderate due to heterogeneity and risk of bias. Key findings indicate that double-centrifugation , non-activated PRP, platelet concentrations of 1000–1500×10⁹/L (2–5× baseline)and subdermal injection (3–5 mm depth, 0.1–0.3 mL/cm², 3–4 sessions/month) yield optimal outcomes. Adverse events were mainly mild; no serious events were reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003ePRP may offer short-term benefits for FPHL, but standardized protocols and higher-quality trials are needed to define optimal preparation, dosing, and durability. Future studies should predefine outcomes, use sham controls, and report patient-important measures and safety systematically\u003c/p\u003e","manuscriptTitle":"Comprehensive Analysis of Platelet-Rich Plasma for the Treatment of Female Pattern Hair Loss: A Subgroup-Based Review of Clinical Evidence","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-17 17:30:09","doi":"10.21203/rs.3.rs-8638974/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-17T21:45:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337162128924600030637999526852350660503","date":"2026-04-30T09:47:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90830203912808136534757672419385510017","date":"2026-04-29T18:59:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-12T00:23:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309448950404516863710654576659377334049","date":"2026-03-13T19:48:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T14:38:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110624013613975664335095382461330203128","date":"2026-03-13T14:11:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-13T10:36:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-04T17:51:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-09T08:45:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-06T13:58:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-02-06T13:36:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccf06dc4-4cf1-4ef5-8ae2-f99356e44a15","owner":[],"postedDate":"March 17th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-17T21:45:39+00:00","index":98,"fulltext":""},{"type":"reviewerAgreed","content":"337162128924600030637999526852350660503","date":"2026-04-30T09:47:35+00:00","index":97,"fulltext":""},{"type":"reviewerAgreed","content":"90830203912808136534757672419385510017","date":"2026-04-29T18:59:21+00:00","index":96,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-17T17:30:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-17 17:30:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8638974","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8638974","identity":"rs-8638974","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}