Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China.
Lasers Surg Med. 2023 Feb;55(2):178-189. doi: 10.1002/lsm.23628. Epub 2022 Dec 27.
Melasma is a refractory skin disease due to its complex pathogenesis and difficult treatment. Studies have found that human umbilical cord mesenchymal stem cell-derived exosomes (hUCMSC-Exos) could serve as a novel cell-free therapeutic strategy in regenerative and esthetic medicine. It could potentially treat melasma, but the skin barrier is a challenge. In this study, we aim to explore the safety and efficacy of hUCMSC-Exos in the treatment of melasma and the means to promote its percutaneous penetration.
In the animal study about the effect of penetration, percutaneous penetration of PKH67-labeled hUCMSC-Exos was studied under microneedles, 1565 nm nonablative fractional laser (NAFL), and a plasma named Peninsula Blue Aurora Shumin Master (PBASM) treatments, observed by confocal laser scanning microscopy. In the clinical application study, 60 patients with melasma treated in our department were divided into four groups. NAFL combined with normal saline treatment was used for Group A. Microneedles, NAFL, and PBASM combined with hUCMSC-Exos treatments were used for Groups B, C, and D, respectively. Each patient received four treatments at 1-month intervals. Assessments were done using the degree of pain posttreatment, melasma area and severity score, improvement rate, physician global assessment score, satisfaction, and complications.
In the animal study about the effect of penetration, hUCMSC-Exos can penetrate the deep dermis under microneedles, NAFL, and PBASM treatments. In the clinical application study, compared with Group A, Groups B, C, and D showed significantly improved therapeutic effect and patient satisfaction (p < 0.05), and there was no significant difference among Groups B, C, and D.(p > 0.05). Patients in Group B reported higher pain levels than those in the other three groups (p < 0.05); the treatment experience of patients in Group D was better.
hUCMSC-Exos can improve the symptoms of melasma safely and effectively. Compared with microneedles, NAFL and PBASM can also achieve a good effect toward promoting penetration. These findings are worthy of exploration and clinical application.
黄褐斑是一种难治性皮肤疾病，其发病机制复杂，治疗困难。研究发现，人脐带间充质干细胞衍生的外泌体（hUCMSC-Exos）可作为一种新型的无细胞治疗策略，用于再生和美容医学。它可能有潜力治疗黄褐斑，但皮肤屏障是一个挑战。在本研究中，我们旨在探索 hUCMSC-Exos 治疗黄褐斑的安全性和有效性，以及促进其经皮渗透的方法。
在关于渗透效果的动物研究中，通过共聚焦激光扫描显微镜观察微针、1565nm 非剥脱性点阵激光（NAFL）和半岛蓝极光舒敏大师（PBASM）处理下 PKH67 标记的 hUCMSC-Exos 的经皮渗透。在临床应用研究中，将我科 60 例黄褐斑患者分为 4 组。A 组采用 NAFL 联合生理盐水治疗，B、C、D 组分别采用微针、NAFL 和 PBASM 联合 hUCMSC-Exos 治疗，每组 1 个月接受 4 次治疗。通过治疗后疼痛程度、黄褐斑面积和严重程度评分、改善率、医生整体评估评分、满意度和并发症评估。
在关于渗透效果的动物研究中，hUCMSC-Exos 可以在微针、NAFL 和 PBASM 处理下穿透真皮深层。在临床应用研究中，与 A 组相比，B、C、D 组的治疗效果和患者满意度均有显著改善（p<0.05），B、C、D 组之间差异无统计学意义（p>0.05）。B 组患者报告的疼痛水平高于其他三组（p<0.05）；D 组患者的治疗体验更好。
hUCMSC-Exos 安全有效地改善了黄褐斑的症状。与微针相比，NAFL 和 PBASM 也能达到良好的促进渗透效果。这些发现值得进一步探索和临床应用。
