UW sports medicine helps one athlete make her comeback – University of Washington Magazine

For six weeks following surgery, she was on crutches and in a brace. Stueckle, the teams athletic trainer, developed a program of non-weight-bearing exercises to keep Powells upper body in shape and build a foundation for the rehabilitation of her kneeincluding stretching her leg muscles and increasing her knees range of motion, and setting a volleyball while sitting on a box. And then, when Powell was able to start putting weight on her leg, Stueckle introduced new, challenging exercises, like standing on an unstable surface with her left leg and working on her sets.

I had lost a ton of muscle in my quad, calf and hamstring. So the silliest little exercises like leg raises would absolutely gas me. It was a lot of lonely work, Powell says. But she wasnt truly alone. Every day before practice, and often multiple times a day, she would meet with Stueckle for her ever-evolving rehabilitation. She also had periodic check-ins with OKane and Hagen, who confirmed her knee was improving as expected.

When a resurgence of COVID-19 pushed the 2020 season to January 2021 and the NCAA granted athletes an extra year of eligibility, Powell had renewed hope and a clear recovery target. Still, she endured her share of low moments, including recurring pain in her knee due to a suture. Hagen had OKane evaluate the area using ultrasound and inject it with a steroid to decrease inflammation, which solved the problem. Later, Powell went through a two-week slump in which she didnt feel like she was making any progress, but Stueckle continued to reassure her that she was on the right path. A big aspect of rehab is educating and collaborating with my athletes, Stueckle says. A lot of it is, first and foremost, having that relationship with athletes, building that trust.

Jenn has been there with me since day one, says Powell, who, like the rest of the team, has seen Stueckle in the training room for preventive maintenance and minor injuries since she was a freshman. She did such a great job handling both the physical and emotional side of my recovery.

When Powell returned home to Arkansas for winter break in 2020, Stueckle provided her and her personal trainer with a rehab program. And in January, when Powell was back in Seattle, Hagen had her run through a litany of tests and a thorough knee examand told her she was physically ready to play. It was just up to Powell to decide if she was mentally ready.

For athletes, the mental hurdle in recovering from an injury is often the hardest, says Hagen. UW Medicine doctors sometimes refer athletes to team psychologists, who help them process everything from the academic and personal struggles to intense pressure and career-ending injuries. That holistic care wasnt always the case, says OKane, speaking of sports medicine practices in general, not specifically at the UW. It used to be a race to see how fast surgeons could get athletes back out there after injuries like ACL tears.

In the early 2000s, UW Athletics formalized a partnership with UW Medicine to provide team physician services. To avoid any potential conflict of interest, says OKane, the doctors have the final say in whether an athlete is ready to play: Its written into our contract. Today, this type of autonomous health care is a guiding NCAA principle, and while some institutions have found it challenging to achieve, its fundamental to the relationship between UW Athletics and UW Medicine.

In her final season, Powell reached 162 career aces, setting a school record and prompting the Seattle Times to call her the Queen of Aces.

Coaches and players are often the gas, and were the brakes, OKane says. Theyre the ones who are pushing a little bit, and were the ones who are holding back a little bit. Its a really tight connection at the UW, but the final say about play, not play, is with the physician.

Fortunately for Powell, her recovery had gone smoothly, and Hagen and OKanes reassurance was all she needed mentally. We dont see a reason to hold you back, Hagen told Powell in that final appointment. Powell didnt either.

Over the next few months, she helped lead the Huskies to a conference championship and to the Final Four for the first time since 2013. Ella May went from sitting on a box in the fall to first-team All-American in the spring, Stueckle says.

But Powell wasnt done. Just months later, she and the Huskies were back again, winning their second-straight Pac-12 title and advancing to the Sweet Sixteen. Powell was named Pac-12 setter of the year both seasons, cementing her spot as a Husky great.

While OKane and his team see more than 700 student-athletes for their primary-care needs, and Hagens team treats them for musculoskeletal injuries, thats just part of their caseloads. The rest are patients from the community. (Other specialists at the center, including physiatrists and physical therapists, also treat UW athletes and community patients alike. And a number of UW sports medicine clinics in the greater Seattle area extends that community reach even further.)

UW Medicine as a research powerhouse applies just as much to someone like Powell as it does to anyone else. Theres nothing about Ella May that resembles most of the other people in the world, says OKane. But the way you approach her is carried over to the way that you approach other folks.

Those other folks could include a young soccer player or a senior who hikes. And regardless of who the patient is, the same tools are available, from technologically advanced surgery to nonsurgical treatments like ultrasound-guided procedures, nerve pain reduction techniques and platelet-rich plasma injections to help inflamed tendons and joints. Whether the treatments and technologies are new or have been used for decades, UW Medicine relies on its wealth of research and expertise to ensure they remain safe and effective.

In 2015, Dr. John Drezner, a UW Athletics team physician and director of the UW Medicine Center for Sports Cardiology, was a leader in a Seattle meeting of international experts who used new research to standardize the interpretation of electrocardiograms in athletes. Known as the Seattle criteria, it is today used by doctors around the world to improve the screening of amateur and professional athletes and identify potentially life-threatening cardiovascular abnormalities before they strike on the court or on the field. There is a lot of community trickle-down from UW Medicines research, says OKane.

Dr. John OKane examines a student-athletes knee.

* * *

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UW sports medicine helps one athlete make her comeback - University of Washington Magazine

Platelet-Rich Plasma (PRP) Injections | Johns Hopkins Medicine

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Platelet-rich plasma (PRP) injections are gaining popularity for a variety of conditions, from sports injuries to hair loss. The treatment uses a patients own blood cells to accelerate healing in a specific area.

Platelet-rich plasma consists of two elements: plasma, or the liquid portion of blood, and platelets, a type of blood cell that plays an important role in healing throughout the body. Platelets are well-known for their clotting abilities, but they also contain growth factors that can trigger cell reproduction and stimulate tissue regeneration or healing in the treated area. Platelet-rich plasma is simply blood that contains more platelets than normal.

To create platelet-rich plasma, clinicians take a blood sample from the patient and place it into a device called a centrifuge that rapidly spins the sample, separating out the other components of the blood from the platelets and concentrating them within the plasma.

After creating platelet-rich plasma from a patients blood sample, that solution is injected into the target area, such as an injured knee or a tendon. In some cases, the clinician may use ultrasound to guide the injection. The idea is to increase the concentration of specific bioproteins or hormones, called growth factors, in a specific area to accelerate the healing process.

The mechanism behind PRP injections is not completely understood. Studies show that the increased concentration of growth factors in platelet-rich plasma may stimulate or speed up the healing process, shortening healing time for injuries, decreasing pain and even encouraging hair growth.

PRP injections are used for a range of conditions,* from musculoskeletal pain and injuries to cosmetic procedures.

PRP injections may be able to treat a range of musculoskeletal injuries and conditions. For example, chronic tendon injuries such as tennis elbowor jumpers kneecan often take a long time to heal, so adding PRP shots to a treatment regimen can help to stimulate the healing process, decrease pain and enable a return to activities sooner.

Clinicians first used PRP to accelerate healing after jaw or plastic surgeries. Now, post-surgical PRP injections have expanded to help heal muscles, tendons and ligaments, as procedures on these tissues have notoriously long recovery times.

Early studies indicate that PRP injections may help treat osteoarthritis pain and stiffness by modulating the joint environment and reducing inflammation, but research is growing.

Our team of experts at the Johns Hopkins Musculoskeletal Center offers platelet-rich plasma injections to help alleviate pain, improve mobility and decrease inflammation.

PRP injections can be effective in treating male pattern baldness, both in preventing hair loss and promoting new hair growth. PRP can also aid in the stimulation of hair growth after hair transplants.

PRP injections are sometimes used as an anti-aging treatment, but there is little evidence to show that PRP reduces wrinkles and other signs of aging.

A PRP injection is a low-risk procedure and does not usually cause major side effects. The procedure involves a blood draw, so you should make sure you are hydrated and have eaten beforehand to prevent feeling lightheaded. After the procedure, you may experience some soreness and bruising at the injection site.

Because PRP injections are made up of your own cells and plasma, the risk of an allergic reaction is much lower than with other injectable medications like corticosteroids. Less common risks of PRP injections include:

If you are considering PRP injections, be sure to talk with your health care provider about all the benefits and risks.

*Research for the different applications of PRP is promising and rapidly growing. Although the equipment used to produce PRP and the injections themselves have been cleared by the FDA, this procedure is considered investigational and has not been officially approved by the FDA for most uses. Since PRP is a substance derived from ones own blood, it is not considered a drug. FDA clearance means that doctors can prescribe and administer PRP if they believe its in the best interest of the patient. However, lack of the FDA approval means that PRP treatments may not be covered by insurance.

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Platelet-Rich Plasma (PRP) Injections | Johns Hopkins Medicine

Broncos Already Have A Week 6 Russell Wilson Update – Yardbarker

The Denver Broncos are among the more disappointing teams through Week 5 of the 2022 NFL season.

After hiring Nathaniel Hackett as head coach and trading for All-Pro quarterback Russell Wilson, there were high hopes for this team.

Football experts thought their additions would help the talented but underperforming Broncos offense.

Meanwhile, their fans were thrilled about Wilson completing touchdown passes to Jerry Jeudy, Courtland Sutton, and K.J. Hamler.

If that approach didnt work, the Broncos still had Javonte Williams and Melvin Gordon III from the backfield.

Unfortunately, the narrative did not unfold that way, as the Broncos have a losing record after five games.

They struggled to score or move the ball even before Williams suffered a season-ending injury.

However, Wilsons shoulder injury may explain his depressing start.

He has a torn lat in his throwing shoulder which is concerning for their prospects throughout the season.

But despite his condition, Wilson will still suit up for the Broncos in Week 6.

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Broncos Already Have A Week 6 Russell Wilson Update - Yardbarker

Global Joint Pain Injections Market Report (2022 to 2031) – Featuring Seikagaku, Flexion Therapeutics and Zimmer Biomet Among Others -…

DUBLIN--(BUSINESS WIRE)--The "Joint Pain Injections Global Market Report 2022" report has been added to ResearchAndMarkets.com's offering.

This report provides strategists, marketers and senior management with the critical information they need to assess the global joint pain injections market.

This report focuses on joint pain injections market which is experiencing strong growth. The report gives a guide to the joint pain injections market which will be shaping and changing our lives over the next ten years and beyond, including the markets response to the challenge of the global pandemic.

The global joint pain injections market is expected to grow from $4.20 billion in 2021 to $4.63 billion in 2022 at a compound annual growth rate (CAGR) of 10.17%. The joint pain injections market is expected to reach $6.36 billion in 2026 at a CAGR of 8.25%.

Companies Mentioned

Reasons to Purchase

The joint pain injections market consists of sales of joint pain injections and products by entities (organizations, sole traders, and partnerships) that are used to relieve joint pain and inflammation quickly through non-surgical treatments. Joint pain injections reduce inflammation and discomfort and are typically injected directly into the joint for pain relief. Joint pain is very frequent among the elderly or as a result of pre-existing medical problems or disorders. It can happen as a result of musculoskeletal illnesses such as arthritis, which causes pain and inflammation.

The main types of injection for joint pain includes steroid joint injection, hyaluronic acid injections, platelet-rich plasma (PRP) injections, placental tissue matrix (PTM) injections and others. The steroid joint injection are anti-inflammatory medications that are used to treat a joint pain. Steroid joint injections, also called corticosteroid injections, help to reduce inflammation in the people with rheumatoid arthritis and other types of inflammatory arthritis. Joint pain injection are used to for various types of joints including hip joint, knee and ankle, shoulder and elbow, facet joints of the spine and others. These are mainly distributed though hospital pharmacies, retail pharmacies, online pharmacies.

North America was the largest region in the joint pain injections market in 2021. The regions covered in the joint pain injections market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa.

The joint pain injections market research report is one of a series of new reports that provides joint pain injections market statistics, including joint pain injections industry global market size, regional shares, competitors with a joint pain injections market share, detailed joint pain injections market segments, market trends and opportunities, and any further data you may need to thrive in the joint pain injections industry. This joint pain injections market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

The rise in the prevalence of arthritis and musculoskeletal disorders will propel the growth of the joint pain injections market. Musculoskeletal disorders are the biggest cause of disability worldwide, with low back pain being the single most common cause of impairment in 160 nations. Patients are taking injections for pain relief and inflammatory condition.

New product development is a key trend gaining popularity in the joint pain injections market. Major companies operating in the join pain injections sector are focused on new product innovations to meet consumer demand and strengthen their position.

The countries covered in the joint pain injections market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK and USA.

For more information about this report visit https://www.researchandmarkets.com/r/cl1z24

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Global Joint Pain Injections Market Report (2022 to 2031) - Featuring Seikagaku, Flexion Therapeutics and Zimmer Biomet Among Others -...

Comparison of the Efficacy of Platelet-Rich Plasma (PRP) and Local Corticosteroid Injection in Periarthritis Shoulder: A Prospective, Randomized,…

Background

Periarthritis or frozen shoulder, also called adhesive capsulitis, is characterized by stiffness and pain along with gradual loss of active and passive movement in the glenohumeral joint. More than 2-5% of the population suffers from periarthritis with a higher incidence in the age group of 40-60 years. The various treatment modalities used for its management include simple physiotherapy, short-wave therapy, ultrasonic therapy, transcutaneous electrical nerve stimulation, hydrotherapy, analgesics, intra-articular injections, manipulation under general anesthesia (MUA), and surgical management. The application of intra-articular steroid injection has been a common and efficacious option in rapidly diminishing shoulder pain and disability. Some recent studies reported a better outcome using platelet-rich plasma (PRP) injections in frozen shoulder cases. Hence, this randomized controlled trial was conducted to compare the efficacy of intra-articular injections of PRP and triamcinolone in patients of shoulder periarthritis in a population from the eastern region of India

A total of 60 patients with periarthritis shoulder were allocated into two groups after randomization. Group A received 2 mL autologous PRP, and Group B received 2 mL of triamcinolone (40 mg/mL) intra-articular injection. Patients were followed up on the 4thweek, 12thweek, and 24thweek. The assessment of pain and function using the visual analog scale (VAS) score and the Disabilities of Arm, Shoulder, and Hand (DASH) score, respectively, was done at each follow-up. The primary analyses of both primary and secondary outcomes were conducted in the intention-to-treat (ITT) population. SPSS version 24 (IBM Corp., Armonk, NY, USA) was used for data analysis.

The mean VAS score in the PRP and triamcinolone groups was 14.33 3.79 and 31.63 7.62, respectively (p = 0.0001) after 24 weeks. The mean DASH score in the PRP and triamcinolone groups was 18.08 8.08 and 31.76 3.63, respectively (p = 0.0001), which shows significant improvement in both pain and disability scores in the PRP group after 24 weeks.

The triamcinolone group showed better short-term outcomes whereas PRP showed better long-term outcomes in reducing pain and disability scores in terms of VAS and DASH scores.

Periarthritis of the shoulder is characterized by functional loss of passive and active shoulder motion. This condition was termed by Duplay in 1896 and later substituted by the term frozen shoulder by Codman in 1932. Subsequently, Nevaiser introduced the term adhesive capsulitis [1]. This disorder is defined by the American Shoulder and Elbow Surgeons as a condition of significant restriction of both active and passive motion of the shoulder joints because of an unknown etiology that occurs without an intrinsic shoulder disorder [2].

The definite pathophysiology of periarthritis remains unclear. The progressive fibrosis causing the contracture of the glenohumeral joint capsule results in pain and stiffness [3]. Periarthritis can be primary or secondary. The primary (or idiopathic) type occurs without any known trauma or provoking event. The secondary type is often observed after periarticular trauma, fracture, or dislocation of the glenohumeral joint [4].

According to recent studies, the incidence of periarthritis is 2-5% in the general population [5,6]. The affected population includes 70% females. The idiopathic type often involves the non-dominant extremity, while 40-50% of cases have been reported as bilateral involvement. Regardless of the etiology, the condition is more prevalent in the 40-60-year age group [4,7]. The risk factors for developing periarthritis include diabetes. Patients with type I diabetes have a 40% chance of developing periarthritis. Up to 29% of individuals with type II diabetes may develop this condition. Thyroid disease, Parkinsons disease, cardiac disease, autoimmune disease, chronic obstructive pulmonary disorder, and myocardial infarction are also linked with increased incidence of periarthritis or adhesive capsulitis [3,8].

In most cases, periarthritis resolves spontaneously or it can last for up to three years [9]. Various treatment approaches have been used and explored to treat this disorder. Physical therapy individually or in combination with short-wave therapy, ultrasonic therapy, transcutaneous electrical nerve stimulation, and hydrotherapy is used [10]. Pharmacological treatment includes the use of analgesic or non-steroidal anti-inflammatory drugs, oral or intra-articular use of corticosteroids, and sodium hyaluronate injections. Other approaches to treat periarthritis include manipulation under anesthesia (MUA), dilation or distension of the capsule, and arthroscopic or open capsular release (arthroscopic capsulotomy) [3,4,11].

Platelet-rich plasma (PRP) is an emerging entity in the field of tissue engineering and regenerative medicine due to its availability, affordability, and minimally invasive procedure. Its autologous nature prevents an immunological reaction and offers good therapeutic safety. Recently, evidence in immune-mediated disorders and inflammatory processes has garnered attention due to their anti-inflammatory effects through the inhibition of nuclear factor kappa B signaling in target cells and by tissue inhibitor of matrix metalloproteinase. The creation and remodeling of the extracellular matrix also encompass a function of platelet growth factors which further supports this treatment modality [12]. The application of intra-articular steroid injection has been a common and efficacious option in rapidly diminishing shoulder pain and disability [5]. Some recent studies show a better outcome using PRP injections in frozen shoulder cases [13]. A systemic review and meta-analysis by Sun et al. described that patients taking a single steroid injection for a frozen shoulder is effective and safe and improves functional outcomes and pain scores [14].

Corticosteroid injections have been associated with prominent side effects, which have led to the conception of modalities such as PRP. This randomized trial aimed to evaluate and compare the efficacy of intra-articular injections of PRP and steroid (triamcinolone) in periarthritis. We hypothesized that PRP would prove more effective in relieving pain and improving function. Several studies have reported comparative analyses of steroids and PRP. Most of these were conducted outside India. Studies by Upadhyay et al. [15], Kothari et al. [16], and Kumar et al. [17] reported the effect of PRP versus steroids in periarthritis in the Indian population. One study from the eastern part of India with a similar intervention was conducted by Barman et al. [18], but the follow-up period was only 12 weeks. Hence, this study was conducted to analyze the comparative efficacy of PRP versus steroids in periarthritis with a follow-up duration of 24 weeks in a population from the eastern region of India.

This study was a parallel-group, prospective, randomized, open, blinded end-point (PROBE), single-center clinical study. Randomization was done in permuted blocks of varying sizes (2, 4, 6) using a sealed envelope website (computer-generated)[19]. There was central randomization, and the person doing randomization was not part of the study. The investigator assigning intervention telephonically contacted the randomizer on the recruitment of every new patient regarding the group to which the patient was assigned. Another investigator (other than the one assigning intervention) assessed the outcomes of the patients without any knowledge of the study group to which the patient belonged to. Patients were recruited to different treatment regimens following proper randomization. Unlike double-blind studies, the treatment regimens were recognizable to both physicians and patients. The trial was conducted according to the principles of the Consolidated Standards of Reporting Trials (CONSORT).

The study was conducted from December 2020 to December 2021 at the Department of Orthopaedics, Rajendra Institute of Medical Sciences (RIMS), Ranchi Jharkhand, India. Ethical approval was obtained (vide reference number: 123, dated November 23, 2020) from the Institutional Ethical Committee of RIMS, Ranchi.

A total of 60 patients from the outpatient department (OPD), Department of Orthopedics, RIMS who were clinically diagnosed to have periarthritis shoulder and willing to participate were randomized into two groups. A written informed consent regarding participation was obtained before recruitment. The complete procedure of the study was explained to all participants in their language by the investigator before recruitment. The inclusion and exclusion criteria are presented in Table1and Table2, respectively.

The sample size was calculated by OpenEpi, Version 3, an open-source calculator based on the findings of the study by Kothari et al., in which the mean VAS score for PRP and steroid group were reported [16]. The calculated sample size was 29 for each group (Table 3). Rounding off to the nearest, the total sample size was finally set as 60 (30 per group).

All information about the history, clinical features, examination findings, and treatment (if any were taken before) were recorded in a predesigned proforma. All patients were subjected to routine blood investigation and radiographic examinations of the cervical spine and ipsilateral shoulder under study.

Before administrating the injection, povidone-iodine and ethyl alcohol were applied to the skin. One milliliter of 2% lignocaine with adrenaline was injected at the injection site after administering the test dose. After 10 minutes, the proposed injection was injected. If any resistance was felt during the injection, the needle was withdrawn slightly and again injected.

The first group of patients was administered 2 mL of triamcinolone (40 mg/mL). The second group was given 2 mL autologous PRP. To prepare PRP, about 15 mL of the patients blood was drawn through a scalp vein catheter. The PRP was prepared using a differential centrifugation technique with two spins. The blood was collected in three citrate tubes having 0.9% sodium citrate as an anticoagulant. The first spin was performed at 1,500 rpm for 15 minutes using a laboratory centrifuge. This spin separated the red blood cells from the rest of the components. The upper half of the supernatant was discarded. The lower halves of the supernatant from all three tubes were transferred into another plain tube for the second spin. The second spin was performed at 2,500 rpm for 10 minutes. The upper half of the supernatant was discarded. Three milliliters of the lower half was taken into a syringe having 0.1 mL of calcium chloride. At the end of the preparation of PRP, 1 mL of obtained PRP (as a sample) was sent for platelet count, and the count was compared with the patients platelet count. Another 2 mL was used for intra-articular injection. The platelet count in the PRP preparation was 860,000 74,500 platelets per mm3which were 4.2 1.37 times higher than whole blood values. In our study, we injected freshly prepared PRP (within 30 minutes of preparation), as a study by Blajchman [20] reported that platelets may alter the shape and reduce the functional properties, including the degranulation of -granules due to prolonged storage.

All patients were advised regarding post-injection care. The possibility of pain increasing during the initial two weeks was explained to the patient. Post-injection, patients were prescribed paracetamol (650 mg BD orally for five days) for pain relief in both groups. Patients were advised to rest during the initial two weeks and avoid strenuous activities by the extremity under study after the injection. Physiotherapy was advised for both groups. Bilateral cases were injected simultaneously, and the post-injection protocol was the same.

After inclusion in the study, demographic data, baseline clinical findings, duration of pain, dominancy of the affected side, and associated comorbidities were recorded. Any relevant X-ray findings were noted. Special investigations were performed as per comorbidity present in a case. The follow-ups were done in the 4th week, 12th week, and 24th week for all patients of both groups. The assessment of pain and function through the VAS and the Disabilities of Arm, Shoulder, and Hand (DASH) score, respectively, was done at each follow-up. Any adverse effects were noted and reported. All data were documented in case report form (CRF) designed for the project and in Excel sheets for analysis.

The primary outcome of the study was the pain reduction assessed using the VAS after the injections. The DASH scores were assessed as a secondary outcome.

The primary analyses of both primary and secondary outcomes were conducted in the intention-to-treat (ITT) population (i.e., all randomized participants for whom consent was given to use data). SPSS version 24 (IBM Corp., Armonk, NY, USA) was used for data analysis. The data with categorical variables were expressed as numbers and percentages, while the continuous variables were expressed as the mean standard deviation (SD). An unpaired t-test was used for analyzing continuous variables inthe intergroup analysis. The Fishers exact test and Pearsons chi-square test were used for analyzing categorical variables. P-values of <0.05 were considered to be significant.

A total of 60 patients were recruited for the study and randomized equally into two groups. One patient from the PRP group and two patients from the triamcinolone group did not come for the last follow-up (24 weeks). However, analyses were done for a total of 60 patients as per the ITT analysis protocol (See Figure 1).

The demographic data presented in Table4 reveals that both groups were similar in characteristics.There was no significant difference between both groups in the baseline characteristics, e.g., age, gender, the dominance of the affected side, duration of symptoms, and presence of diabetes mellitus. This revealed that patient variability was not present between both groups. Moreover, the inclusion and exclusion criteria were followed strictly during patient recruitment and randomization. Therefore, the possibility of patient variability in the study groups was negligible.

The patients with frozen shoulders were aged from 33 to 67 years. The incidence of the disease was higher in the fifth decade of life (46.67%). The mean age of the patients was 47.25 8.38 years (in triamcinolone and PRP treatment groups). The incidence of the disease was higher in females (58.33%) compared to males (41.67%). In the triamcinolone group, there were 56.67% females, while in the PRP group, there were 60% females.

Among 60 patients, 30 received prolotherapy (PRP injection) and 30 received triamcinolone injection for frozen shoulder. Table 5 represents the outcome analysis of both groups. In the first follow-up (four weeks), the mean VAS score in the triamcinolone group was 46.27 8.17 while it was in 51.70 6.02 in the PRP group. This significantly shows better improvement of pain with triamcinolone injection (p = 0.0048).

In the second follow-up (12 weeks), the mean VAS score in the PRP group was 43.23 4.01 while it was 31.83 10.31 in the triamcinolone group. This significantly showed better improvement of pain with triamcinolone injection (p = 0.0001) after 12 weeks. However, in the third follow-up (24 weeks), the mean VAS score in the PRP and triamcinolone groups was 14.33 3.79 and 31.63 7.62, respectively, which showed a significantly better improvement in the VAS score in the PRP group (p = 0.0001).

For DASH scores (see Table 5), after four weeks of injection, the triamcinolone group shows somewhat better improvement, although there was no significant difference in both groups (p = 0.069). After 12 weeks of injection, the PRP group showed somewhat better improvement, although no significant difference was found between the groups (p = 0.075). At the third follow-up (24 weeks), the mean DASH score in the PRP and triamcinolone groups was 18.08 8.08 and 31.76 3.63, respectively, which showed significant improvement in the DASH score in the PRP group (p = 0.0001).

Frozen shoulder or shoulder periarthritis is the most common cause of the gradual onset of pain and stiffness with loss of active and passive movement of the glenohumeral joint[16]. Various treatment modalities are used for the management of periarthritis, e.g., physiotherapy, intra-articular injections, oral and injectable corticosteroids, MUA, hydrodilation, and surgery[1,21]. Triamcinolone is a long-acting steroid with anti-fibrotic and anti-inflammatory properties[17]. This study compares the effect of intra-articular injections of triamcinolone versus PRP.

In this study, 60 patients with shoulder periarthritis with ages ranging from 33 to 67 years were included. The incidence of the disease was higher in the fifth decade of life (46.67%). The result was similar to previous studies[16,22]. The mean ageof the patients included in the study was 47.25 8.38 years. The prevalence rate of frozen shoulder is expected to be 2-5% of the population, with the peak occurrence in persons aged 40-60 years [11,23]. Our study reported a higher incidence(46.67%) of the diseasein the fifth decade of life.

Our study reported that periarthritis mostly occurred in female patients than males, which is similar to a previous study[7]. The side of the joint affected by periarthritis was higher on the non-dominant side. A total of 38 (63.33%) patients had affected joints by periarthritis on the non-dominant side. Moreover, the majority of the studies showed a higher prevalence rate on the non-dominant side[24]. About 45% of patients with periarthritis had diabetes mellitus as comorbidity, while 8.33% of patients had hypertension.

In our study, we assessed the VAS and DASH scores at baseline, 4th,12th, and 24th weeks. We found that the VAS score showed significant improvement in the triamcinolone group (p = 0.0048 and p = 0.0001, respectively) than in the PRP group at four and 12 weeks. The DASH score was reduced in both groups in the 4th week (p = 0.0699)and 12th week (p = 0.0752), but the improvement was statistically not significant. However, in a study by Barman et al., there was no significant difference at the end of three weeks after a single dose of PRP injection or steroid injection. However, PRP was found to be more effective than corticosteroid injection at 12 weeks in pain and disability score improvement[18].

At 24 weeks, both the VAS and DASH scores showed significant improvement in the PRP group to the triamcinolone group (p = 0.0001). Our result was similar to previous studies by Kothari et al. and Kumar et al. that assessed triamcinolone and PRP[16,17]. A case study by Aslani et al. in 2016 also reported good results with PRP in the frozen shoulder[25]. Evidence of PRP administration in periarthritis is continuously emerging[26,27]. In their systematic review, Griesser et al. reported that the use of steroidssignificantly improved theforward elevation and abductiontemporarily, as well as short-term and long-term pain reduction assessed through the Shoulder Pain and Disability Index (SPADI) and VAS scores[23]. Our study has added support to this growing technique.

The study showed that at the 12th week, both the steroid and PRP groups improved the VAS and DASH scores. However, the steroid group had a better outcome in the 12th week, while in the 24th week, the PRP group showed better outcomes.

Various studies have reported that the effect of steroids gradually decreases over a long-term follow-up. Blanchard et al. [28] compared the steroid injections and physiotherapeutic interventions for adhesive capsulitis and reported a good efficacy of corticosteroid injections in the short term (six weeks) and, to a lower magnitude, in the longer term (one year). Another study by Shah and Lewis [6] found that corticosteroid injections in adhesive capsulitis improved pain and range of motion for 6-16 weeks after the first injection. A systematic review that included 12 randomized controlled trials on using corticosteroids in adhesive capsulitis reported that the intervention was beneficial, although its effect was small and not well maintained [29]. It has been suggested that the efficacy of corticosteroids on periarthritis is exerted through anti-inflammatory properties and suppressing the granulomatous response in affected tissue which leads to clinical improvement.

In contrast, a study reported that PRP releases a pool of several growth factors (transforming growth factor-, platelet-derived growth factor, vascular and epidermal endothelial growth factor) which helps in tissue repair[18]. PRP also releases hepatocyte growth factor and tumor necrosis factor-alpha, which possess potent anti-inflammatory effects [30] In this study, long-term improvements in the PRP group could be explained by the fact that PRP might have effects on improving all phases of tissue repair, e.g., inflammatory, proliferative, and remodeling phases of capsular healing in periarthritis [18]. Based on the above discussion, it can be concluded that the effect of steroid injections lasts for a shorter period, while PRP injections might have a longer effect.

In this study, the standardized techniquefor PRP preparation was used and comparisons were done with the conventionally used treatment. The actual platelet count in obtained PRP was compared to the whole blood or baseline platelet count. All intra-articular injections were administered by a single experienced clinician.Evaluation of pain and disability outcomes was done at several time points over up to 24 weeks for high-quality evidence of the effect of PRP and corticosteroid injections. Despite the carefully designed protocol for the study, there are some limitations to this study. The study did not explore cost analysis. All stages of periarthritis were included in our study; therefore, further studies are needed to compare the effect of these interventions in different stages of periarthritis. This study was conducted on single injections of steroids and PRP as most of the studies on periarthritis were based on single intra-articular injections [29]. Moreover, this is a standard protocol followed in the institution and approved by the ethical committee. Studies exploring the effect of multiple injections need to be conducted in the future.

Intra-articular injections of PRP and triamcinolone for periarthritis are effective in reducing pain and disability scores in terms of VAS and DASH scores. The triamcinolone group showed a better effect in short-term outcomes (12th-week analysis) whereas PRP showed better results in long-term outcomes (24th-week analysis). A large sample size study to enhance the power of the study with robust design must be conducted in the future that compares single versus multiple injections as well as both steroid and PRP injections simultaneously.

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Comparison of the Efficacy of Platelet-Rich Plasma (PRP) and Local Corticosteroid Injection in Periarthritis Shoulder: A Prospective, Randomized,...

Platelet Rich Plasma and Its Use in Hair Regrowth: A Review

Abstract

Platelet rich plasma (PRP) was described as a small volume of plasma containing higher concentrations of platelets than those found in peripheral blood and initially used as a transfusion product for treatment of thrombocytopenia. To date, it was discovered that there are several growth factors and cytokines that can accelerate wound healing and tissue regeneration, leading to a wider range of applications in the medical field, such as in sport medicine, regenerative medicine, and aesthetic medicine. Several studies have shown that PRP can be used effectively for treatment of hair loss. Although it has been widely used, the exact mechanism of action of PRP is still not fully elucidated. In this article, we aim to review and update current information on the definition, classification, mechanism of action, clinical efficacy in hair regrowth, and adverse events of PRP.

Keywords: platelet rich plasma, androgenetic alopecia, female pattern hair loss, alopecia areata, cicatricial alopecia, hair transplantation

Platelet rich plasma (PRP) was first described in Hematology as a small volume of plasma containing higher concentrations of platelets than those found in peripheral blood and initially used as a transfusion product for treatment of thrombocytopenia since 1970.1 Nowadays, PRP has become a popular treatment for many conditions in sport medicine,2 regenerative medicine,2,3 aesthetic medicine4 and hair loss treatment5,6 as it contains a variety number of growth factors and cytokines that can accelerate wound healing and tissue restoration. Both the device used to separate platelets and the subsequent use of the PRP product fall under the regulation of the US Food and Drug Administration (FDA).7 Any use of PRP other than blood transfusion is an off label use which is not prohibited by the FDA regulation if performed by a physician with the intent to practice medicine. Despite its widely application, the mechanism underlying the hair regrowth effects of PRP remains to be fully explored. We aim to review the effectiveness of PRP as a treatment for hair loss including definition, classification, mechanism of action, clinical efficacy in hair regrowth, and adverse effects.

Platelet-rich plasma, also known as platelet-rich growth factors or platelet concentrate, is a concentrate of platelet-rich plasma protein derived from whole blood, centrifuged to remove red blood cells. In addition to the main component that contains high concentrations of platelets, there are also other components, such as, the presence or absence of leucocytes and platelet-activating agents, which used to define different types of PRP. The effectiveness of stimulating tissue regeneration depends on the concentration of platelets present in the plasma, several studies have shown that concentrations two to six times higher than normal platelet count is required for optimal outcomes.8

Due to the lack of a standardized method of preparation and application of PRP, there is a wide variety method of preparation. However, the main principle is to prepare concentrated platelets from the patients own blood. All PRP preparation protocols follow a generic method, started with collecting venous blood approximately 10 to 60 mL from the patient and placing it into tubes containing an Anticoagulant, either acid citrate dextrose or sodium citrate solution to prevent coagulation and premature secretion of the alpha granules. Subsequently, whole blood is centrifuged and divided into 3 layers based on specific gravity, the bottom layer contains red blood cells (RBCs) with leukocytes the middle layer is the PRP, and the top layer is platelet-poor plasma (PPP).9 There are several types of commercial PRP kits that simplify the PRP preparation. These kits differed in platelet concentrations, the presence of leukocytes and platelet activator leading to the diversity of growth factors concentration. All of these explain the variability in the clinical benefits of PRP reported in the literature. Some studies induced growth factor secretion and degradation of alpha granules by adding calcium gluconate, calcium chloride, or thrombin before administration (activated PRP). There is no consensus as to whether platelets must be activated exogenously or use host thrombin as endogenous activator in order to maximize the therapeutic effect.1012 The platelet alpha granules secrete growth factors within 10 minutes after clotting or activation, so PRP should be used within 10 minutes of activation for maximum benefits.13

There are many variations in PRP preparations, from the type of collection tubes, power used, the number of cycles and the duration of centrifugation, components of PRP and an activation method was applied. A standardized classification of PRP called DEPA was proposed by Magalon et al, based on four components: dose of injected platelets (baseline concentration of platelets at 200109/L), efficiency of the process (platelet recovery rate %), purity of PRP (relative composition in platelets %) and activation process,14 as shown in . From this classification, an AAA DEPA score is referred to a high-concentration platelet injection (>5 billion) with minimal red blood cell contamination and well prepared with a proper method resulting in minor loss of platelets from whole blood. The last category in the DEPA classification is reporting the presence or absence of any exogenous activator, such as thrombin or calcium chloride.

DEPA Score is Categorized in Order from A to D

Currently, many studies have demonstrated that platelets not only affect hemostatic system, but also affect inflammatory system, angiogenesis, stem cell induction, and cell proliferation through the release of many different growth factors and cytokines.1517 Activated platelets in PRP release numerous growth factors and cytokines from their alpha granules, including platelet-derived endothelial growth factor (PDGF), transforming growth factor (TGF-), fibroblast growth factor-2 (FGF-2), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insulin-like growth factor-1 (IGF-1), glial cell linederived neurotrophic factor (GDNF), which play a major role in stimulating hair growth through cell proliferation, differentiation and angiogenesis.1822 GDNF can stimulate cell proliferation and protect hair follicle from premature catagen transition.23,24 VEGF play a major role as a potent hair growth stimulator via an angiogenesis induction.25,26 While IGF-1 stimulates proliferation of cycling Ki67+ basal keratinocytes, induce and prolong the anagen phase of the hair growth cycle.2729 In addition, PRP can induce the proliferation of dermal papilla (DP) cells by activating extracellular signal-related kinase (ERK), fibroblast growth factor 7 (FGF-7), beta-catenin, and Akt signaling (an anti-apoptotic signaling molecule). There is also an increase in expression of Bcl-2 protein (an anti-apoptotic protein) in vitro human dermal papilla cells cultured with PRP. Thus, it was clearly illustrated that PRP can increase the survival of hair follicle cells through anti-apoptotic effects and stimulate hair growth by extending the anagen phase of the hair cycle.30 This theory was further supported by the results of microscopic examination which demonstrated an increase in number of follicular bulge cells, hair follicles, epidermal thickening, vascularization, and a higher number of Ki67+ basal keratinocytes in PRP-treated scalp tissue compared with placebo.31

Although PRP is a safe treatment with minimal side effects, there are some contraindications that need to be considered. Absolute contraindication for PRP include critical thrombocytopenia, platelet dysfunction, hemodynamic instability, sepsis, local infection (site PRP) and patient with unwilling to accept risk. Relative contraindications include NSAIDs use in 48 hours, glucocorticoid injection at treatment site within one-month, systemic glucocorticoid within 2 weeks, recent illness or fever, cancer especially bone or hematolymphoid, anemia (hemoglobin less than 10 grams per deciliter), thrombocytopenia (platelets less than 150,000 per microliter) and tobacco use.32

Androgenetic alopecia (AGA) is a non-scarring alopecia characterized by a shortened anagen phase and progressive miniaturization of terminal hairs into vellus hairs.33 This condition is found in approximately 50% of Caucasian men by the age of 50 years, and in women, it can be as much as 50% over the course of their lifetime.34 In men, baldness started with frontal recession and thinning of hair on vertex area (MPHL), while in women, hair loss is characterized by less hair density and smaller hair shaft diameter over the crown without frontal hairline recessions (FPHL). FDA has approved oral finasteride (for men only) and topical minoxidil for the treatment of AGA.35

A meta-analysis from six studies (four studies were randomized controlled trials, while the other two were retrospective studies) involving 177 patients, showed a significant increase in number of hairs per cm2 after PRP injections compared to control (mean difference (MD) 17.90, 95% CI 5.8429.95, P=0.004) and the tendency to increase in number of hairs and the percentage of hair thickness.36 Similar result was confirmed by another two meta-analysis studies which showed a significantly increased hair numbers per cm2 after PRP injections in the treatment group versus the control group with MD 38.75, 95% CI 22.2255.28, P <0.00001 and MD 30.35, 95% CI 1.7758.93, P <0.00001, respectively.37,38 Compared to minoxidil, finasteride, and adult stem cell-based therapy, 84% of all studies reported a positive effect of PRP, 50% demonstrated a statistically significant improvement while 34% showed hair density and hair thickness improvement, although no P values or statistical analysis was described.39

Despite several clinical trials showed the success of PRP therapy in AGA, there is no standard practice for PRP preparation and administration as well as a method to evaluate results. Attempts have been made to standardize PRP treatment for AGA patients. A standard PRP procedure was proposed by Stevens et al, employing a single spin centrifugation method to produce pure PRP with a platelet enrichment of 3 to 6 times the mean concentration of whole blood and adding a platelet activator such as calcium chloride or calcium gluconate before administration of PRP as subdermal injections. Treatment intervals should include monthly sessions for the first 3 months, then every 3 months for the first year.27

However, there is still debate in the literature about the standardization of PRP preparation. A split scalp prospective comparative clinical study included 15 females with AGA was performed by intradermal injection of double-spin prepared PRP into the right half of the scalp and single-spin prepared PRP into the left half of the scalp of each patient for three treatment sessions, 3 weeks apart. Results showed clinical improvement in both sides of scalp while hair density measured by trichoscan revealed that the right half of the scalp was significantly higher in median terminal hair density than the left half (P=0.031), which illustrated that double-spin method could yield better results than single-spin method.40 In addition, there was a comparative study demonstrated that patients treated with non-activated PRP were found to have greater increase in hair count and total hair density (31% 2% versus 19% 3%, P= 0.0029) than patients treated with activated-PRP, leading to the conclusion that PRP does not require activation before injection.31

The important factors that affect the effectiveness of PRP is the number of platelets. Higher numbers of platelets have a greater effect than lower numbers of platelets in terms of hair density, follicle diameter, and terminal hair density.41 In AGA, action of dihydrotestosterone on dermal papilla cells suppressed canonical WNT signaling, resulting in defective hair growth and retarding hair cycling. PRP promoting hair growth by activating WNT/-Catenin signaling lead to proliferation and differentiation of hair follicle cells and triggering new hair cycle.42

Some studies have reported ineffectiveness of PRP in AGA treatment, which may be caused by low platelet concentration, low volume of PRP injected, and inadequate frequency of treatment.9 The treatment response to PRP in AGA patients can be predicted by measuring pro-inflammatory cytokine IL-1 polymorphism from peripheral blood. A study has reported significantly higher frequency of C/C genotype of IL-1 in responder (66%) than in non-responder patients (22%) with odds ratio (OR) 6.68, 95% CI 0.9972.95 (p<0.05).43

Evidence from randomized controlled trials of PRP in AGA is summarized in .

Randomized Controlled Trials of PRP in Male Androgenic Alopecia

Female pattern hair loss (FPHL) is the most common cause of hair loss in middle-aged women, characterized by progressive follicular miniaturization and conversion of terminal follicles into vellus-like follicles, leading to a decrease in hair density, thinning of hair and diffuse non scarring alopecia especially in the central, frontal and parietal regions of the scalp. The cause of this problem is unknown, but it is related to genetics, hormones, and environmental conditions.49

A systemic review study evaluating the efficacy of PRP in the treatment of FPHL comprising 92 patients from 6 randomized controlled clinical trials showed that PRP has a positive effect on FPHL treatment by increasing hair thickness and hair density.50 Recently, two meta-analysis studies have confirmed the efficacy of FPHL treatment with PRP. The first study consisted of 776 female participants covering 16 randomized controlled trials and 26 observational trials, demonstrated that PRP has a good therapeutic effect on FPHL in hair density compared to the control groups with OR 1.61, 95% CI 0.522.70, and compared to baseline with OR 1.11, 95% CI 0.861.37.51 The second study from 8 clinical studies and a total of 197 subjects showed a significant increase in hair count and hair diameter in 4 studies after PRP treatment. Moreover, PRP has been shown to produce high levels of satisfaction and improvement in the quality of life in patients affected by FPHL.52

Differences in the treatment efficacy for AGA with PRP between men and women was discovered by a meta-analysis study, which revealed that PRP significantly increased both hair density (N = 250, MD = 25.83, 95% CI: 15.4836.17, P < 0.00001) and hair diameter (N = 123, MD = 6.66, 95% CI: 2.3710.95, P = 0.002) in men while significantly increased hair diameter (N = 95, MD = 31.22, 95% CI: 7.5254.91, P = 0.01), but did not increase hair density (N = 92, MD = 43.54, 95% CI: 1.3588.43, P = 0.06) in women.53 However, PRP effectiveness in the treatment of AGA is influenced by gender is still controversial because of the differences in several reports listed, many of the analyzed studies were non-randomized, uncontrolled, and had small sample size.

Evidence from randomized controlled trials of PRP in FPHL is summarized in .

Randomized Controlled Trials of PRP in Female Pattern Hair Loss

Alopecia areata (AA) is a common autoimmune disorder that causes nonscarring alopecia in males and females at any age. The estimated lifetime risk of AA is around 2% of population, with no difference in incidence between genders. Most patients have only one lesion of alopecia and spontaneous hair regrowth can occur within months to years. However, there are many patients who may develop multiple lesions and turn into chronic hair loss.58

PRP was discovered to have a potent anti-inflammatory effect. It suppresses cytokine release and decreases local tissue inflammation, which makes PRP potentially beneficial in treating inflammatory hair loss such as AA.59,60 PRP was initially tested in patients with AA by a randomized, double-blind, placebo controlled, half-head study. Forty-five patients with AA were randomized to receive intralesional injections of PRP or triamcinolone acetonide or placebo on one half of their scalp, while the other half was untreated. The results showed that PRP significantly increased hair regrowth and Ki-67 level (marker for cell proliferation) compared with triamcinolone acetonide or placebo injection.61 Collectively, many randomized controlled trials demonstrated that treatment with PRP can stimulate hair regrowth to the same extent as intralesional injection of triamcinolone acetonide in the treatment of AA.6265 Two recent studies compared the therapeutic effect of intralesional injections of PRP with triamcinolone acetonide in AA. One study found that final severity of alopecia tool (SALT) score showed significant lower levels in both groups compared to baseline levels (P = 0.025 and P = 0.008) with no significant difference between both treatment modalities in term of clinical improvement, while final alopecia areata symptom impact scale (AASIS) showed significant decrease in PRP group (P = 0.006) but not in triamcinolone group (P = 0.062).62 Similar results were found in the other study by showing that there was no statistically significant difference in SALT score reduction and hair regrowth scale between these two groups.63

On the contrary, different results were found in three randomized controlled clinical trials which demonstrated that PRP was significantly less effective than intralesional steroid injection based on Mac Donald Hull and Norris grading system, percentage of hair regrowth and reduction in SALT score from baseline, respectively.6668 All these results could explain that steroid is more potent than PRP in terms of having immunosuppressive and strong inhibitory effect on T lymphocyte activation.

A beneficial effect of combination therapy with PRP was reported in a patient with long standing AA treated with a combination of intralesional injection of triamcinolone acetonide and PRP in one half of the scalp while the other half of the scalp was treated with intralesional triamcinolone acetonide only. The half head treated with the combined therapy showed greater hair regrowth and larger hair fiber diameter.69 Furthermore, there was a prospective study on the efficacy of PRP treatment in 20 cases of chronic AA who had not responded to conventional therapy for 2 years, demonstrated that all patients with chronic AA were successfully treated with PRP, only one patient had a relapse after one year of follow-up.70 The successful treatment with PRP was also reported in a patient with corticosteroid-resistant ophiasis AA who experienced hair regrowth after PRP injections71 and a patient who suffering from alopecia areata barbae.72 Hence, PRP can be used as an alternative therapy in patients unresponsive to conventional therapy or patients who do not want to be treated with steroids and can also be used as an adjuvant therapy for alopecia areata.

Evidence from randomized controlled trials of PRP in AA is summarized in .

Randomized Controlled Trials of PRP in Alopecia Areata

Cicatricial alopecia is a type of scarring alopecia, caused by different inflammatory conditions, physical trauma, burn, or severe infections that lead to the destruction of the hair follicles and subsequent scarring. The goal of treatment is to stop the disease progression, prevent further hair loss and scarring by using different anti-inflammatory drugs, such as topical steroid, intralesional triamcinolone acetonide injection and immunomodulating agents. However, there is no effective treatment to stimulate hair regrowth in fibrotic area.73

Frontal fibrosing alopecia (FFA), a variant of lichen planopilaris, is currently the most common type of cicatricial alopecia characterized by progressive recession of the frontal and temporoparietal hairline along with perifollicular erythema and papules leading to band-shaped scarring alopecia in the frontotemporal area.74 The satisfactory treatment outcome with five consecutive PRP injections was reported in a 44-year-old female with FFA, who had a history of unresponsive to conventional intralesional steroid therapy. Only one month after treatment, perifollicular erythema, scaling, and lichenoid papules on the frontotemporal hairline were improved, and no further hair loss was seen after 5 months.75

Lichen planopilaris (LPP) is a chronic inflammatory scarring alopecia characterized by follicular hyperkeratosis, perifollicular erythema, and loss of follicular orifices on vertex and parietal area of the scalp. Bolana et al have reported for the first time the efficacy of PRP therapy in a case of LPP diagnosed by histopathology and unresponsive to any previous treatments. After 3 consecutive treatments of PRP and followed up for 6 months, patients experienced complete regression of scalp itching and hair shedding, confirmed by undetectable perifollicular erythema and scaling on trichoscopic examination.76 Subsequently, two patients with central centrifugal cicatricial alopecia (CCCA) and one patient with LPP were reported on the success of PRP treatment, resulting in a significant increase in hair density despite a history of unresponsiveness to conventional therapy before.77,78

Effective treatment of cicatricial alopecia with PRP is possible due to various cytokines and growth factors such as TGF, TGF1 in platelet granules, which have anti-inflammatory and proangiogenic effects.79 Although there is evidence that PRP can be used as an effective treatment for some types of cicatricial alopecia, more clinical trials are needed to produce further evidence.

Several studies have shown a beneficial effect of using PRP in combination with hair transplantation. The first report was an experimental study in a group of 20 patients with male pattern baldness demonstrated a 15% greater hair yield in follicular unit density in areas pretreated the harvested donor with platelet plasma growth factors obtained from the patients autologous plasma as compared with normal saline (18.7 follicular units per cm2 vs 16.4 follicular units per cm2).22 Similar results were found in another two studies, the first was a comparative study showed that transplanted follicular unit grafts in conjunction with platelet lysate (PL) or activated PRP (AAPRP) resume growth faster than normal saline at 4 months after operation, 99%, 75%, and 71% of follicle regeneration had occurred in the PL, AAPRP, and saline treatment areas, respectively.80 The second was a randomized controlled study demonstrated that preserving hair grafts in PRP before implantation enhances the hair density, the graft uptake, and the hair thickness compared with preserving in normal saline.81

Furthermore, PRP can also be used as a combination treatment with the follicular unit extraction (FUE) hair transplantation as shown in a single-blind, prospective randomized study in 40 FUE hair transplant patients. The patients were divided into two groups, PRP was injected intra-operatively immediately after creating slits over the recipient area in PRP group while normal saline was injected in non-PRP group. It was clearly seen that intra-operative PRP therapy is profitable in giving significantly improved density and quality of hair growth, reducing the catagen loss of transplanted hair, early recovery of the skin and faster appearance of new anagen hair in FUE transplant patients.82 Thus, PRP is not only an effective hair loss treatment, but it can also be used as an adjunct to hair transplantation.

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Platelet Rich Plasma and Its Use in Hair Regrowth: A Review

What Is the Appropriate Price for Platelet-Rich Plasma Injections for …

Purpose: To identify the price of treatment at which platelet-rich plasma (PRP) is cost-effective relative to hyaluronic acid (HA) and saline solution intra-articular injections.

Methods: A systemized review process of the PubMed, Embase, and MEDLINE databases was undertaken to identify randomized controlled trials comparing PRP with HA and saline solution with up to 1 year of follow-up. Level I trials that reported Western Ontario and McMaster Universities Arthritis Index Likert scores were included. These scores were converted into utility scores. Cost data were obtained from Centers for Medicare & Medicaid Services fee schedules. Total costs included the costs of the injectable, clinic appointments, and procedures. The change in utility scores from baseline to 6 months and 1 year for the PRP, HA, and saline solution groups was divided by total cost to determine utility gained per dollar and to identify the price needed for PRP to be cost-effective relative to these other injection options.

Results: Nine randomized controlled trials met the inclusion criteria. A total of 882 patients were included: 483 in the PRP group, 338 in the HA group, and 61 in the saline solution group. Baseline mean utility scores ranged from 0.55 to 0.57 for the PRP, HA, and saline solution groups. The 6-month gains in utility were 0.12, 0.02, and -0.06, respectively. The 12-month gains in utility from before injection were 0.14, 0.03, and 0.06, respectively. The lowest total costs for HA and saline solution were $681.93 and $516.29, respectively. For PRP to be cost-effective, the total treatment cost would have to be less than $3,703.03 and $1,192.08 for 6- and 12-month outcomes, respectively.

Conclusions: For patients with symptomatic knee osteoarthritis, PRP is cost-effective, from the payer perspective, at a total price (inclusive of clinic visits, the procedure, and the injectable) of less than $1,192.08 over a 12-month period, relative to HA and saline solution.

Level of evidence: Level I, systematic review.

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What Is the Appropriate Price for Platelet-Rich Plasma Injections for ...

How to Stop and Regrow a Receding Hairline – Shine My Crown

Hair loss and thinning typically come with age, but dealing with it can be beyond frustrating, especially when it shows up in areas that are difficult to hide.

While its true that hair loss impacts men more than it does women, over 50% of us gals suffer from it. So, if you think you have a thinning hairline, you are far from alone.

Nevertheless, if youre reading this, chances are you are not in search of some song and dance on self-acceptance at the momentyou want solutions.

Well, friends, youve come to the right place; from quick fixes to long-term help, you have options.

First Things First

Before you develop a regimen to address a thinning hairline, its best to seek the assistance of a board-certified dermatologist, to identify the source of why youre losing your hair. Potential underlying causes vary and will often dictate future courses of action.

The Quick Fixes

1. Camoflage it.

In many cases, the fastest way to treat a thinning hairline is to create the illusion of a fuller one. Sprays, powders and hair fibers are great to use in a pinch and those on todays market are easy to use and offer a natural finish. Theyre also great for covering up grays. Our faves:

2. Tweak your partings.

Small changes like playing with your part (opt for blurred zig-zag partings over clean straight ones) or directing hair to one side to create added weight work wonders for creating lift and fullness at the roots.

3. Ease up on the styling.

Prolonged pulling, tight styling and chemical abuse can cause traction alopecia, one of the main causes of a receding hairline.

Long-Term Options

1. Medication

Cost: prices vary, based on medical plans

If your diagnosis is androgenetic alopecia (male or female pattern baldness) topical treatments such as minoxidil (Rogaine) or spironolactone (offsets the effects of testosterone) can help to encourage hair growth.

In addition, oral contraceptives like Yaz and Yasmine or oral finasteride (Propecia) are recommended by doctors, but they can help you to decide which is right for you.

2. Scalp Botox

Cost: $1000

If you suffer from genetic alopecia, Botox might work for you. Doctors prescribe it to treat receding hairlines and other forms of hair loss for its muscle-relaxing qualities. The injections relax the muscles in the scalp which allows more blood flow and hair growth.

3. Hair Transplantation

Cost: $4,000 to $15,000

A more permanent option, doctors harvest hair from donor areas and move it to a receding scalp. You need not worry about that dreaded plug appearance of years past; todays results are natural-looking.

4. Hairstim

$60.00 per month

When you arent seeing any results with topical hair loss treatments, but do not want to take oral medications, Hairstim is a viable option. Doctors create personalized prescription hair medications, by using ingredients that arent readily available. It is definitely worth exploring with your dermatologist.

5. Platelet-rich Plasma

$500 to $1,200 per treatment

PRP is a hair loss treatment that stimulates hair growth through the use of the patients own blood plasma. The plasma contains white blood cells and platelets, which are rich in what are known as growth factors.

PRP requires regular, ongoing treatments (about every four to six months), so it is a major commitment of time and money, but definitely worth exploring with your doctor if youve got the cash.

There are no one-size-fits-all solutions to treating a receding hairline, so if you notice a change, always check with your board-certified doctor before tackling the issue on your own. If you need a doctor, start here.

Good luck!

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How to Stop and Regrow a Receding Hairline - Shine My Crown

We Are Taking it to the Next Level – Magazine of Santa Clarita

Valencia Medical Center is Now Offering Regenerative & Aesthetic Medicine Training to Physicians & Medical Practitioners Valencia Medical Center is one of the pioneer centers in Regenerative Medicine and Platelet-Rich Plasma Therapy (PRP) for the following: Joint pain injuries of knee, shoulder and elbow Osteoarthritis and inflammation Our highly concentrated PRP injections guided by Ultrasound Imaging with needle recognition capability, has given our patients an opportunity to enjoy life pain-free. We are also offering advanced PRP Hair restoration, PRP Penile shots and Acoustic Wave Therapy for Erectile Dysfunction (ED) and PRP Vaginal shots for women. High success rate and patients satisfaction along with weekly Live at Five with our doctor on our social media accounts, has won us patients loyalty. Due to high demand and our expertise in the advancement in the field of regenerative medicine, Valencia Medical Center & Ageless Life Institute successfully launched a Regenerative and Aesthetic training back in March 2022. It was a privilege to provide this type of training for our medical community and physicians worldwide. For more information, please contact us at 661-222-9117.

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We Are Taking it to the Next Level - Magazine of Santa Clarita

A Prospective Multicenter Study to Evaluate the Safety and Efficacy of the Topical Application of MYOWNN, an Autologous Growth Factor Concentrate…

Background

Growth factors from platelets have been emerging as a revolutionary treatment with the ability to induce cell growth in the skin, which results in retarding and reversing the aging process. Platelet-rich plasma (PRP) allows for greater release of growth factors and biologically active proteins, which in turn activates the cascade of stimulation of neoangiogenesis and collagen production. PRP is used in anti-aging and facial skin rejuvenation in the form of dermal injections and topical application during micro-needling. This study was conducted to assess the safety and efficacy of a topically applied face serum, MYOWNN (Wockhardt Ltd., Mumbai, India). MYOWNN is an autologous growth factor concentrate that has been made into a topical face serum.

Male and female subjects in the age group between 30 and 55 years (both inclusive) with Fitzpatrick skin type III-V who had not taken any oral or topical treatments for at least four weeks before and any platelet-rich plasma (PRP) based facial treatment (injections) at least six months before the study entry were included. MYOWNN serum was applied on the face once daily at night, approximately 30 minutes before sleeping preferably, for a total duration of five months. Six parameters, i.e. spots, pores, wrinkles, texture, moisture, and pigmentation, were evaluated at regular intervals with Visage-LS (dermaindia, Tamil Nadu, India), a face analysis system that gives the live status of these six parameters and is an advanced live status skin detection equipment together with shooting, analyzing, and displaying functions, as well as the subjective analysis, was performed by subjects and physicians using different globally accepted scales like physicians global aesthetic improvement scale (PGAIS), subjects global aesthetic improvement scale (SGAIS), subject satisfaction score (SSS), and wrinkle severity rating scale (WSRS). For analysis, a mixed model for repeated measures was used. The model had change from baseline as the dependent variable visit as a factor and baseline assessment result as a covariate. All primary and secondary efficacy endpoints were analyzed using Modified Intent-to-Treat (mITT) populations.

Improvement in an average of six anti-aging parameters was observed as early as three months while statistically significant improvement was observed by the end of five months of application. A statistically significant improvement in wrinkles was observed by the end of three months of the application itself. There were no product-related adverse events reported.

Five months of application of MYOWNN serum showed a statistically significant improvement in an average of six parameters of anti-aging and face rejuvenation with a p-value of 0.0150 (<5% level of significance (i.e. 0.05) and was also well-tolerated.

The skin fulfills a large range of functions, including the prevention of percutaneous water loss, temperature maintenance, sensory perception, and immune surveillance [1]. Moreover, skin health and appearance play crucial roles in self-esteem and social interactions [2].

Environment factors, such as sun exposure, smoking, and air pollution, as well as intrinsic factors like advancing physiological processes and poor nutrition, leadto skin aging, resulting in gradual dermal atrophy, fine and coarse wrinkles, and dry skin with loss of laxity, elasticity, and rough texture. Both the extrinsic and intrinsic factors contribute to skin aging with photoaging, i.e. long exposure to UV radiation is the primary factor of extrinsic skin aging [3-4].

Aging reduces the basal layer cell proliferation and leads to thinning of the epidermis, resulting in the reduction of the contact area between the epidermis and dermis, which reduces the nutrition of the epidermis. The inadequate nutrition weakens the ability of cells of the basal layer to proliferate [5-6]. In addition, the dermis of photo-protected aged skin shows not only fewer mast cells and fibroblasts than photo-protected young skin but also rarefied collagen fibers and elastic fibers [7].

Photoaging accounts for about 80% of facial aging [8], but it also causes epidermis thickening, which is in contrast to intrinsic factors, i.e. thinning of the epidermis leading to skin aging [9].

PRP has received extensive attention in recent years in different conditions like tissue regeneration, wound healing, scar revision, and alopecia, including skin rejuvenation [10]. The effects reported by the use of PRP are due to the presence of growth factors present in the platelets, which are released on activation.

Growth factors are derived from a subjects whole blood. The blood is spun down in a centrifuge, which allows the red blood cells to be removed [11]. Most systems require a second centrifuging step to create the final product. Once the red blood cells are removed, the remaining plasma is again centrifuged, which allows the platelet-rich layer to be extracted, which is then activated with thrombin or calcium chloride. This activation step causes the platelets to begin releasing growth factors like vascular endothelial growth factor (VEGF) and fibroblast growth factor-2 (FGF-2), which enhances revascularization and angiogenesis, whereas collagen synthesis is believed to be stimulated by transforming growth factor-beta (TGF-). Other growth factors like epidermal growth factor (EGF), insulin-like growth factor (IGF), and platelet-derived growth factor (PDGF) are also released.

PRP treatment achieved a faster wound healing rate in rabbits [12]compared to normal saline using Wockhardts Growth Factor Concentrate (Wockhardt Ltd., Mumbai, India) in excised wound model in diabetic and nondiabetic rats, whichdemonstrated better healing and contraction of the wound [13]. Significant improvement was observed in soft tissue healing in oral surgery by autologous PRP application [14]. The ability of autologous platelet gel (APG) to facilitate the proliferation of endothelial cells was confirmed by in vitro experiments [15]. PRP is expected to have a positive effect on facial rejuvenation and anti-aging due to its ability to facilitate collagen production, fibroblasts proliferation, and hyaluronic acid generation to increase dermal elasticity and keratinocyte proliferation [16-17].

Most of the PRP used for skin rejuvenation or anti-aging is injectable. Most of the PRP treatments on the face for rejuvenation are actually subdermal injections and very few topical PRP with GFC applications have been studied. Topical GFs can cross the skin barrier and bind to cell surface receptors, which trigger a signaling cascade and stimulate keratinocyte proliferation.

To obtain the maximum benefit from growth factors, it is usually thought that platelets should be maximally concentrated; however, if WBCs are simultaneously concentrated in the platelet fraction, the positive effects of growth factors may be reduced. Several studies demonstrate that the presence of WBCs and RBCs are detrimental to the healing effects demonstrated by the released growth factors. Most commercially available PRP preparation kits do not remove RBCs and WBCs and therefore do not harness the use of an acelluar growth factor solution that has several advantages. The Wockhardt process derives acellular growth factors from the subjects own blood.

Wockhardts Autologous Growth Factor Concentrate (AGFC), MYOWNN, is a topical application of essentially plasma that has been processed to contain a high concentration of platelets and growth factors but has an advantage over traditional PRP in that it is acellular and growth factor rich, i.e. without red blood cells (RBCs) and neutrophils which may cause pain and inflammation post-treatment. This study was designed to assess the safety and efficacy of a topically applied face serum - MYOWNN for anti-aging and facial rejuvenation.

This study was conducted in accordance with globally accepted standards of Good Clinical Practice (GCP) (as defined in the ICH E6 Guideline for GCP), in agreement with the Declaration of Helsinki, and in keeping with local regulations. Ethics committee approvals were obtained from Wockhardt Hospitals Institutional Review Board (ECR/624/Inst/MH/2014/RR-17) and Cutis Institutional Ethics Committee (ECR/930/Inst/KA/2017/RR-20).

In the format of an open-label study, 50 subjects (26 female and 24 male) seeking facial skin rejuvenation with Fitzpatrick skin type III-V [18] who have not taken any oral or topical treatments for at least four weeks before and any PRP-based treatment (injections) at least six months before the screening visit were recruited from two centers in India. Exclusion criteria were active acne, platelet count less than 150,000 l, known history of bleeding disorders or hemoglobinopathies, or history of systemic disease resulting in an immunocompromised state affecting the ability to heal soft tissue. Complete details of the study procedure were presented to all the subjects and written consent was obtained.

For subjects who met the eligibility criteria and agreed to participate in the study, the facial assessment was done using Visage-LS (dermaindia, Tamil Nadu, India) and a face analysis system; bloodwas collected for AGFC serum preparation. Demographic information, vital signs, and laboratory investigation were done to evaluate eligibility and safety during the study. Before application of the serum, subjects were instructed to wash their face, and if dryness was felt on the face, they were allowed to apply a moisturizer at least 20 minutes before the application of AGFC serum. However, in the case of oily skin, the use of a moisturizer was not recommended. Subjects were asked to apply a sunscreen lotion (at least 30 SPF) every three to four hours during the daytime for the entire study period. Subjects were instructed to avoid all kinds of cosmetic products, spa visits, any other facial treatment, and excessive exposure to sunlight during the study.

Blood collected for AGFC preparation was sent to Wockhardts processing facility in break-proof packaging. Blood vacutainers were centrifuged to separate platelets and then activated by the Wockhardt proprietary activator to get growth factor concentrate (GFC), which was extracted from the blood. Extracted GFC was transferred aseptically into sterile glass containers, which were then loaded in the lyophilizer. The lyophilization of GFC involved three basic steps, i.e., freezing, primary drying (sublimation), and secondary drying. Lyophilized GFC was then reconstituted with carrier serum and the Wockhardt proprietary permeabilizing agent to get the finished product. The finished product was shipped at 2-8C to the study sites for a further dispensation to the subjects.

AGFC serum was dispensed to the study subject for daily application. The subjects were instructed to do a local application on the face once daily at night, approximately 30 minutes before sleeping, preferably. The dispensed preparation was sufficient for topical application on the face once daily at bedtime for three months. At the end of 3 months, subjects were re-consented to evaluate their willingness to participate for additional 2 months i.e. till the end of five months. Out of 50 subjects, 36 agreed to participate for an additional two months and provided blood for AGFC preparation.

All these subjects were followed up on a monthly basis till Month 3 and subjects who agreed to a re-bleed were followed till Month 5. At each monthly visit, subjects were evaluated for adverse events, concomitant medications, general facial examination, vital examination, treatment compliance since the last visit, and a facial assessment by the face analysis system. Objective analysis was performed by Visage-LS, a face analysis system, which is an advanced live status skin detection equipment together with shooting, analyzing,and displaying functions. It adopts theRGB (Red Blue Green), ultraviolet (UV), and polarized light (PL 3) spectrums combined with artificial intelligence and image analysis technology. It gives the live status of spots, pores, moisture, textures, wrinkles, and pigmentation. Subjective analysis was performed by globally accepted and validated scales like physicians global aesthetic improvement scale (PGAIS), subjects global aesthetic improvement scale (SGAIS), subject satisfaction score (SSS), and wrinkle severity rating scale (WSRS). PGAIS and SGAIS were scored from 1 to 5, with 1 being much worse, 2 being worse, 3 being no change, 4 being improved, and 5 being much improved. WSRS was scored from 1 to 5, with 1 being absent, 2 being mild, 3 being moderate, 4 being severe, and 5 being extreme. SSS were scored from 1 to 6, with 1 being very dissatisfied, 2 being dissatisfied, 3 being somewhat dissatisfied, 4 being somewhat satisfied, 5 being satisfied, and 6 being very satisfied.

All statistical analysis was carried out using the SAS software, Version 9.4 (SAS Institute Inc., Cary, NC). The primary efficacy endpoint was computed as the average of six skin anti-aging parameters (spots, pores, wrinkles, texture, moisture, and pigmentation) measured by the face analysis system (Visage-LS). The secondary efficacy endpoints were the individual skin anti-aging parameters (spots, pores, wrinkles and texture, moisture, and pigmentation) from the face analysis system, PGAIS, SGAIS, SSS, and the photographic assessment (using the WSRS scale).

A mixed model for repeated measures was used for this purpose. The model had change from baseline as the dependent variable visit as a factor and baseline assessment result as a covariate. All primary and secondary efficacy endpoints were analyzed using modified Intent-to-Treat mITT populations.

Out of the 50 subjects who were enrolled, 26 were female and 24 were male. The patients average age was 40 years, ranging from 30 to 55 years with a standard deviation of 8.62 years. According to the Fitzpatrick scale, 14 subjects (28%) had type III skin, whilst 27 patients (54%) had type IV and nine patients (18%) had type V skin.

A total of five adverse events were reported during the study and none of these events were considered related to study treatment. These adverse events were erythema, hypothyroidism, coronavirus disease (COVID) infection, and two events of acne. There were no serious adverse events or treatment-related adverse events reported during the study, as well as no adverse events leading to study discontinuation.

The results were analyzed from 47 subjects for Month 3 and 33 subjects for Month 5 who met the criteria for the mITT population. The mITTpopulation included subjects who used at least one dose of study medication and had at least one post-baseline efficacy assessment.

On statistical evaluation in the mITT population, there was a statistically significant percentage change in an average of six skin anti-aging parameters (spots, pores, wrinkles, texture, moisture, and pigmentation) from baseline to Month 5. The improvement in percentage change in an average of six skin anti-aging parameters started right from Month 3 (p-value of 0.1047) but significant improvement was seen by Month 5 (p-value of 0.0150) (Table 1).

A statistically significant percentage change in individual skin anti-aging parameters like moisture, texture, and wrinkles was also visible at Month 5 (with p-values of 0.0006, 0.0054, and 0.0007, respectively) (Table 2).

At the end of Month 5, the PGAISmaximum score of 4 or 5, i.e. improved or much improved, respectively, was reported in 100% of the cases (Figure 1), and on similar lines, the subjects also rated the SGAISas the maximum score of 4 or 5, i.e. improved or much improved, respectively, in 100% of the cases (Figure 2).

The subjects were asked to rate their satisfaction with SSS, whereupon at the end of Month 5, it was found that 12.12% of subjects were somewhat satisfied with the treatment, 84.85% subjects were satisfied, 3.03% subjects were very satisfied with the treatment, and none of the subjects were dissatisfied (Figure 3).

On an assessment of WSRS, it was found that at least one point improvement in wrinkles was seen in 14.89% of cases at the end of Month 3, which improved to 37.5% and 48.48% at the end of Months 4 and 5. respectively (Table 3, Figure 4). Photographic improvement from baseline to the end of Month 5 is depicted in Figure 5.

Sensitivity analysis was also done to assess the efficacy parameters for the skin anti-aging parameters in subjects with age more than 50 years in the mITT population. The median percentage change from baseline to Month 3 (Day 105) was 4.1 compared to the median change in the overall population of 3.5, whereas the median percentage change from baseline to Month 5 (Day 165) was 7.3 compared to the median change seen in the overall population of 5.0. For the individual parameters like texture and wrinkles similar to the overall population and the trend in the median percentage change from baseline to Month 3 (Day 105) and Month 5 (Day 165) was seen. A statistically significant percentage change was seen in wrinkle parameters at Month 5 (p-value=0.0274) even with the small size (N=6) of this age population. For PGAIS and SGAIS assessment, at Month 5 (Day 165), all patients (6 (100.0%) of 6 patients) reported scores of 4 and 5. As per SSS, all patients were satisfied with the treatment at Month 3 (Day 105) and Month 5 (Day 165). For WSRS, at Month 5, five (83%) of six patients had scores between 1 and 3 and one (16.67%) of six patients had a score of 4; none of the subjects reported a score of 5.

Environmental factors and aging damageour skinand self-rejuvenation of the skin is supported by intrinsic growth factors that are generated by our own cells. As compared to young skin, aging skin generates fewer growth factors, which deems it necessary for the regular use of skin-care products with growth factors with the advancement of age basically to reduce the appearance of aging parameters like wrinkles, texture, fine lines, and tone[19].

The effects of three PRP injections over the course of 12 weeks were assessed on infraorbital wrinkles and skin tone in Asian subjects in a split-face study; this study showed significant improvement in both wrinkles and skin tone in infraorbital skin [20]. Dermaroller application of PRP over the subjects malar area and forehead along with PRP injection into the wrinkles of crows feet biweekly for three times showed a statistically significant difference in skin firmness, wrinkles, and general appearance according to the grading scale of the patients before and after three PRP applications, whereas per the dermatologists, a statistically significant difference was seen only in skin firmness-sagging [17].

A limited number of controlled studies have been conducted to demonstrate that topically applied GFs can stimulate collagen synthesis and epidermal thickening, which is associated with clinical improvement in signs of photoaging. Also, very few studies have used objective analysis face systems to demonstrate improvement with the use of AGFC.

In this study, both an objective analysis with a face analysis system like Visage-LS, as well as a subjective analysis with different globally accepted scales like PGAIS, SGAIS, SSS, and WSRS was performed with topical application of AGFC.

In this open-label study, daily local application of AGFC over the face for three or five months showed a significant improvement in the average of six skin anti-aging parameters (spots, pores, wrinkles, texture, moisture, and pigmentation) from baseline. The improvement in percentage change in the average of six skin anti-aging parameters started right from Month 3 but significant improvement was seen by Month 5.

A statistically significant percentage change in individual skin anti-aging parameters like moisture, texture, and wrinkles was also seen. There was a statistically significant improvement in skin texture at the end of five months of application with a p-value of 0.0054, whereas a similar statistically significant improvement was seen in moisture as early as the end of four months of application with a p-value of 0.0130, which further improved by the end of five months of application with a p-value of 0.0006. The fastest and earliest improvement in individual skin anti-aging parameters was seen in skin wrinkles; a statistically significant improvement in wrinkles was seen as early as the end of three months of application with a p-value of 0.0387, which was further improved by the end of four months of application with a p-value of 0.0188, whereas the most improvement in wrinkles was seen by the end of five months of application with a p-value of 0.0007. Similar improvement was seen in subjects with age more than 50 years, especially in individual parameters like texture and wrinkles.

Our study results are in line with other studies that have used injectable PRP, and our study also used an objective advanced face analysis system to assess the difference.

There were no serious adverse events or treatment-related adverse events reported during the study as well as no adverse events leading to study discontinuation. There were no clinically meaningful laboratory-related changes observed and no clinically significant changes in vital signs parameters were observed during the study.

Our study had a few limitations like the relatively small sample size. Also, this was a non-comparative study but comparative studies are difficult to design in this indication, as variability in inter-individual skin conditions and skin aging factorsis very high and can confound the results.

Improvements in the average of six skin anti-aging parameters, as well individual parameters like wrinkles, moisture, and texture, depicted by objective analysis with a face analysis system were complemented by subjective analysis performed by different globally accepted scales like PGAIS, SGAIS, SSS, and WSRS. There were no safety concerns seen with the use of MYOWNN in this study, and long-term safety is being evaluated in an ongoing study.

In conclusion, this study showed that topical MYOWNN treatment started showing a difference as early as three months with significant improvement by Month 5, and MYOWNN can be safely and effectively used for anti-aging and face rejuvenation.

Read more:
A Prospective Multicenter Study to Evaluate the Safety and Efficacy of the Topical Application of MYOWNN, an Autologous Growth Factor Concentrate...