Our understanding of the complex process of hair growth has advanced rapidly. As a result, new possibilities for treating hair loss have been discovered. One such discovery is the exosome. Exosomes have become an exciting area of research for the treatment of androgenic alopecia – also known as male-patterned or female-patterned hair loss – which is the most common form of hair loss in humans. The following blog post is a summary of the current literature on the use of exosomes to encourage hair growth. Seek a fellowship-trained facial plastic surgeon if you have aesthetic concerns about your face and/or neck.
Exosomes for Hair Loss: Are They Ready for Prime Time?
Dr. Jeffrey Harmon
What are Exosomes?
Exosomes facilitate communication between cells, even at great distances from each other. It is helpful to think of exosomes like packages delivered between cells. These exosome “packages” have protein markers on their surface that function much like an “address” which ensure the exosome reaches the appropriate cell. Both human and animal cells make exosomes, suggesting their importance in the function of life of all kinds.
Exosomes are much smaller than the cells they come from. They contain a combination of proteins and genetic material, the “package contents,” which induce changes in cells they communicate with.
Exosomes from many different cell types have been studied for their therapeutic effects in hair growth. The most common, and promising source is derived from dermal papilla cells (DPC). The dermal papilla is one component of a hair follicle, which is a complex organizational body for hair formation. DPCs are a source of stem cells - cells with the potential to turn into many different other cells – for the hair follicle itself. Therefore, it makes sense that exosomes derived from these cells would contain signals, or “package contents,” that could encourage hair growth.
Why are People Excited About Exosomes?
Hair follicles are constantly cycling between three stages, called anagen, catagen, and telogen. Anagen is the growth phase of a hair follicle and lasts many years. Catagen is the phase in which the hair breaks down. This lasts only a short period of time. The third stage is telogen, which is a resting phase. Telogen lasts an intermediate amount of time. Exosomes are thought to be a potential minimally-invasive treatment option for encouraging the transition of hair follicles to the anagen phase, similar to platelet-rich plasma.
What Evidence is There That Exosomes Work?
The evidence that exosomes work is largely limited to studies on animals and human cells in the laboratory, otherwise known as pre-clinical studies. More specifically, a review of the available literature on the use of exosomes in hair growth demonstrated 15 of these pre-clinical studies and only 1 clinical study on human subjects (Gupta AK et al). Furthermore, a search of “hair loss” and “exosomes” on the website ClincalTrials.gov, a government website listing all registered clinical trials, shows only two, one in Iran and one in Pakistan. Overall, the evidence for the effectiveness of exosomes is encouraging. However, there are many questions that need to be answered and challenges that need to be overcome before they are determined a safe, viable treatment for hair loss.
What are the Current Challenges to Making Exosomes a Viable Therapy for Hair Loss?
There is no agreed upon ideal cell origin for the exosomes or signals to include in the exosomes. There is no agreed upon ideal method for delivering the medication at an amount and for an amount of time that would be most effective. It is difficult to produce and isolate exosomes at the scale needed for them to be a viable treatment for many. In addition, exosomes must be stored at very low temperatures, which would increase their cost.
What Does the Food and Drug Administration (FDA) Have to Say About Exosomes?
The FDA considers exosomes to be a biological drug. As a result, exosome therapy is highly regulated. There are currently no FDA-approved treatments for hair loss using exosomes. In fact, the FDA has released warnings about the use of exosomes due to reports of complications from the use of exosomes on patients. It is for the above reasons that we feel exosomes are not yet ready for mass therapeutic use is medical practices. Additional research, including clinical trials, are necessary.
Could Exosomes Replace the Need for Hair Restoration Surgery?
No, exosome therapy will not replace the need for hair restoration surgery. Exosome therapy does not create new hair follicles in areas where they have been lost. Instead, exosome therapy is hoped to encourage growth of dormant hairs follicles. However, it could support the growth of transplanted hair follicles after surgery.
Trust Your Face to a Facial Plastic Surgeon
It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck.
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References
- Buontempo MG, Alhanshali L, Ide M, Shapiro J, Lo Sicco K. Examining the Uncertainties Surrounding Exosome Therapy in Androgenetic Alopecia: A Call for Evidence-Based Practice. J Drugs Dermatol. 2024 Mar 1;23(3):e86-e90.
- Gangadaran P, Rajendran RL, Kwack MH, Jeyaraman M, Hong CM, Sung YK, Ahn BC. Application of Cell-Derived Extracellular Vesicles and Engineered Nanovesicles for Hair Growth: From Mechanisms to Therapeutics. Front Cell Dev Biol. 2022 Jul 14;10:963278.
- Gupta AK, Wang T, Rapaport JA. Systematic review of exosome treatment in hair restoration: Preliminary evidence, safety, and future directions. J Cosmet Dermatol. 2023 Sep;22(9):2424-2433.
- Hartman N, Loyal J, Fabi S. Update on Exosomes in Aesthetics. Dermatol Surg. 2022 Aug 1;48(8):862-865.
- Kost Y, Muskat A, Mhaimeed N, Nazarian RS, Kobets K. Exosome therapy in hair regeneration: A literature review of the evidence, challenges, and future opportunities. J Cosmet Dermatol. 2022 Aug;21(8):3226-3231.
- Xiong M, Zhang Q, Hu W, Zhao C, Lv W, Yi Y, Wang Y, Tang H, Wu M, Wu Y. The novel mechanisms and applications of exosomes in dermatology and cutaneous medical aesthetics. Pharmacol Res. 2021 Apr;166:105490.
- Zhou Y, Seo J, Tu S, Nanmo A, Kageyama T, Fukuda J. Exosomes for hair growth and regeneration. J Biosci Bioeng. 2024 Jan;137(1):1-8.
This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.