COMPARATIVE EFFECTIVENESS OF REGENERATIVE BIOLOGICS IN AESTHETIC DERMATOLOGY: A SYSTEMATIC REVIEW WITH QUANTITATIVE SYNTHESIS EVALUATING EXOSOMES, PRP AND STEM-CELL-DERIVED THERAPIES ON SKIN AND HAIR

Abstract

Background:

Platelet-rich plasma (PRP), exosome-based therapies, and stem-cell-derived products are regenerative biologics that have been considered to have an increased role in aesthetic dermatology in addressing hair loss and skin rejuvenation. Despite the extensive application of these modalities in clinical practice, there is still a question about their relative effectiveness because of differences in study designs, outcome measures and biologic preparations. The overall summary of the existing evidence is necessary as well.

Objectives:

To comparatively assess and contrast the efficacy and safety of regenerative biologics, such as PRP, exosomes, and stem-cell-derived therapies, in aesthetic indications of hair and skin involvement, and to conduct quantitative synthesis in cases where there was sufficient clinical and methodological homogeneity.

Methodology:

The systematic review was done based on PRISMA 2020 principles. Electronic search was conducted on the key databases such as PubMed, PMC, and publisher databases. Primary clinical trials testing PRP or exosomes therapy or stem cell-derived products as aesthetic dermatology indicators were considered. Quantitative synthesis was given priority to randomized trials. The Cochrane RoB-2 tool was used to determine the risk of bias. PRP in androgenetic alopecy in which outcome reporting was comparable enough to justify quantitative synthesis had been attempted, whereas exosome-based and stem-cell-based therapies were synthesized narratively or with a limited amount of quantitative analytics, as everything was different.

Results:

Six original clinical studies had been included to undergo primary analysis. There were five randomized or controlled studies on PRP in the treatment of androgenetic alopecia, and its objective data included hair density, hair count and terminal hair density measured by phototrichogram or TrichoScan system. The PRP studies conducted a quantitative comparison that revealed a directional increase in the parameters of hair growth, relative to the use of a placebo or control treatment but there was moderate heterogeneity as a result of variability in PRP preparation guidelines and outcome measures. A single split-face randomized trial evaluated adipose-derived stem cell exosome treatment with fractional CO₂ laser against acne scars, and the clinical outcomes were better in this group than in the control group. Therapies based on stem cells demonstrated positive regenerative outcome; differences of outcomes and lack of randomized trials blocked pooled quantitative synthesis. In the literature, negative events were not severe and not long-lasting.

Conclusion:

PRP has reproducible clinical efficacy in androgenetic alopecia and is the most supported evidence-based regenerative biologic that can be used in quantitative synthesis in the aesthetic dermatology field. Exosomes and stem-cell-based therapies demonstrate promising outcomes in skin rejuvenation, yet the existing evidence is not homogeneous enough to be pooled in and analyzed. Biologic preparation methods, outcome measures, and trial design must be standardized so that comparative meta-analyses of high quality can be done in the future.