Microneedling radiofrequency followed by topical exosome application therapy for pattern hair loss: A scoping review and prospective study.

Microneedling radiofrequency (MNRF) and exosome therapies have recently garnered attention as potential treatments for pattern hair loss (PHL). This study aimed to conduct a scoping review of these treatments and present a series of patients with PHL treated with MNRF followed by topical exosome application therapy. We searched the PubMed, Google Scholar, and Cochrane databases for relevant articles regarding MNRF and exosome treatments for PHL. Our search yielded two studies on MNRF and nine studies on exosome therapy, all of which demonstrated positive effects on hair regrowth. One of these studies specifically focused on MN combined with exosome therapy. In our current study, we prospectively evaluated the efficacy and safety of MNRF followed by topical exosome application in 20 patients (median age, 46 years), comprising 16 men and four women, with PHL. Clinical evaluations were conducted using macroscopic photographs and digital image analysis with a trichoscopy device at baseline and then again at three, six, and nine months after treatment. The median followup duration was 10 months. Our results revealed significant increases in mean hair density and diameter, along with high patient satisfaction. No adverse events were reported. The treatment response was found to be independent of sex and the severity of PHL. Overall, this study underscores the potential therapeutic benefits of the MNRF followed by topical exosome application therapy. Randomized controlled trials, however, are needed to confirm the efficacy of this therapy and to determine the optimal treatment parameters. Pattern hair loss (PHL), also known as androgenetic alopecia, is a multifactorial condition influenced by genetic factors, mineral deficiencies, hormonal imbalances, and psychologic stress. Currently, topical minoxidil and oral finasteride are the only approved PHL treatments by the US Food and Drug Administration, with reported efficacy between 40% and 60%. Their use, however, is limited due to potential side effects such as dermatitis, headaches, sexual dysfunction, and muscle atrophy. To overcome such limitations and optimize efficacy, alternative therapies have been developed, including low-level laser therapy, microneedling (MN), platelet-rich plasma, and stem cell-based treatments. Identifying a treatment with high efficacy and minimal adverse effects, nevertheless, remains challenging. Among newer modalities, MN radiofrequency (RF; MNRF) and exosome therapies have gained increasing attention. Exosomes are cell-free, containing signaling proteins and growth factors that promote hair follicle regeneration by activating the Wnt-β-catenin pathway, prolonging the anagen phase, and preventing follicular miniaturization. MNRF delivers bipolar RF through microneedles, creating controlled thermal injury to stimulate hair regrowth. Combining MNRF with exosomes (MNRF-Exo) enhances targeted delivery to hair follicles, which may boost their therapeutic effects.