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Patients with photoaged skin reported improvements in both skin texture and wrinkles after a single injection of platelet-rich plasma (PRP) compared with saline (placebo), a parallel, split-face, randomized clinical trial found.

At 6 months post-treatment, participants gave their PRP-injected cheek significantly higher scores over their saline-injected cheek for skin texture (mean [SD] score of 2.00 [1.20] versus 1.21 [0.54], P=0.02) and wrinkles (1.74 [0.99] versus 1.21 [0.54], P=0.03), according to Murad Alam, MD, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues.

But dermatologists who assessed these same patients via photograph found no significant differences at any time point studied (2 weeks, 3 months, 6 months) for the primary outcomes of overall photoaging scores and fine line, mottled pigmentation, and skin roughness and sallowness subscores, they wrote in .

"Improvements may be subtle and difficult to detect for external raters relying on photographs, which may contain less information than live viewing," Alam and colleagues wrote. "Participants may have been able to see differences more clearly because they knew their faces intimately and in great detail and had time to scrutinize their appearance at length and in close-up view (e.g., by using magnification mirrors)."

Alam's group noted that there are a limited number of studies assessing the effects of PRP on photoaged skin, and much of the existing literature is based on cohort studies without controls.

"Regardless of the dearth of research, PRP has emerged as a popular clinical phenomenon, with practitioners offering it to patients (often in combination with microneedling) for a range of purported benefits, including facial rejuvenation," the researchers wrote. "The objective of this randomized clinical trial was to assess, via a placebo-controlled design, the effects of PRP on the physical appearance of photoaged facial skin."

One might think that the science behind PRP would be relatively certain by now, but when it comes to clinical practice it is not, said Christopher Zachary, MD, of University of California Irvine. "When a treatment such as PRP becomes the panacea for all that ails, you can generally bet that it is effective in none."

He noted that the study showed no improvement in patients self-assessment of either pigmentation or telangiectasias, nor in the blinded evaluators' assessment of the comparative photographs. "This begs the question as to whether the outcomes would have been more obvious with a course of monthly PRP injections for the duration of the study," he said.

Joshua Zeichner, MD, of Mount Sinai Hospital in New York City, who was not involved in the study, told MedPage Today that while the promise of PRP injections is that they use "your body's own growth factors to stimulate activity" in skin cells, there is little data to prove that they work. "This study is one of the few objective trials to evaluate the true effectiveness of PRP in treating signs of the skin aging."

"The results do not support the use of PRP for aging skin," Zeichner said, while noting the small number of participants as a study limitation. "Given the high cost of PRP treatments, the use of traditional facial fillers, lasers, or peels may be a more effective and better financial investment to address skin aging."

From 2012 to 2016, the researchers enrolled 27 participants (mean age of 46.37) with bilateral cheek rhytids of Glogau class II or greater at an academic-based, urban outpatient dermatology office. Both the participants (17 women, 10 men) and raters were masked to the groupings.

There were a number of adverse events reported -- redness (n=18), swelling (n=16), bruising (n=14), pruritus (n=1), skin scaling (n=1), and dryness of skin (n=1) -- but these were not linked to the study agent, and none were reported at 12 months.