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It is more than likely that you have heard about
exosomes
and their use on an aesthetic level. Since 2023, it is a term that appears in many
dermatological and aesthetic treatments
under the premise (and promise) of its
rejuvenating and illuminating 'superpowers'
for the skin
(without pricks,
the key to the matter). Its
regenerating action
is the pillar of its popularity, which, as many experts claim, would surpass that
of platelet-rich plasma.
In short, exosomes are 'the next big thing'. "They represent a novel field in
aesthetic and regenerative medicine,
with
potential applications in aging,"
says Dr.
Mar Mira,
aesthetic doctor and co-director of
Clínica Mira+Cueto.
So far, so good, if it weren't for the fact that like everything new, and even more so if it touches on issues not only cosmetic, but also medical-aesthetic,
controversy looms around it.
Everything that is introduced into the skin requires a lot of literature, in expert terms, and years of research and verification of long-term results, to demonstrate its anti-aging effectiveness and, above all,
its safety.
"Everything is very promising, but
more well-regulated clinical studies are needed
to learn more about its effectiveness and safety," insists Dr. Mira.
Hence, even the SEME (Spanish Society of Aesthetic Medicine) has issued a statement regarding exosomes. A story that will sound similar to that
of Botox to many...
What are exosomes
Before going into details and 'controversies', we must understand what exosomes are. "These are extracellular vesicles produced by cells and that contain
DNA, RNA, proteins, lipids, amino acids and metabolites;
they are released by cells and are found in different body and organic fluids. They have a function in communication between cells, since At the skin level,
they interact between keratinocytes and melanocytes and with fibroblasts,"
summarizes Dr.
José Luis López Estebaranz,
dermatologist at
GEDET
(Spanish Group of Aesthetic and Therapeutic Dermatology of the AEDV).
In other words, these vesicles are loaded with proteins with which cells communicate with each other. Synthesized exosomes with other repairing and regenerating active ingredients, they act as an
anti-aging treatment,
because they are transported into the skin to activate fibroblasts, the cells that produce
collagen,
to help produce it and stimulate the skin from within.
Experts say that exosomes would 'outperform' platelet-rich plasma - which contains growth factors that are extracted from the person's own blood plasma, centrifuged, separated where proteins and growth factors exist and proceed to infiltrate - because "it does not contain DNA, RNA or lipids, only different proteins or amino acids that are activated by adding calcium or other substances when blood is extracted."
In Europe at the moment we only have exosomes of plant origin, mainly obtained from the stem cells of the Damascus Rose, as Dr. Mar Mira explains. Clinical studies of adipocyte stem cell exosomes are being done, but they are not commercialized.
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Antiaging uses of exosomes
Although exosomes were discovered
15 years ago,
it is now that they have aroused the interest of the scientific and medical community due to their great regenerative power. As a consequence, and as many doctors point out,
they are fashionable today.
The 'blame' lies in their virtues, because "they help
revitalize the skin
of the face, neck and décolleté, activate the natural production of collagen and elastin, reduce
spots, wrinkles and the consequences of acne,"
says
María Vicente. ,
surgeon and aesthetic doctor at
Virtudestética.
They also have application on
the scalp (for alopecia) and
intimate area.
Due to their regenerative and anti-inflammatory properties, "exosomes also have
healing and skin repair,
antipruritic (itch control), barrier function repair and anti-inflammatory effects," adds Dr. Mira.
They also work on
skin subjected to chronic stress
or unbalanced, sensitive, dull, dry and/or
photo-aged.
Furthermore, "its anti-inflammatory effects could also be useful in atopic skin, rosacea or acne to improve the inflammatory component of these pathologies," concludes the aesthetic doctor.
Application of exosomes: lights and shadows
The controversies with exosomes come at the time of their application, because they cannot be punctured, to reach the deep layers of the skin, but rather
applied topically, at the epidermal level,
that is, as
a cosmetic.
"The use of exosomes is indicated
topically
on skin in which an ablative or semi-ablative treatment has been performed (CO2 fractionated laser, fractionated microplasma, pixel laser...) and on
post-surgical scars,
due to their regenerative effect on the skin and its ability to improve the response to treatment," explains Mar Mira.
Expert doctors and dermatologists applied them after treatments that create 'small channels' in the skin, such as
radiofrequency
with needles, microneedling...
(never injected like Botox, mind you).
At the end of 2023, however, the SEME issued a statement to clarify some doubts that arose from the advertising of exosomes by the industry and some doctors (on and offline) and because they had observed
how their use as injectables was protocolized.
although the marketers themselves present it objectively and officially as a "cosmetic" (not a drug).
This does not mean, literally, that it cannot be used at all in antiaging treatments. When the SEME was consulted, it responded that "exosomes can be used in any medical field, always taking into account their technical specifications and until now the commercial preparations of which the
AEMPS
(Spanish Agency for Medicines and Health Products) is aware, are all for use topical, that is, they can only be placed above the epidermis, but they cannot penetrate the skin with any method.
SHUTTERSTOCK
The curious case of exosomes... and why it is reminiscent of Botox
In this regard, Virtudes Ruiz comments that: "It reminds me a lot of
botulinum toxin,
which at first was
expressly prohibited
for use in aesthetic medicine from 2001 to 2004, and thanks to scientific studies and advances in science, today we have 20 years of use in Spain with many advances and satisfactions, and not only in the field of aesthetic medicine, also in different branches of medicine, such as rehabilitation, ophthalmology, neurology...".
The doctor insists that the statement does not mean that exosomes cannot be used, "we can use them and in the most effective way possible,
without violating the law.
In consultation, whether they are applied topically after performing
medical peels, laser treatments
or photobiodynamic therapies of any type, to obtain a faster and more effective recovery of the skin, without injecting them or putting them through mesotherapy or microinjections, and because the combination of the protocols is always more beneficial for the skin. You should also know that the "What we use are exosomes from the damask rose, or from bovine colostrum, we can even obtain autologous ones (from ourselves) for those who may have allergic processes, or excessively sensitive skin."
It must be taken into account that doctors, as Ruiz continues, can use compassionate treatments if they consider it appropriate and indicated, in certain patients and when there is an express justification. All in pursuit of continuing to advance the possibilities and benefits of exosomes, to nourish this medical literature. "A lot of progress is being made in this field due to its tissue regenerative capacity, and in the near future there will probably be specific
medications
with exosomes for certain pathologies and also
their approval for injection in aesthetic medicine,"
Ruiz bets.
In the words of José Luis López Estebaranz, "we need to know more about the properties of exosomes, their functions and their different external origin, but
the future is quite promising
and the pre-clinical results that exist with their administration are very successful."
And Dr. Ruiz predicts: "Things change, especially when
the usefulness and effectiveness
are scientifically demonstrated and I am convinced that this will happen with exosomes in the near future."
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