Received: 18 January 2018 | Revised: 27 April 2018 | Accepted: 26 July 2018

DOI: 10.1111/jocd.12772

ORIGINAL CONTRIBUTION

Cervical lymphadenopathy from PRP treatment with

microneedling therapy

Solomon Geizhals BA1 | Joseph Grunfeld BA1 | Hyeokchan Kwon BA1 | Joshua Fox2,3,4 MD

1
SUNY Downstate College of Medicine,
Brooklyn, New York Abstract
2
Advanced Dermatology, PC, New Hyde Background: Platelet‐rich plasma is highly enriched plasma that contains a large
Park, New York
concentration of platelets that secrete various growth factors and is used in a wide
3
Department of Dermatology, Mt. Sinai
Medical Center, New York, New York variety of surgical and cosmetic procedures, including hair regrowth and skin rejuve-
4
Department of Dermatology, Hofstra nation.
Northwell School of Medicine, Hempstead,
Methods: Microneedling therapy is being combined with platelet‐rich plasma to
New York
potentiate patient's cosmetic effects. While microneedling therapy and platelet‐rich
Correspondence
plasma therapy have been around for years and are growing in popularity interna-
Solomon Geizhals, SUNY Downstate College
of Medicine, Brooklyn, NY. tionally, there are limited data regarding complications when they are used in con-
Email: ygeizhals@yahoo.com
junction.
Results: We present a case in which a patient presented with acute, painful lym-
phadenopathy shortly after undergoing the combination treatment of a microneed-
ling pen with platelet‐rich plasma therapy.
Conclusion: Individuals should know of the potential adverse effect of microneed-
ling pen therapy used in conjunction with platelet‐rich plasma therapy, and it should
be included in patient consent forms and doctor–patient education.

KEYWORDS
adverse effect, cosmetic procedure, dermabrasion, microdermabrasion

1 | BACKGROUND
Platelet‐rich plasma (PRP) is a highly enriched plasma that contains a
large concentration of platelets that secrete various growth factors
and is used in a wide variety of cosmetic dermatologic procedures,
such as hair regrowth and skin rejuvenation. Microneedling therapy
(MT) utilizes multiple small needles to puncture the skin and create
“micro channels” that traverse the skin. Although there are a variety
of devices that are utilized in MT, microneedling pens are becoming
more popular and operate via multiple small needles to penetrate
the skin rapidly in succession at up to 6400 RPM. Both PRP and MT
are thought to promote endogenous skin rejuvenation and hair
growth via multiple mechanisms.1 PRP is hypothesized to promote
endogenous skin rejuvenation by inducing the synthesis of collagen
and other matrix components via activation of fibroblasts, thus recti-
fying the structurally impaired integrity of wrinkled skin. MT
increases transdermal delivery of medications to allow for greater
absorption of topical products via the miniature puncture wounds
and the channels they create. MT is also thought to promote skin
revitalization via the creation of normal columns of skin areas spared
between each puncture wound that act as adjacent stem cell reser-
voirs for the migration of skin cells and regeneration of new collagen
and elastic fibers. Another proposed mechanism for MT skin rejuve-
nation, more specific to microneedling pens, was posted in 2012 in
an article in The Journal of The American College of Clinical Wound
Specialists. It is believed that the short duration of needle penetra-
tion creates an electrical imbalance in cell membrane potential and
influences the body to increase gene expression of growth factors
that facilitate healing of epithelial and endothelial cells in the pene-
trated area. PRP is widely popular in European nations and has lately
seen an increase in popularity in the United States as well. Recently,
MT has been combined with PRP therapy (PRPT) to potentiate the
effects of PRPT (MT‐PRPT). While MT and PRPT have been around

J Cosmet Dermatol. 2018;1–2. wileyonlinelibrary.com/journal/jocd © 2018 Wiley Periodicals, Inc. | 1

2 |
for years, there is limited data regarding potential complications of
MT in conjunction with PRPT. We present a case in which a patient
presented with acute, painful lymphadenopathy 24 hours after
undergoing MT‐PRPT via microneedling pen therapy.
2 | METHODS/RESULTS
A 35‐year‐old female patient (whose brother had dramatic hair
regrowth after undergoing PRPT) underwent PRPT with MT to stim-
ulate new hair growth. The MT was performed via a high speed 12‐
needle device that traversed a depth of 2.2 mm into the skin. During
the procedure, the patient was topically anesthetized for one hour
with a compounded product that contained benzocaine 20%, lido-
caine 6%, and tetracaine 5%. Using PRPT, three vials of PRP were
collected; one of them was used to coat the patient's scalp post‐MT,
and the rest were injected into areas of patchy scalp alopecia. No
additional topical solution or cream was applied afterwards. She
returned 24 hours later presenting with severe pain in her posterior
scalp and neck. Physical examination was notable for large anterior
and posterior cervical lymph nodes with no abscesses, or sign of any
skin infection or breakage. The patient reported that her husband, a
physician, suspected an infectious etiology, and had prescribed
Cephalexin 500 mg BID in the interim. No further antibiotics were
prescribed. The patient's lymphadenopathy and severe pain subse-
quently resolved 2 weeks later without further intervention.
It is unclear if the localized lymphadenopathy was due to infec-
tion, reactive lymphadenopathy, or perhaps an autoimmune
response. Noted complications from PRPT include mild pain on the
scalp after treatment as well as scalp sensitivity.2 Complications from
MT‐PRPT have included facial granulomas and systemic hypersensi-
tivity.3 One study from the Journal of Cutaneous and Aesthetic Sur-
gery in 2014 mentioned that 2% of its patients with atrophic acne
scars that were treated with Dermaroller®, a drum‐shaped, non‐elec-
trical roller studded with 192 microneedles size of 1.5 mm, devel-
oped tender cervical lymphadenopathy that subsided after 3 weeks.4
Our patient is the first reported case using electric high‐speed MT‐
PRPT to have the side effect of painful lymphadenopathy, even
though our depth and apparent likelihood for granulomas maybe sig-
nificantly greater at a 2.2‐mm depth.
GEIZHALS ET AL.
3 | CONCLUSION
While the authors cannot exclude the risk of infection in the sterile
field during or after the procedure, the microneedling device is
packed in a sterile container, and the local anesthetic and the PRP
used in the treatment had been tested for endotoxicity. It is unclear
whether the rapid development of the patient's symptoms implies a
reactive lymphadenopathy or infection. Additionally, the severe pain
in our patient may have been enhanced by her low BMI/thinness
with her subsequent enlargement being more noticeable and poten-
tially more painful.
This patient is the first reported case that involved painful poste-
rior cervical lymphadenopathy from the treatment with either PRPT or
electric microneedling, two rapidly increasing cosmetic procedures in
dermatology today. Therefore, although this procedure cannot directly
be proven as the source of the lymphadenopathy, nevertheless, the
authors felt that readers of this journal should be made aware of this
potential adverse reaction and therefore include it in patient consent
forms and physician–patient discussions in the future.
REFERENCES
1. Dhurat R, Mathapati S. Response to microneedling treatment in men
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Study of platelet‐rich plasma injections in the treatment of androge-
netic alopecia through an one‐year period. J Cutan Aesthet Surg.
2014;7(4):213‐219.
3. Soltani‐arabshahi R, Wong JW, Duffy KL, Powell DL. Facial allergic
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How to cite this article: Geizhals S, Grunfeld J, Kwon H, Fox J.
Cervical lymphadenopathy from PRP treatment with
microneedling therapy. J Cosmet Dermatol. 2018;00:1–2.
https://doi.org/10.1111/jocd.12772