One of the Most Important Discoveries of the 21st Century: Exosomes and Their Effects on Human Biology

Exosomes are nanoscale extracellular vesicles released by many types of cells that can carry biological components such as proteins, lipids and nucleic acids. These structures contribute to communication between cells and have recently been investigated in dermatological fields such as skin rejuvenation and hair loss.

However, not every product marketed as an “exosome treatment” has the same contents, manufacturing standards or level of clinical evidence. Although early studies of skin and hair applications have reported promising results, exosomes are not currently considered an established first-line treatment for many dermatological concerns.

What Is Exosome Treatment?

Exosome treatment is a regenerative approach based on applying extracellular vesicles said to be obtained from particular cells to the skin or scalp. The biological molecules carried by exosomes are thought to influence communication, repair and regeneration processes in target cells.

Exosomes are not living cells. Exosome application and stem cell treatment should therefore not be considered the same procedure. The presence of small particles in a product is also not sufficient to prove that those particles are scientifically verified exosomes. The International Society for Extracellular Vesicles recommends clearly reporting the source, composition, purity and characterisation methods of extracellular vesicle products.

For Which Skin Concerns Are Exosomes Being Used?

Exosome applications in dermatology are mainly being investigated for skin rejuvenation, photoageing, acne scars, uneven pigmentation and supporting recovery after cosmetic procedures.

Skin Rejuvenation And Photoageing

Exosomes are thought to have potential effects on collagen production, elasticity, hydration and skin texture. In a small randomised study, an exosome-containing solution used with microneedling produced greater improvement in certain skin-ageing measurements than microneedling alone. However, the short duration and limited number of participants mean that the findings cannot be generalised to every product or patient.

In another split-face study, exosomes and platelet-rich plasma applied after radiofrequency microneedling produced similar improvements in skin texture and appearance. These results are important for research, but they do not demonstrate that exosomes are definitively more effective than other approaches.

Acne Scars And Pigmentation

Products described as containing exosomes may be used after laser or microneedling procedures to support recovery of the skin barrier. However, acne scars, melasma and other pigmentation problems have different underlying causes. The type of scar or pigmentation should first be identified, and sun protection, medication, chemical peels, laser treatment or other methods should be considered individually.

Exosome treatment does not automatically replace established treatments for active acne or pigmentation. A dermatology assessment is particularly important before treating a skin mark whose cause has not been identified.

Hair Loss

The effects of exosomes on hair-follicle cells and the hair-growth cycle are being investigated in laboratory and early clinical studies. Clinical trials evaluating exosome injections for androgenetic alopecia are ongoing, so the most effective product, dose, number of sessions and patient group have not yet been clearly established.

Hair loss can develop because of iron deficiency, thyroid disease, hormonal conditions, severe stress, the postpartum period, medicines, autoimmune diseases or hereditary predisposition. The cause should therefore be assessed by a dermatologist before any regenerative treatment is applied to the scalp.

How Is Exosome Treatment Applied?

The method varies according to the product and the treatment area. Products described as containing exosomes may be:

• Applied directly to the skin surface
• Used after microneedling
• Applied following laser or radiofrequency treatment
• Applied topically or injected into the scalp

Topical application and intradermal injection do not have the same risk profile. Injection requires more careful assessment because of the potential for infection, tissue injury and other complications. A case of skin necrosis following intradermal injection of a lyophilised exosome product has been published.

Treatment duration varies according to the method, size of the treatment area, use of anaesthetic cream and whether the application is combined with laser or microneedling. There is no universally accepted standard treatment duration or number of sessions.

Is Exosome Treatment Safe?

It is not accurate to say that exosome applications have no side effects. Redness, tenderness, swelling, pain, infection, allergic reactions or procedure-related tissue injury may occur.

Risk is not determined only by the application technique. The biological source of the product, purity, manufacturing conditions, microbiological safety, storage method and route of administration are also important.

The US Food and Drug Administration states that no exosome product has been approved for treating diseases and has warned about serious adverse events reported after the use of unapproved products. This statement describes the regulatory situation in the United States. The authorisation, licensing and conditions of use of any product considered in Türkiye should be verified separately.

What Should Be Considered When Selecting An Exosome Product?

The word “exosome” on a package is not sufficient evidence of safety or effectiveness. The following questions should be clarified before treatment:

• What biological source was used?
• How was the presence of exosomes or extracellular vesicles confirmed?
• Has the product undergone sterility and quality testing?
• What are its storage and transport requirements?
• Will it be applied topically or by injection?
• Is it authorised or licensed for the intended use?
• Have possible side effects and alternative treatments been explained?
• What is the specialty and experience of the practitioner?

Significant differences between products make clinical results difficult to compare. Applications involving products with an unclear source or composition should therefore be avoided.

Who Should Receive A Dermatology Assessment?

Anyone considering exosome treatment may benefit from a dermatology assessment beforehand. Medical review is particularly important in the presence of:

• Active acne, cold sores, fungal infection or bacterial skin infection
• Hair loss of unknown cause
• A rapidly changing, bleeding or non-healing skin lesion
• A condition or medicine affecting the immune system
• Active or recently completed cancer treatment
• Pregnancy or breastfeeding
• A history of keloids or abnormal scarring
• A known allergy to one of the product ingredients

These conditions do not always mean that treatment cannot be performed. The decision should be based on medical history, the cause of the skin or hair concern, product characteristics and the intended method.

Does Exosome Treatment Provide Guaranteed Results?

No. Exosome treatment cannot be guaranteed to remove wrinkles, pigmentation or hair loss. Outcomes may vary according to age, skin type, the cause of hair loss, the product, application method and accompanying treatments.

When exosomes are used together with laser or microneedling, it may also be difficult to determine how much of the observed improvement comes from the exosome product and how much comes from the other procedure. Expectations should therefore remain realistic, and established alternatives should also be considered.

Online Dermatology Consultation With Happ Health

When considering exosome treatment for skin rejuvenation, pigmentation, acne scars or hair loss, you can first discuss the cause of the concern and suitable options with a dermatologist.

Through Happ Health, you can arrange an Online Dermatology Consultation and share your symptoms, previous treatments, current medicines and the procedure you are considering. The dermatologist can help determine whether exosome treatment should be considered in your situation and whether an in-person examination is necessary.

Online dermatology can support the initial assessment of visible skin, hair and nail concerns. However, a suspicious mole, non-healing wound or finding requiring detailed physical examination may require an in-person visit, dermoscopy or biopsy.

References

• Republic of Türkiye Ministry of Health. Regulation on the Provision of Remote Healthcare Services.
  https://www.saglik.gov.tr/TR-87381/uzaktan-saglik-hizmetinin-sunulmasina-dair-yonetmelik-yayimlandi.html
• Official Gazette of the Republic of Türkiye. Regulation on the Provision of Remote Healthcare Services.
  https://www.resmigazete.gov.tr/eskiler/2022/02/20220210-2.htm
• U.S. Food and Drug Administration. Public Safety Notification on Exosome Products.
  https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/public-safety-notification-exosome-products
• U.S. Food and Drug Administration. Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes.
  https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes
• U.S. Food and Drug Administration. Important Patient and Consumer Information About Regenerative Medicine Therapies.
  https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/important-patient-and-consumer-information-about-regenerative-medicine-therapies
• U.S. National Library of Medicine, ClinicalTrials.gov. Mesenchymal Stem Cell-Derived Exosomes in Skin Rejuvenation.
  https://clinicaltrials.gov/study/NCT05813379
• U.S. National Library of Medicine, ClinicalTrials.gov. Exosome Treatment in Androgenetic Alopecia.
  https://clinicaltrials.gov/study/NCT06539273