Optimising the delivery system for exosome therapy in scar management: standardisation of delivery methods and optimal dosing in acne scarring : a systematic review of randomised controlled trials and primary studies
Abstract
Introduction: Atrophic acne scarring affects a substantial majority of patients with inflammatory acne and remains one of the most refractory indications in aesthetic and reconstructive dermatology. Mesenchymal stromal cell-derived and plant-derived exosomes are 30–150 nm extracellular vesicles that carry microRNA, growth-factor, and lipid cargo capable of suppressing transforming growth factor-beta 1 (TGF-β1)/SMAD2-3 signalling, reprogramming macrophages towards an M2 phenotype, and restoring organised type I and type III collagen deposition. Their clinical translation, however, is constrained less by intrinsic bioactivity than by the physics of cutaneous delivery: the 15–20 μm stratum corneum is an efficient exclusion filter for nanoscale vesicles. No previous synthesis has interrogated the delivery system itself as the principal determinant of clinical effect, nor mapped the completeness of dose reporting across the human evidence base. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Eligible designs included randomised controlled trials, cohort studies, case-control studies, cross-sectional studies, and other observational designs reporting exosome or exosome-like extracellular-vesicle therapy delivered to human skin for scar, post-acne, or dermal-remodelling indications. Two reviewers independently screened, extracted, and appraised. Results: Eighteen primary studies enrolling 472…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 472 participants or records.
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