Platelet-rich plasma therapy (PRP) in the treatment of melasma
Melasma - the cause of facial spots
Melasma is a chronic dermatological condition that is easy to recognise and requires no special diagnosis; it is often detected by the dermatologist during a simple clinical examination.
Hyperpigmentation is one of the largest and most common problems of the skin, especially skin prone to tanning. Although it can occur in both sexes, melasma affects women in 90% of cases because they are genetically more predisposed.
The presence of melasma can be detected with the naked eye because it is the appearance of pigmented patches, areas of tissue that are darker in colour than the normal skin tone surrounding them.
The small areas where pigment proliferation can be seen have a colour that varies from brown to grey-brown and are mainly found on the face.
Melasma is therefore quite common on the cheeks, nose, forehead, chin, the skin above the upper lip and around the mouth, but can also occur on other parts of the body that are frequently exposed to the sun, such as the neck, chest and arms.
Generally not dangerous, this skin condition is caused by an excess of melanin in the skin, the brown pigment that normally gives the skin its colour, and in this case it is deposited in very specific areas.
Although harmless, melasma can have a dramatic effect on a person's appearance, especially because it is on the face and because it is a common blemish that is very difficult to remove over time.
Was ist PRP (Platelet Rich Plasma)?
Platelet rich plasma (PRP) is an effective cellular biological treatment in the field of orthopaedic medicine, musculoskeletal medicine, sports injury medicine and of course very often in cosmetic aesthetics, especially in the treatment of hair loss and skin rejuvenation.
The reason PRP therapy is so popular in the treatment of hair loss and skin rejuvenation is because of its ability to stimulate hair follicles and promote and restore new skin collagen.
In musculoskeletal medicine, PRP treatment is used to treat a variety of distortions/tears, ligament/damage to joints, delayed lesions, arthritis/board degeneration and joint retention. PRP therapy is used to facilitate the repair and healing of damaged tissue.
PRP treatment is a very common and simple form of regenerative medicine that consists of a special procedure in which specialised bioactive growth factors are extracted from the patient's own blood, then concentrated and introduced into an area of tissue damage to stimulate the healing process, reduce inflammation and decrease pain.
Our blood is made up of red blood cells, white blood cells, plasma and platelets. It is the platelets that release healing proteins called growth factors, and it is these growth factors that speed up tissue healing. By increasing these platelets, we are able to deliver an enhanced mix of growth factors that can dramatically improve tissue repair and healing.
How does platelet-rich plasma therapy (PRP therapy) work?
During the PRP procedure, blood is taken from the patient with PRP tubes and centrifuged with a special PRP centrifuge to separate the cells from the platelets and serum. Plasma is then injected into the desired areas.
Pilot study on PRP treatment of melasma
In a randomised, placebo-controlled study on the treatment of melasma with PRP, a Thai research team investigated the efficacy of PRP therapy in a group of melasma patients. A cohort of 10 women (mean age 46.2 years) with bilateral mixed-type melasma were enrolled in the single-blinded, prospective study.
The researchers injected platelet-rich plasma intradermally into one side of the face every fortnight for a total of four treatment sessions, while simultaneously injecting saline into the other (control) side. Outcomes were measured using the modified Melasma Area and Severity Index (mMASI), Mexameter and Antera 3D.
Participant satisfaction was assessed at baseline and after 2, 4, 6 and 10 weeks.
The results of the pilot study, published in the Journal of Cosmetic Dermatology, showed that platelet-rich plasma injections were associated with an improvement in melasma condition within 6 weeks of treatment. Both the mMASI score and melanin levels measured with Antera 3D showed significant improvement on the side of the face treated with PRP injections compared to the control side between measurements at baseline and those at week 6. The Antera 3D measurement also showed a reduction in mean wrinkle level from measurements at baseline to week 4. In addition, reported patient satisfaction increased significantly over the duration of PRP treatment.
The study authors reported that there was no difference between the PRP and control sides of the face in terms of erythema or melanin indices measured with the Mexameter - although there was a trend towards less pigmentation in the latter. All side effects that occurred during treatment were of low severity and resolved spontaneously.
The authors of the study acknowledge the limitations of their study, including: the small size of the cohort, the participation of women only, and the short follow-up period of only one month after treatment.
The latest study showed not only a significant improvement in melasma symptoms and patient satisfaction associated with regular injections of platelet-rich plasma, but also the added benefit of wrinkle reduction from week 4 onwards. This was "likely due to the rejuvenating effect of PRP, which has been demonstrated in many studies, stimulating fibroblast and collagen proliferation and increasing hyaluronic acid synthesis", according to the study authors.
How do I prevent a relapse of melasma after successful PRP therapy?
After your melasma has cleared, you may need to continue treating your skin. Your dermatologist may call this maintenance therapy. Maintenance therapy can prevent the melasma from coming back.
You can prevent your melasma from returning by wearing sunscreen and a wide-brimmed hat every day.
Avoid sun exposure without sunscreen. Reduce screen time in front of your LED TV, tablet, mobile phone and computer.
Always listen to your doctor's advice and follow your treatment plan carefully.
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