AlBargawi Salma
Department of Dermatology, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
J Cosmet Dermatol. 2025 Aug;24(8):e70387. doi: 10.1111/jocd.70387.
Exosomes are extracellular vesicles produced by virtually all cell types. In dermatology, exosomes have garnered significant attention for their potential applications in skin restoration and rejuvenation. Despite their widespread marketing in aesthetic medicine, no exosome product is currently approved for dermal injection, and their safety profile remains unclear.
To report a rare case of ischemic necrosis following dermal injection of lyophilized exosomes for acne scar treatment and to emphasize the potential risks of unregulated aesthetic products.
PATIENT/METHODS: A 38-year-old male presented with painful ulcerated papules and dusky discoloration on both cheeks 3 days after receiving multiple intradermal injections of Korean-manufactured exosomes. Clinical findings were consistent with ischemic necrosis. Laboratory tests including ANA, CBC, and LFTs were unremarkable. The patient declined biopsy. Supportive care and subsequent laser treatments were performed to manage the resulting atrophic scars and pigmentation.
At 2 weeks, eschars spontaneously sloughed off without secondary infection. However, the patient developed significant atrophic scarring with hyperpigmentation. Three laser sessions (CO followed by Er:YAG) yielded only modest improvement. The clinical progression and absence of systemic findings indicated localized vascular compromise, likely due to the exosome product.
This case highlights a serious, underreported complication of unapproved exosome-based injectable therapies. The ischemic necrosis and resulting scarring underscore the importance of regulatory oversight and clinical caution when using such products. Further research and safety evaluation are essential before exosomes can be routinely used in dermatologic practice.
外泌体是几乎所有细胞类型产生的细胞外囊泡。在皮肤病学领域，外泌体因其在皮肤修复和年轻化方面的潜在应用而备受关注。尽管它们在美容医学中广泛销售，但目前尚无外泌体产品被批准用于真皮注射，其安全性仍不明确。
报告一例罕见的真皮注射冻干外泌体治疗痤疮瘢痕后发生缺血性坏死的病例，并强调未经监管的美容产品的潜在风险。
患者/方法：一名38岁男性在接受多次韩国产外泌体皮内注射3天后，双侧脸颊出现疼痛性溃疡丘疹和暗褐色变色。临床发现与缺血性坏死一致。包括抗核抗体、全血细胞计数和肝功能检查在内的实验室检查均无异常。患者拒绝活检。进行了支持性护理及后续激光治疗，以处理由此产生的萎缩性瘢痕和色素沉着。
2周时，焦痂自行脱落，无继发感染。然而，患者出现了明显的萎缩性瘢痕伴色素沉着。三次激光治疗（先二氧化碳激光后铒钇铝石榴石激光）仅带来轻微改善。临床进展及无全身表现提示局部血管受损，可能是由于外泌体产品所致。
本病例突出了未经批准的基于外泌体的注射疗法一种严重但报道不足的并发症。缺血性坏死及由此产生的瘢痕强调了使用此类产品时监管监督和临床谨慎的重要性。在外泌体能够常规用于皮肤科实践之前，进一步的研究和安全性评估至关重要。
