Exosomes in aesthetic medicine: scientific arguments for use or against use

In the aesthetic field, exosomes are gaining popularity for their potential to enhance skin health and rejuvenation. Exosomes are believed to offer several benefits in aesthetic medicine. They possess anti-aging properties by reducing oxidative stress, inflammation, and cellular senescence, which are key factors in skin aging. Additionally, they can boost collagen and elastin production, enhancing skin elasticity and reducing wrinkles. Stem cell derived exosomes show promise in regenerating and rejuvenating damaged skin tissue by modulating intracellular signalling pathways and improving the skin’s physiological functions (Chernoff, 2021; Cho et al., 2020; Hu et al., 2019; Kwon et al., 2020; Li et al., 2021; Olumesi & Goldberg, 2023; Pinto & Sánchez-Vizcaíno Mengual, 2024; Rodriguez et al., 2024; Yang et al., 2021).

What are exosomes?

Exosomes are tiny extracellular vesicles secreted by most cell types. They contain proteins, lipids, and nucleic acids, and play a crucial role in cell to cell communication (Chernoff, 2021; Zhang et al., 2022).

Some key types pf exosomes used in cosmetic medicine:

Mesenchymal Stem Cell (MSC) derived exosomes: These are commonly sourced from umbilical cord or adipose tissue. They are known for their regenerative properties, promoting tissue repair and reducing inflammation (Rajput et al., 2022; Szwedowicz et al., 2022).

Platelet derived exosomes: These exosomes are derived from platelets and are used for their growth factors, which can aid in skin healing and rejuvenation (Rajput et al., 2022; Szwedowicz et al., 2022).

Keratinocyte derived exosomes: These are naturally produced by skin cells and can modulate melanin synthesis, affecting pigmentation and overall skin tone (Rajput et al., 2022; Szwedowicz et al., 2022).

Fibroblast derived exosomes: These exosomes can stimulate collagen production and improve skin elasticity, making them valuable for anti-aging treatments (Rajput et al., 2022; Szwedowicz et al., 2022).

Exosome therapy in aesthetics often involves topical applications or microneedling techniques to deliver these exosomes deep into the skin, enhancing their effectiveness (Rajput et al., 2022; Szwedowicz et al., 2022).

The following exosome based products and brands are available in Australia (Aesthetic Medical Practitioner, 2023):

Exomide™: Distributed by Xytide, this brand offers exosome-based products for skin and scalp rejuvenation.

ASCE+ Exosomes: Provides treatments aimed at skin and hair rejuvenation.

Kimeravive: Known for its regenerative exosome-based skin rejuvenation products.

Benev: Offers exosome treatments to enhance skin health and texture.

ExoCel Bio: Focuses on exosome-based skin and hair rejuvenation treatments.

These brands utilise the regenerative properties of exosomes to promote skin and hair health effectively.

Please note, there are currently NO exosomes listed with TGA.

Scientific arguments for use

Efficacy in skin treatments: studies have shown that exosomes can effectively treat skin defects such as aging, atopic dermatitis, and wounds (Olumesi & Goldberg, 2023; Pinto & Sánchez-Vizcaíno Mengual, 2024; Rodriguez et al., 2024; Yang et al., 2021). They can be used in both topical products and local injections, with injections providing more effective treatment by bypassing the skin barrier (Rodriguez et al., 2024).

Cell free therapy: exosome therapy is a cell free therapeutic intervention, reducing the potential for uncontrolled cell differentiation and proliferation seen in stem cell therapies (Olumesi & Goldberg, 2023; Pinto & Sánchez-Vizcaíno Mengual, 2024; Rodriguez et al., 2024).

Scientific arguments against use

High cost and accessibility: The production and isolation of exosomes are expensive and complex processes (Rahman et al., 2024; Yang et al., 2021). This makes the treatments costly and less accessible to a broader population.

Lack of standardisation: There is a lack of standardised protocols for the isolation, characterisation, and quantification of exosomes (Pinto & Sánchez-Vizcaíno Mengual, 2024; Rahman et al., 2024; Yang et al., 2021). This can lead to inconsistencies in the quality and efficacy of the treatments.

Potential for contamination: During the isolation process, there is a risk of contamination with other extracellular vesicles or cellular debris (Rahman et al., 2024; Yang et al., 2021). This can affect the purity and safety of the exosome preparations.

Limited clinical evidence: While preclinical studies show promise, there is still a paucity of robust clinical evidence supporting the efficacy and safety of exosome-based therapies in humans (Ash et al., 2024; Pinto & Sánchez-Vizcaíno Mengual, 2024; Rahman et al., 2024; Yang et al., 2021). More extensive clinical trials are needed to validate their benefits and risks.

Infective potential: The potential for exosomes to carry infectious agents has not been thoroughly assessed (Rahman et al., 2024; Yang et al., 2021). This raises concerns about the safety of using exosomes derived from donor cells.

Stability and storage issues: Maintaining the stability and bioactivity of exosomes during storage and transportation is challenging (Pinto & Sánchez-Vizcaíno Mengual, 2024; Rahman et al., 2024; Rodriguez et al., 2024; Yang et al., 2021). Techniques like lyophilisation are used, but they add complexity and cost to the process (Ash et al., 2024; Pinto & Sánchez-Vizcaíno Mengual, 2024; Rahman et al., 2024; Rodriguez et al., 2024; Yang et al., 2021; Zhang et al., 2022).

Complex mechanisms: The mechanisms by which exosomes exert their effects are not fully understood (Ash et al., 2024; Pinto & Sánchez-Vizcaíno Mengual, 2024; Rahman et al., 2024; Rodriguez et al., 2024; Yang et al., 2021; Zhang et al., 2022). This complexity can lead to unpredictable outcomes and makes it difficult to optimise treatments.

Conclusion

While exosome injections hold the potential for facial rejuvenation, the current challenges related to cost, standardisation, contamination, clinical evidence, infective potential, stability, and complex mechanisms need to be addressed.

Furthermore, practitioners need to know that no exosome products are listed with the TGA and using unapproved products can lead to legal issues, unknown safety risks, and loss of patient trust. Adhering to TGA regulations ensures compliance, safety, and maintains professional standards.

Would you like to become a qualified cosmetic nurse or dermal therapist?

If you’d like to learn more about becoming a qualified Cosmetic Nurse or Dermal Therapist, you can complete one of our free introductory courses:

Becoming a Successful Cosmetic Nurse

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For further enquiries, email enquiries@aacds.edu.au or visit aacds.edu.au

References

Aesthetic Medical Practitioner. (2023).  https://aestheticmedicalpractitioner.com.au/products-services/skincare/exosomes-a-new-approach-in-regenerative-medicine/

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