Patients seeking PRP therapy for COVID-related hair loss, but does it work?

Nurse's hair falling out after getting COVID-19 After a long battle with COVID-19, a Vancouver nurse is speaking out about a troubling side-effect - her hair has started falling out.

The list of ways a COVID-19 infection disrupts the body's natural functions is long and diverse, and, as Viktorya Skrypnyk's clients have come to learn, includes hair loss.

Skrypnyk is a registered nurse who owns and operates VBeauty Spa, a medical aesthetic clinic in Toronto. The last two years have sent a parade of people through the doors of her clinic struggling with hair loss they say began after a COVID-19 infection.

"Lately, I do see that there's people that are coming in that have no history of hair loss in the family, no history of alopecia that are developing these symptoms of alopecia within last few years," she told CTVNews.ca on Friday. "Most of them are saying that they generally noticed an increase in the year loss specifically after acquiring COVID."

Multiple published studies have shown COVID infections can trigger a type of hair shedding called telogen effluvium (TE). With TE, thinning typically occurs around the top of the head.

When clients suffering from TE come to Skrypnyk, it's usually for a treatment she offers known as platelet-rich plasma (PRP) therapy. Before the pandemic, Skrypnyk estimates 70 per cent of her PRP therapy clients were men. Now?

"Lately I've noticed, after COVID especially, it's been more popular among women," she said.

WHAT IS PRP THERAPY?

Platelet-rich plasma therapy is a form of regenerative medicine that uses a patient’s own blood cells – specifically platelets – to accelerate healing in a specific area of the body.

Plasma is the liquid portion of blood; the medium that carries red and white blood cells and platelets through the body. It's made mostly of water and proteins. Platelets are blood cells that aid in blood clotting and contain a naturally-occurring substance called growth factor, which stimulates cell growth and wound healing.

In PRP therapy, a patient's blood is collected and spun in a centrifuge to concentrate the platelet component of the blood. The patient's own platelet-rich plasma is then injected into an area of the body that needs help with growth or healing, like an injured muscle or, in some cases, a scalp losing hair.

"We usually withdraw the platelets and re-inject them back into the hairline, specifically where there's a lot of hair loss," Skrypnyk said.

PRP meets the definition of a drug under Canada's Food and Drugs Act, but isn't covered by provincial health insurance plans. At VBeauty Spa, a treatment typically costs $600, though other clinics may charge more or less.

According to an entry by doctors Neera Nathan and Maryanne Makredes Senna in the Harvard Health Blog, most of the research on PRP for hair loss has looked at its use to treat androgenetic alopecia, also known as hormone-related baldness. Androgenetic alopecia affects both men and women, resulting in balding at the crown and front of the head in men, and balding that begins with a widening of the part in women.

"There is not enough evidence to make conclusions about the effectiveness of PRP for other types of hair loss, like telogen effluvium, alopecia areata or forms of scarring hair loss," Nathan and Senna wrote.

YOUR MILEAGE MAY VARY

A person can elect to receive PRP therapy for any type of hair loss, but Dr. Jeff Donovan cautions it should only be considered as a second- or third-line treatment for most patients and most types of hair loss.

"PRP is very popular, but the overwhelming message that I would have is that there is no hair loss condition for which PRP is the first-line option," Donovan told CTVNews.ca in a phone interview on Friday.

Donovan is a dermatologist and member of the Canadian Dermatology Association who specializes in hair loss. Like Skrypnyk, he sometimes treats patients using PRP therapy. However, he rarely uses it to treat the type of hair loss most commonly linked to COVID-19 infections – telogen effluvium – and he never prescribes it as a first-line treatment.

For one thing, he explained, TE normally resolves on its own after four to eight months, as long as the condition that triggered it has resolved. It often doesn't respond to the typical hair loss treatments.

"Telogen effluvium is a hair loss condition that happens due to a trigger," Donovan told CTVNews.ca on Friday. "The treatment for telogen effluvium involves treating the trigger, not a bandaid with some other treatment plan."

If a patient's TE was triggered by low iron, treatment would involve restoring their iron levels, he said. Likewise, TE triggered by a thyroid condition, or a condition like anorexia nervosa, should resolve after the underlying condition has been treated.

In rare cases, Donovan will recommend PRP therapy for a patient suffering from TE for which an underlying cause can't be pinpointed. More often, he'll recommend it for patients suffering from other types of hair loss, but even then, only after exhausting other treatment options.

"When we speak about treatment for hair loss, we must speak about what is the first-line treatment, what is the second-line treatment and what is the third-line treatment," he said. "These are treatment ladders according to evidence-based medicine."

For a client with alopecia areata, a type of hair loss that results in circular bald patches, Donovan said the first-line treatments are topical steroid injections and topical minoxidil, which is the active ingredient in Rogaine. For genetic hair loss or androgenetic hair loss, Donovan would first recommend oral and topical minoxidil as well as topical and oral anti-androgens.

Among clients who do end up using PRP therapy, Donovan said between 20 and 40 per cent will see mild benefits, such as a slower rate of hair loss or some modest growth. In order for PRP therapy to provide long-term benefits, however, Donovan said clients typically need to return for treatments three times per year, indefinitely.

Like Skrypnyk, Donovan has noticed more people seeking out PRP therapy for TE in the past year or two. However, he cautions against shelling out for the treatment before speaking to a doctor.

"Due to the popular nature of PRP and the marketing that goes into PRP, there has been an increase in the number of patients demanding that therapy," he said. "However, that is not necessarily reflective of the benefit of the treatment. Nor is it reflective of how these conditions should be managed based on current scientific evidence."

Instead, Dovovan said anyone who has hair loss concerns should start by seeking a diagnosis from their usual health-care provider, who can screen for underlying triggers and suggest treatments.

"In my practice, I really prefer when patients come after having tried several therapies," he said, "because then I get a sense of how well the hair is responding to certain types of treatments."