{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:00:06Z","timestamp":1785427206551,"version":"3.56.0"},"reference-count":59,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania"},{"id":[{"id":"https:\/\/ror.org\/031d5vw30","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background\/Objectives: Platelet-rich plasma (PRP)\u2013based regimens are widely used in non-scarring alopecia, yet objective response is variable and clinic-ready predictors are lacking. We evaluated short-term trichoscopic outcomes in routine practice and tested whether baseline complete blood count\u2013derived inflammatory status, quantified by the neutrophil-to-lymphocyte ratio (NLR), can stratify response under PRP-based therapy. Methods: We performed an ambispective observational cohort study (October 2024\u2013October 2025) in an outpatient dermatology practice. The final analytic cohort included 129 patients allocated to four treatment groups: PRP alone (n = 54), PRP combined with microneedling-assisted Purasomes Hair &amp; Scalp Complex (HCS50+, Dermoaroma; exosome-containing) (n = 33), PRP combined with microneedling-assisted Mesoaroma Hair Cocktail (scalp formulation; nutrient complex) (n = 24), and a nutrient complex alone (n = 18). Trichoscopy (FotoFinder ATBM; FotoFinder Systems GmbH, Bad Birnbach, Germany) was obtained at baseline (T1) and first follow-up (T2). Density response was defined as a \u226510% increase in total hair density and hair-cycle response as an anagen fraction increase \u22655 percentage points. Predictive analyses were prespecified and restricted to PRP-containing regimens, using logistic regression and a multilayer perceptron with repeated cross-validation for internal validation. Results: Across the full cohort (n = 129), total hair density and hair-cycle parameters improved from T1 to T2. In the PRP-containing subgroup (n = 111), baseline NLR strongly discriminated density responders (AUC 0.85, bootstrap 95% CI 0.77\u20130.91). In multivariable models, NLR remained independently associated with density response (OR 0.31 per 1-unit increase, 95% CI 0.20\u20130.48). Conclusions: In this cohort, baseline NLR was associated with discrimination of early trichoscopic response in PRP-based treatment of non-scarring alopecia. Using the Youden-derived cut-off (NLR = 2.202), patients with NLR &gt; 2.202 had a higher risk of density non-response (72.1% vs. 4.7%), corresponding to a 15.49-fold increased failure risk in this cohort. These findings are exploratory and hypothesis-generating, and external validation and calibration are required before any routine clinical or decision-support use.<\/jats:p>","DOI":"10.3390\/life16040606","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T09:40:31Z","timestamp":1775554831000},"page":"606","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Baseline Neutrophil-to-Lymphocyte Ratio Stratifies Early Trichoscopic Response to Platelet-Rich Plasma\u2013Based Regimens in Non-Scarring Alopecia: A Real-World Cohort with Internal Validation Using an Interpretable Neural Network"],"prefix":"10.3390","volume":"16","author":[{"given":"Adelina","family":"Vrapcea","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200585 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9444-0618","authenticated-orcid":false,"given":"Sarmis-Marian","family":"S\u0103ndulescu","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora Daniela","family":"Ciupeanu-Calugaru","sequence":"additional","affiliation":[{"name":"Department of Biology and Environmental Engineering, University of Craiova, 200585 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil-Tiberius","family":"Tra\u015fc\u0103","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3990-6483","authenticated-orcid":false,"given":"Dumitru","family":"R\u0103dulescu","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia-Mihaela","family":"R\u0103dulescu","sequence":"additional","affiliation":[{"name":"Department of Pneumology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2840-1263","authenticated-orcid":false,"given":"Cristina Violeta","family":"Tutunaru","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra-Alice","family":"Buteica","sequence":"additional","affiliation":[{"name":"Pharmaceutical Chemistry Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena-Camelia","family":"St\u0103nciulescu","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of Medicine and Pharmacy of Craiova, St. Petru Rares, No. 2\u20134, 200433 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103t\u0103lina Gabriela","family":"Pisoschi","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of Medicine and Pharmacy of Craiova, St. Petru Rares, No. 2\u20134, 200433 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jdin.2023.07.005","article-title":"Androgenetic alopecia: An update","volume":"13","author":"Ntshingila","year":"2023","journal-title":"JAAD Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/s40265-023-01880-x","article-title":"Androgenetic Alopecia: Therapy Update","volume":"83","author":"Kelley","year":"2023","journal-title":"Drugs"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.21103\/Article13(1)_RA4","article-title":"Telogen Effluvium, Diagnosis and Management: A Narrative Review","volume":"13","author":"Hussein","year":"2022","journal-title":"Int. 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