Efficacy and Safety of Autologous Platelet
Concentrate in the Treatment of Photoaging
on the Back of the Hands
Israel Alfonso Trujillo*, Yetter Cruz Leon, Charllonne Angelica Marte Arias, Yaquelin Luciana Morales Novo, Jesus Lazaro Diego De la Campa, Angela Rosa Gutierrez Rojas, Julio Antonio López Silva and Daymi Serpa Almaguer
Clinical Surgical Hospital Hermanos Ameijeiras, Cuba
Submission: April 08, 2021;Published: April 26, 2020
*Corresponding author: Israel Alfonso Trujillo, Clinical Surgical Hospital Hermanos Ameijeiras. Havana, Cuba
How to cite this article: Israel A T, Yetter C L, Charllonne A M A, Yaquelin L M N, Jesus L D D l C, et al. Efficacy and Safety of Autologous Platelet
Concentrate in the Treatment of Photoaging on the Back of the Hands. JOJ Dermatol & Cosmet. 2021; 4(1): 555628.
Introduction: From the fourth decade of life (especially on the back of the hands) the skin becomes dry and brittle, spots appear, the venous network increases and soft tissues decrease.
Objectives: To evaluate the efficacy and safety of intradermal microinjection of autologous platelet concentrate (APC) in the treatment of rejuvenation of the back of the hands.
Method: An observational, analytical and longitudinal study was carried out in 60 patients from the Hospital Clínico Quirúrgico: “Hermanos Ameijeiras”, in the period between March 1, 2017 and March 31, 2020. The treatment was applied monthly for 1 year. The final evaluation was carried out 3 months after the end of the treatment.
Results: 51 women with an average age of 45 ± 4.3 years were treated. After treatment, there were significant changes in the Glogau photodamage scale (p = 0.012), in the global scale of aesthetic improvement (p <0.001) and in the scale of the degree of involvement of the volume of the hand (p = 0.018). The adverse events found were pain, inflammation and ecchymosis. The degree of satisfaction reported by the patients was good (26.6%) and very good (73.4%) (p <0.001).
Conclusion:The autologous platelet concentrate proved to be effective and safe in reducing the signs of cutaneous aging on the back of the hands, associated with a high degree of patient satisfaction.
From the fourth decade of life, the skin becomes dry and brittle, spots appear, red vein increases and soft tissues decrease, especially on the back of the hands. To achieve rejuvenation of the hands, the aesthetic doctor must combine and adapt various treatments. Platelet-rich plasma (PRP) and its growth factors (GF) have a recognized revitalizing, regenerative and biorepairing effect, [1,2] however few studies objectively evaluate their efficacy, which led to the realization of the present investigation.
The primary objective was: to determine the effectiveness and safety of the microinjection of autologous platelet concentrate
(APC) in the treatment of photoaging of the back of the hands and
the secondary objectives were: 1) to evaluate the clinical response to treatment, 2) to evaluate type and intensity of adverse events that occur and 3) describe the degree of patient satisfaction.
An observational, analytical, longitudinal study was carried out in 60 patients at the Hospital Clínico Quirúrgico: “Hermanos Ameijeiras”, in the period between March 1, 2017 and March 31, 2020. Treatment with APC was applied monthly for 12 months. Three months after the end of the treatment, the response to it was sent (final evaluation), comparing the current state (soft tissues, veins, tendons and skin) with the initial state; for this, the patient had to attend the scheduled consultation. Throughout the
study there was a rigorous control of adverse reactions. Before
and after proceeding, the platelets were quantified to know the
quality of the applied product (the average concentration of the
platelets after advancing 10.8 times its initial value). Microbiological
culture of the extracted plasma was performed to guarantee
that a sterile germ product was administered.
Patients between 20 and 60 years old, of any sex and skin phototype,
skin photoaging grade II, III and IV (Glogau classification)
(Table 1),  grade 1 to 3 according to scale of the degree of affectation
of the volume of the (HVRS) (Table 2),  normal complementary
tests (hemogram with differential, coagulogram, blood
chemistry and serology for HIV, hepatitis B and C), with signed
Once the patients gave informed consent, the included subjects
registry template and the investigator’s internal registry
were filled out. All information on the included patients was compiled
in the data collection notebook. The blood was extracted
(500 milliliters), then the APC was obtained with the Rotixa centrifuge
(221 mm radius) according to international standards .
To obtain the APC, a first light centrifugation of the whole blood
was carried out in the plastic bag for 3 minutes at 2800 rpm at
22 oC, with a centrifugation force of 2000 g, in this way 250 ml of
red blood cells and 250 ml were obtained of PRP; then a second
weighted centrifugation was performed on the PRP in the plastic
bag for 5 minutes at 4500 rpm at 22 oC, with a centrifugation force
of 5000 g. Once the heavy centrifugation had been carried out, the
supernatant plasma was transferred through the tubes that have
the plastic bags for blood collection and only 10 ml were left and it
is in said volume that by shaking the platelets that were deposited
in the cell were resuspended. bottom of the bag as results of the
centrifugation procedure. Subsequently, the red blood cells were
returned to the patients and finally a microinjection of 10 milliliters
of the APC was performed, distributed between the back of
the hands, the entire facial area, V of the décolleté and neck.
Asepsis and antisepsis of the back of the hands were performed.
Radial and ulnar nerve block was performed by subcutaneous
infiltration of 3 ml of 2% lidocaine close to the styloid
process of the radius (anatomical tobacco box) and another 3 ml
of 2% lidocaine at the level of the styloid process of the ulna (between
the flexor carpi ulnaris tendon and the ulnar artery). Once
the APC was activated with 10% calcium gluconate (concentration
10:1), it was administered by combining cannulas and needles.
Punctures were made with a 20G needle at the level of the
dorsal surface of the second, third and fourth interdigital spaces
and through these punctures a 1 mm × 10 cm long cannula with a
blunt tip was introduced, with which the APC was administered by
subcutaneously (fan and backtracking techniques). Subsequently,
with a 25G × 16 mm hypodermic needle and 1 ml syringes, intradermal
injections of approximately 1.5 ml were administered at a
distance of 1.5 to 2 mm between each application area (point-topoint,
fan, backtrace and nappage).
The response to treatment was evaluated taking into account
the clinical examination of the patient, using the Glogau photodamage
scale (Table 1), the global aesthetic improvement
scale (GAIS) (Table 4) and the scale of the degree of involvement
of the volume of the hand (Table 2).
The protocol was submitted to the consideration and approval
of a Review and Ethics Committee for Clinical Research created
for this purpose, which evaluated it from an ethical point of view.
Additionally, this protocol was submitted to scientific and methodological
review and approval by the Institutional Scientific Council
of the Hospital Clínico Quirúrgico “Hermanos Ameijeiras”.
The medical records of the patients included in the study were
stored in the Department’s file. With the information gathered, a
Microsoft Office version XP database in Excel format was created,
which was exported to the SPSS version 21.0 system for analysis.
To summarize the information of the study sample, the arithmetic
mean, standard deviation and minimum and maximum values
will be used. The Student’s t test was used for all quantitative variables.
For all qualitative variables (degree of aesthetic improvement,
degree of affectation of the volume of the hand and degree
of satisfaction), the absolute numbers and percentages were calculated
before and after the treatment, which were compared using
Pearson’s Chi-square test. In all the hypothesis tests carried
out, a significance level α = 0.05 was performed.
The sample size was calculated using the C4-Study Design
Pack computerized program. (C4- SDP) for sample size calculation
(CTM). Version 1.1 ® Glaxo Wellcome. SA;  considering the
following values: percentage of success reported in the literature
70%, percentage of success in the current study of 80%. With an
alpha error of 0.05, a power of 80% and covering a loss of 5% of
the patients, it was necessary to have 60 subjects in total.
The study sample consisted of 60 women with skin phototypes
between II and IV. The average age ranged around 45 ± 4.3 years
(Table 7). Regarding the Glogau Photodamage Scale, 51 patients
were classified as grade III, and 9 as grade II before the start of
the study. After treatment, 33/51 (64.7%) patients who were classified
as grade III were reclassified as grade II and 6/9 (66.6%)
patients who were classified as grade II were reclassified as grade
I (p = 0.012); the rest of the patients remained in the same grade
assigned before treatment. According to the Global Esthetic Improvement
Scale, there were significant changes after treatment
(p <0.001); 3/60 (5%) patients achieved a total response, 37/60
(61.6%) patients achieved a marked partial response, and 20/60 (33.3%) patients achieved a slight partial response (Figure 1& 2).
Regarding the Scale of the degree of involvement of the volume of
the hand, 51 patients were classified as grade III, 6 as grade II and
3 as grade I before the start of the study.
After treatment, 35/51 (68.6%) patients who were classified
as grade III were reclassified as grade II, 4/6 (66.6%) patients who
were classified as grade II were reclassified as grade I and 2 / 3
(66.6%) patients who were classified as grade I were reclassified
as grade 0 (p = 0.018); the rest of the patients remained in the
same grade assigned before treatment. All the patients reported
some adverse event (pain, inflammation and ecchymosis), which
were of slight intensity, did not imply changes before the intervention
and were completely resolved. The pain occurred during
the procedure and disappeared immediately after the completion
of the procedure (100%), the inflammation (83.3%) lasted 2 to 3
days and the ecchymosis at the puncture sites (16.7%) were infrequent
and of short duration (five to seven days in duration) (Table
8). Of the 60 patients treated with APC, 16/60 patients (26.6%)
reported a good degree of satisfaction and a very good degree of
satisfaction 44/60 patients (73.4%), because they achieved evident
improvement with respect to their condition initial (Table 9).
Platelets play a vital role in initiating hemostasis and wound
healing. In response to tissue and vascular damage, a platelet plug
is formed, with the subsequent release from its alpha granules of
more than 30 biologically active proteins, including: transforming
growth factor β, platelet-derived factor, growth factor, vascular
endothelial growth factor, fibroblast growth factor, and epithelial
cell growth factor. These factors not only aid in clotting but
also drive angiogenesis and promote tissue repair and regeneration
. Multiple authors have shown that topical application
or intradermal injection of PRP and its growth factors produce
favorable cutaneous changes: clinical (restores its vitality, increases
its thickness, recovers its elastic consistency, improves blood
circulation, increases its smoothness, decreases its wrinkles and
improves their appearance) [2,10,11] histopathological (increases
the number of fibroblasts, collagen fibers and blood vessel basement
membranes) [2,10,12] immunohistochemical (improves
collagen expression type I, III and IV) [13-15] and the genetic material
(through the polymerase chain reaction expression of three
target genes, such as: collagen IA, matrix metalloproteinase gene
1 and protein rich in proline of keratinocytes) [13,14]. PRP has
been used as an adjunct to multiple skin rejuvenation treatments
(lipotransference, laser, peeling, lifting).
In all the studies reviewed these treatments expected a higher
response when combined than alone [12,16-18], PRP has also
been used to reduce the intensity and duration of adverse events
in these modalities. In a study by Kim H. and Gallo J, they were able
to objectively reduce erythema and edema after treatment with
fractional carbon dioxide laser by administering intradermal PRP
(P = 0.02), associated with fewer subjective symptoms reported
by patients (itching, burning and pain) . There is only one previous
report on the use of PRP as a rejuvenating monotherapy of
the back of the hands, which was carried out by Cabrera-Ramírez
JO and collaborators who applied 3 sessions of subcutaneous PRP
with a cannula on the back of the hands. At the end of the treatment,
the subjects had clinical improvement in the Fitzpatrick
wrinkle and elastosis classification scale (p <0.001) and in the
Glogau photodamage scale (p = 0.01) and a histological increase
in the number of fibroblasts (p = 0.000), number of vessels (p =
0.000) and amount of collagen (p = 0.27) . In our study there
was clinical improvement in the Glogau photodamage scale (p =
0.012), in the global scale of aesthetic improvement (p = 0.001) and in the scale of the degree of involvement of the volume of the
hand (p = 0.018).
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