PRP for Hair Loss: Why I'm cautious with actinic keratoses

Could PRP Accelerate Actinic Keratosis Progression?

Actinic keratoses (AKs) are red scaly lesions. They are typically found in patients with lighter skin types, especially those who have had previous sun exposure in their past. Actinic keratoses are not cancers, but they do have a very small risk of becoming cancers. For that reasons, most AKs get treated.

I'm often asked if there are any concerns with performing platelet rich plasma (PRP) on the scalp in a patient with multiple AKs. Nobody really knows this answer because studies have not been done. I think one should always be aware that many of the growth factors in PRP could theoretically favour progression of actinic keratoses en route to cancer. These include Vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and fibroblast growth factor (FGF). This topic needs study. 

FGF for example may promote progression. In 2011, Cuevas Sánchez P, et al showed that an FGF blocking cream was able to actually treat AKs. Similarly VEGF is known to drive AKs and VEGF levels reduce as AKs are successfully treated.  EGF is overexposed in a variety of tumors.

Conclusions/Comments

In the present day, we have no evidence that use of PRP in patients with preexisting actinic keratoses is safe.  While we have no evidence it is harmful, the overwhelming evidence would suggest that growth factors in PRP have the potential to drive progression of AKs towards cancer.

Reference

Cuevas Sánchez P, et al. Topical treatment of actinic keratoses with potassium dobesilate 5% cream. a preliminary open-label study. Eur J Med Res. 2011.

Bobyr I, et al. Ingenol mebutate in actinic keratosis: a clinical, videodermoscopic and immunohistochemical study. J Eur Acad Dermatol Venereol. 2017.

Groves RW, et al. Abnormal expression of epidermal growth factor receptor in cutaneous epithelial tumours. J Cutan Pathol. 1992