Mesenchymal stem cell (MSC)-derived extracellular vesicles (MSC-EVs) represent the next generation of biomedical applications, offering advantages over MSCs such as higher stability and lower immunogenicity. As cell-free nanoparticles MSC-EVs have demonstrated both efficacy and safety in the treatment of a range of diseases. This article discussed the applications of MSC-EVs in hair regeneration, immunomodulation, and the treatment of acute kidney injury. MSC-EVs promote hair regeneration by enhancing dermal papilla cell proliferation and migration. They also modulate immune responses and mitigate inflammation through immune-related signaling pathways. Additionally, MSC-EVs contribute to improved renal function by modulating multiple signaling pathways. Despite these promising applications challenges remain in the clinical translation of MSC-EVs. Overcoming these challenges requires extensive research to fully optimize the therapeutic potential of MSC-EVs and advance their translation into clinical practice.