Microneedling With Exosomes Shows Early Promise Across Multiple Skin Conditions, Systematic Review Finds

A systematic review published in the Journal of Cosmetic Dermatology offers one of the first comprehensive evaluations of microneedling combined with exosome therapy across multiple dermatological indications, finding early evidence of efficacy and calling for larger, longer-term studies to confirm those results.¹

The review, conducted by Dhaliwal and colleagues and following PRISMA-SWiM guidelines, screened 256 unique references across PubMed, Embase, and Scopus through June 2025. After quality appraisal using the Joanna Briggs Institute critical appraisal tool—with a 70% threshold for inclusion—8 studies comprising 171 patients were analyzed. Conditions addressed across the included studies were androgenetic alopecia (AGA), skin aging, melasma, hyperpigmentation, enlarged pores, active acne, and atrophic scarring.

Alopecia and Aging

In AGA, a 24-week, open-label, prospective study examined a freeze-dried exosome solution administered via microneedling. Mean hair density increased from 158.03/cm² at baseline to 166.14/cm² at week 24 (P < .001). Global photographic assessment showed statistically significant improvement at both week 12 (P = .023) and week 24 (P = .004), with 41.38% of patients demonstrating minor improvement and 10.34% marked improvement by the study's conclusion. Patient-reported outcomes at week 24 showed meaningful gains across hair thickness (58.62%; P < .001) and daily hair loss (55.17%; P = .003).

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Two split-face trials addressed skin aging. Park et al compared human adipose stem cell–derived exosomes plus microneedling against saline plus microneedling in 28 patients over 12 weeks, finding statistically significant advantages on the exosome side across wrinkle roughness parameters (reductions of 12.4%-14.4% vs 6.6%-7.1% on control), skin elasticity (+11.3% vs −3.3%; P = .002), hydration (6.5% vs 4.5%; P = .037), and pigmentation reduction (9.9% vs 1%; P = .044). Histological analysis confirmed greater collagen density and new collagen synthesis on the exosome-treated side. A second split-face trial by Estupinan et al found photoaging scores on the Griffiths scale improved by 37% at 3 months and 22% at 6 months, with histological analysis at those time points showing increases in collagen I, glycosaminoglycans, and collagen remodeling compared with baseline.

Pigmentation

Both studies examining hyperpigmentation reported favorable outcomes. In the study by Proietti et al, 88.9% of patients with melasma improved from moderate to mild modified Melasma Area and Severity Index scores. The study conducted by Theodorakopoulou et al, which included solar lentigines, melasma, postinflammatory hyperpigmentation (PIH), and periorbital hyperpigmentation, reported that 58% of patients rated their outcome as "very much improved" and 42% as "much improved" (P < .007) at the final visit. Objective measurements via a 3D facial analyzer showed that superficial dark spots decreased from 39.75% to 26.8% (P = .000) and deep pigmented lesions decreased from 45.33% to 29.42% (P = .000) by week 12.

Acne, Scarring, and Pores

A small case series of 3 patients treated with a single session of Lactobacillus-derived exosomes applied following microneedling demonstrated improvement across acne severity (Investigator Global Assessment scale: 3.34-1.34), PIH (PIH Area and Severity Index: 12-6.67), and scarring (Goodman and Baron score: 3.34-2.34) at the 2-month end point, with a mean patient satisfaction score of 8.6/10. A separate 3-patient case series targeting enlarged pores showed Global Aesthetic Improvement Scale scores of 4.00 and 4.32 at 12 and 24 weeks post treatment, respectively, suggesting the durability of effect at least in the short term.

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Safety and Limitations

Across all 8 studies, no patient discontinued treatment due to adverse effects. Commonly reported events—transient erythema, mild edema, petechiae, tingling, and burning—resolved within 24 to 72 hours to 1 week. The authors noted, however, that complications, including delayed-onset granulomas, PIH, and anaphylaxis, have been reported in the broader exosome literature, specifically in the context of injection rather than topical application via microneedling.

The review carries significant limitations. Sample sizes were uniformly small, follow-up periods did not exceed 6 months, and the evidence base consists largely of case series, single-center pilots, and split-face trials. Heterogeneity in exosome source—human adipose tissue, umbilical cord mesenchymal stem cells, plant-derived, and bacterial (Lactobacillus)—as well as variable preparation and delivery protocols, limits cross-study comparability. Regulatory status of externally sourced exosome products was undisclosed across all relevant studies, a gap the authors flag as a priority for future reporting.²

The authors conclude that although early signals are promising, adequately powered randomized controlled trials with extended follow-up are necessary before definitive conclusions about long-term safety and efficacy can be drawn.

References

1. Dhaliwal NK, Moothathamby T, Sokhal BS, Gkini MA. The use of microneedling with exosomes in dermatology: a systematic review. J Cosmet Dermatol. 2026;25(4):e70881. doi:10.1111/jocd.70881
2. Wang CK, Tsai TH, Lee CH. Regulation of exosomes as biologic medicines: regulatory challenges faced in exosome development and manufacturing processes. Clin Transl Sci. 2024;17(8):e13904. doi:10.1111/cts.13904