The external environment may have some devastating effects, instability and dysfunction of the skin, which may show up in form of refractory wounds, skin ageing, pigmented dermatosis, hair loss, some immune-mediated dermatoses, and connective tissue diseases. Skin treatments for these conditions must aim in achieving a commendable balance between medical recovery and cosmetic needs. 

Exosomes, cell-derived nanoscale vesicles, carries numerous biomolecules like proteins, nucleic acids, and lipids. They have the potential to communicate with adjacent or distant cells. Endogenic multiple kinds of exosomes have shown their effects in shaping physiological and pathological development of the skin in recent studies. Similarly, exogenous exosomes like stem cell exosomes can serve as novel treatment options to repair, regenerate, and rejuvenate skin tissue. 

A study explained the role of endogenic and exogenous exosomes in the skin microenvironment and discussed the recent advances in applications of exosomes in dermatology and cutaneous medical aesthetics.

Wound healing-

Exosomes are known to affect angiogenesis, cell proliferation and differentiation, apoptosis, and inflammation, which can be effectively applied in wound healing.

Exosomes (derived from multiple sources) could regulate the wound healing process through different mechanisms, especially, by affecting effector cells.

Skin flaps reconstruction-

Since Exosomes contains a variety of proangiogenic factors, they have shown the ability of tissue damage repair due to neovascularization.

Immune-mediated dermatoses

Pathogenesis and therapeutic application of exosomes for inflammatory skin conditions are widely studied. Exosomes coordinate the immune response by effective communication between immune cells. They show immunoregulatory mechanisms like modulation of antigen presentation, immune activation, immune suppression, immune surveillance, and intercellular communication.

Systemic lupus erythematosus

Exosomes act as triggers of regenerative effects in target cells and regulate physiological responses and the pathogenesis of SLE. This characteristic makes exosomes potential diagnostic or prognostic biomarkers of disease and possible therapeutic targets.

Psoriasis

Exosomes can suppress or stimulate immune responses depending upon the context of inflammatory and autoimmune diseases.

Atopic dermatitis

Exosomes act by reducing the level of serum IgE, eosinophils, and pro-inflammatory cytokines, such as IL-4, IL-23, IL-31, and TNF-α in Atopic dermatitis.

Systemic sclerosis

Serum exosome levels are reduced in systemic sclerosis, which may lead to vascular abnormalities, causing higher susceptibility to pitting scars and ulcers. Thus exosome acts as potential biomarkers for diagnosing, monitoring the disease evolution, and treatment responses.

Exosomes in cutaneous medical aesthetics

Exosomes had wide application in cutaneous medical aesthetics also. They inhibit the differentiation of fibroblasts to myofibroblasts, thus reducing excessive fibrosis and scar formation. They can also improve keratinocytes and fibroblasts function, enhance collagen and elastin synthesis, and increase dermal fat, thus promoting the regenerative and restorative capacity for skin anti-ageing, etc.

Source: Xiong M, Zhang Q, Hu W, Zhao C, Lv W, Yi Y, Wang Y, Tang H, Wu M, Wu Y. The novel mechanisms and applications of exosomes in dermatology and cutaneous medical aesthetics, Pharmacological Research,2021;166 https://doi.org/10.1016/j.phrs.2021.105490.