Understanding and managing PRP side effects: A guide for patients and physicians

Understanding and managing PRP side effects: A guide for patients and physicians

Imagine you could reactivate the body's own healing powers in a targeted manner. An injection - obtained from the patient's own blood - that is used where the body needs healing: Skin, hair, joints, nerves. Welcome to the world of platelet-rich plasma, or PRP for short.

PRP sounds almost too good to be true: it is natural, individual and versatile - from aesthetic wrinkle treatment and joint therapy to urological and gynecological regeneration. But as fascinating as PRP is, it is not a risk-free magic potion.

In this article, we take a realistic but not alarming look at what really matters in practice: possible side effects, their causes, frequency and - crucially - how to manage them safely.

What is PRP - and where is it used?

PRP stands for platelet-rich plasma. It is obtained from the patient's own blood by centrifugation and contains highly concentrated platelets and growth factors that can activate healing processes.

The most important areas of application at a glance:

  • Aesthetics: skin rejuvenation, acne scars, wrinkle treatment
  • Trichology: treatment of androgenetic alopecia
  • Orthopaedics: osteoarthritis, tendinopathies, muscle injuries
  • Urology: erectile dysfunction
  • Gynecology: vaginal atrophy, incontinence

However, PRP is legally off-label in many of these applications - a fact that is important for risk disclosure and documentation.

PRP tubes

PRP - what side effects can occur?

Even though PRP consists of the body's own material, every injection is a medical procedure. Complications are rare, but cannot be ruled out. The good news is that they are usually harmless and manageable - provided they are recognized early and dealt with correctly.

Local reactions - the typical "little things"

Pain, redness, swelling: these are the classics after every PRP injection. They occur in almost every part of the body, whether face, scalp or joint.

  • Cause: The needle itself + the inflammatory response that PRP triggers
  • Duration: usually 24-72 hours
  • Treatment: Cooling, rest, paracetamol if necessary (NSAIDs are controversial)

Importantthese symptoms are not a warning signal - but part of the healing stimulus provided by PRP.

Infections - rare, but to be taken seriously

Infection through PRP is extremely rare, but possible - especially with poor hygiene.

  • Symptoms: Overheating, increasing pain, pus formation, fever
  • Management: Early antibiotic treatment
  • Prevention: Strict asepsis, no reuse of syringes or kits!

Case study: HIV transmission occurred in a clinic through the reuse of PRP injection systems - a tragic exceptional case that shows how important sterility is.

Allergic reactions - the big misunderstanding

Can you have an allergic reaction to PRP? To your own blood - probably not. To additives such as calcium chloride or thrombin - definitely.

  • Possible reactions: Skin rash, itching, rarely anaphylaxis
  • Tip: Prior clarification of intolerances, skin test for additives if necessary

Autoimmune reactions and rare immune phenomena

Theoretically, PRP can lead to reactions in people with an autoimmune predisposition. A documented case: Sarcoidosis-like granulomas after PRP facial treatment in a patient with a history of uveitis.

Specialty-specific PRP side effects - What applies where?

Every part of the body reacts differently. What is completely harmless in the scalp can be critical in the face. That is why we are now looking specifically at the special features of the most important PRP application areas.

Aesthetic medicine - beauty with side effects?

PRP on the face - it's more than just a vampire lift from Instagram videos. Whether for skin rejuvenation or against acne scars: the skin almost always reacts.

Typical reactions:

  • Redness, burning, swelling (like a sunburn)
  • Hematomas, especially on thin-skinned areas (eyelids, lips)

Critical risks:

  • There is a risk of intravascular injection if the injection technique is incorrect.
  • Extremely rare, but possible: retinal artery occlusion → blindness.

Management & prevention:

  • Inject slowly, aspirate beforehand
  • Use a blunt cannula if possible
  • Facial injections only by trained hands

Exciting (but rare): PRP can trigger granulomatous reactions (sarcoidosis-like) - especially in patients with a corresponding immune history.

Trichology - The head as a pincushion?

The scalp is sensitive, well supplied with blood and... painful during injections. Hair root stimulation with PRP is effective - but not entirely free of side effects.

Frequent complaints:

  • Localized pain during/after treatment
  • Feeling of pressure, itching, tightness
  • Mini-haematomas or crusts at the injection sites

Rare, but possible:

  • Folliculitis (due to contaminated needles)
  • Triggering of flare-ups with existing scalp diseases (e.g. psoriasis)

Tip for the practice:

  • Apply anesthetic creams (lidocaine) in advance
  • Aftercare: no hair washing for 24 hours, no scratching at scabs
  • Reassure patients: "Tension and irritation are signs of regeneration!"
PRP in trichology

Orthopaedics - healing stimulus with side effects

Joint injections with PRP are used for osteoarthritis, tendinopathies or ligament injuries. The benefits are there - but there is also a bit of "initial pain".

What often happens:

  • Reactive pain intensification 24-72h post injection
  • Swelling, feeling of pressure, warmth

What almost never happens - but would be dangerous:

  • Septic arthritis (extremely rare)
  • Vascular or nerve injuries with poor technique

Special feature of PRP types:

  • Leukocyte-rich PRP (LR-PRP) is more irritating than leukocyte-poor PRP (LP-PRP)

Management:

  • Prepare patient in advance for temporary increase in pain
  • Cooling, relief, possibly NSAIDs (with caution, as anti-inflammatory)

Professional tip: Ultrasound-guided injection significantly reduces the risk of incorrect injections or vascular injuries.

PRP in orthopaedics

Urology - When it's about more than technology

PRP injections into the penis to treat erectile dysfunction are increasingly in demand - and are surprisingly well tolerated.

Typical reactions:

  • Brief burning sensation during the injection
  • Slight swelling, hematomas
  • Temporary feeling of pressure

Feared but not yet documented:

  • Priapism, infection or tissue damage

Important in education:

  • No immediate effect
  • Several sessions necessary
  • PRP is not a Viagra alternative, but a regenerative approach

Practical tip: Ask patients to take it easy on the day of treatment - no mechanical irritation (sex, cycling) immediately afterwards.

PRP in urology

Gynecology - Innovation in the intimate area

PRP for vaginal atrophy, incontinence or sexual dysfunction? Sounds new - works well - but is sensitive.

Possible reactions:

  • Spotting, feeling of pressure, swelling
  • Small hematomas (especially with injections on the clitoris or vaginal wall)

Not yet occurred, but theoretically conceivable:

  • Vaginal infections due to inadequate hygiene
  • Vascular complications (embolism due to incorrect injection depth)

Management tips:

  • Treatment under sterile conditions
  • Education about hygiene rules (no sex, no tampons, no baths for 48 hours)
  • Follow-up after 2-4 weeks
PRP in gynecology

How often do PRP side effects really occur?

The short answer: Rarely. And when it is, it's usually harmless.

The long answer? Let's take a scientific look.

What does the research say?

  • A large systematic review showed that most PRP studies did not document any serious side effects.

  • The most common effects were:

- Pain after injection (3-10%)

- Swelling (3-7 %)

- Bruising (2-5 %)

- Nausea, dizziness or vasovagal reaction (1-2 %)

  • Infections, vascular complications or autoimmune reactions?

→ Virtually undocumented - mostly only in individual case reports

An impressive comparison: in a study on PRP for knee osteoarthritis, the rate of side effects in the placebo group was similar to that in the PRP group. This indicates excellent tolerability - comparable to a saline injection.

Avoiding side effects - the best strategies from practice

Now it's getting really practical. Here are the four golden pillars with which you can make PRP applications safer:

1. Information & consent - legally compliant & confidence-building

  • Tell me the truth: PRP is off-label. There is promising data, but no universal approval.
  • Written information: Give your patients a leaflet. Make it clear what is possible - and what is not.
  • Avoid false expectations: Not a "miracle cure", but a building block. If you expect miracles, you will be disappointed later - or in the worst case, take legal action.

Tip: Document the informed consent discussion and have the consent signed. That way you are on the safe side legally.

2. Hygiene & technology - The no-go zone starts with reuse

  • Only use sterile disposable products
  • Use closed PRP systems (no open decanting!)
  • Disinfect generously - not only the patient, but also the surrounding area
  • Injection only by trained specialist personnel
  • For joint injections: always use ultrasound or X-ray support

If something looks unhygienic, it usually is.

3. Correct patient selection - not everyone benefits

These groups are contraindicated or should only be treated with caution:

  • Active infections (systemic or local)
  • Untreated autoimmune diseases
  • Coagulation disorders or taking strong anticoagulants
  • Allergies to additives (e.g. calcium chloride)
  • Patients with unrealistic expectations or questionable compliance

A well-chosen patient is half the success of the therapy.

4. Aftercare & monitoring - Be available

  • Patients should be able to give feedback within 48 hours after the injection.
  • Give clear rules of conduct: e.g. rest, no sport, no heat.
  • In the event of complications such as fever, increasing pain or pus formation: check immediately!
  • Document even mild reactions in order to gather experience for future patients.

An accessible doctor prevents a minor reaction from turning into a major concern - or a poor assessment.

Conclusion - Between fascination and responsibility

PRP is fascinating. And with the right preparation, technique and care - it is also safe.

The side effects? Small, brief and treatable in the vast majority of cases.

The serious ones? Extremely rare, but avoidable - through knowledge, care and clear communication.

If you use PRP responsibly, you are doing something good for your patients - without blindly accepting risks.

Because true innovation is not what is new. It's what works safely.

Studies and references - What does science say?

Here you will find a selection of relevant specialist sources on PRP side effects, their frequency and management. All studies mentioned are publicly available or can be accessed via medical databases such as PubMed or SpringerLink:

PRP in science

Department-specific sources

  • General safety and side effects of PRP

Johns Hopkins Medicine (2022): PRP treatments can support wound healing in trauma and joint injuries. Results are visible after several weeks.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/plateletrich-plasma-prp-treatment

Izhakoff et al (2020): Report of cutaneous sarcoidosis after PRP injections in the face, possibly triggered by the Koebner phenomenon.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7422914/

  • Trichology (hair)

Evans et al (2020): PRP may be effective for androgenetic alopecia, particularly in men, with efficacy in women still under debate.

https://pubmed.ncbi.nlm.nih.gov/32761771/

PubMed

  • Orthopaedics

Kim et al (2021): PRP injections provide better outcomes than other injection options for knee osteoarthritis, with benefits increasing over time.

https://pubmed.ncbi.nlm.nih.gov/32551947/

Comparison of LP-PRP and LR-PRP: Study shows that leukocyte-poor PRP (LP-PRP) provides better results in the repair of disc degeneration than leukocyte-rich PRP (LR-PRP).

https://josr-online.biomedcentral.com/articles/10.1186/s13018-024-05196-8

  • Urology

Anastasiadis et al (2022): Review of the efficacy of PRP injections for erectile dysfunction, with reference to the potential of regenerative medicine.

https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2022.944765/full

  • Gynecology

Waghe et al (2024): Study on the safety of PRP in vulvovaginal atrophy and menopausal genitourinary syndrome.

https://pubmed.ncbi.nlm.nih.gov/39100535/

Closing words

PRP is not a risk-free wellness trend. It is a medical treatment with enormous potential - and just as much responsibility. But that is precisely its strength:

  • If you know what you are doing, how to minimize risks and inform your patients properly, then PRP becomes a therapy that you can recommend with a clear conscience - and represent with pride.

Legal notice

Disclaimer: The contents of this blog article are for informational purposes only and do not constitute medical advice. It is not a substitute for individual consultation and treatment by a licensed physician or other qualified healthcare professional

Off-label note: Some of the mentioned applications of PRP (platelet-rich plasma) are outside the approved indications ("off-label use"). Such treatments should only be carried out by appropriately qualified medical personnel and require an individual risk-benefit assessment and comprehensive patient information

Liability for content: Despite careful checking, we assume no liability for the topicality, accuracy and completeness of the information provided. Liability for damages arising directly or indirectly from the use of this blog article is excluded.

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