Increased Incidence of Telogen Effluvium Following Platelet-Rich Plasma Therapy in Patients with Elevated TNF-α Expression: A Prospective Cohort Study

Stimulation of hair regrowth with platelet-rich plasma (PRP) is a popular treatment for androgenic alopecia (AGA). However, a subset of patients experiences paradoxical telogen effluvium (TE) following treatment. To find the reason, we investigated the expression levels of inflammatory cytokines, dihydrotestosterone (DHT), its receptors, and related enzymes. In a prospective cohort study, we examined thirty male persons who complained of telogen effluvium following PRP administration in the last 12 months. The intervenors were tested with multiplex immunoassay for proinflammatory plasma cytokines, ELISA for Tissue DHT levels, western blot for androgen receptors (ARs), and RT-PCR for 5α-reductase isozymes and aromatase gene expression from the biopsy of dermal papilla cells (DPCs) of the vortex scalp. TE occurred in patients have twice-fold TNFα ( p ≤0.05) in their PRP, 40% higher levels of ARs ( p ≤0.05), and significant differences in 5α-reductase gene expression ( p =0.03) in their DPCs. There are significant quantitative differences in the down-expression levels of the aromatase in the outer root sheath of the HFs in these patients. We should consider that elevated TNF-α expression is a significant risk factor for the development of TE following PRP therapy.