Lactobacillus-Derived Exosome Therapy for Active Acne Vulgaris, Post-Inflammatory Hyperpigmentation, and Atrophic Scarring

Background: Acne vulgaris often leads to post-inflammatory hyperpigmentation (PIH) and atrophic scarring, affecting patients’ quality of life. Traditional treatments may have side effects and inconsistent efficacy. An imbalance in the skin microbiome, particularly a deficiency in Lactobacillus species, has been implicated in acne pathogenesis. Lactobacillus-derived exosomes (LDE) offer a novel, cell-free therapeutic approach with anti-inflammatory and regenerative properties. Objective: This case series evaluates the efficacy and safety of LDE therapy combined with microneedling in patients with active acne, PIH, and atrophic scarring. Methods: Three patients with moderate to severe acne [Investigator’s Global Assessment (IGA) scores 2–4], visible PIH, and atrophic scarring underwent biweekly microneedling treatments followed by topical application of LDE (BLESKIN EXXO, Daeyang Medical) over 2 months. Assessments were conducted at baseline and 2-month post-treatment, utilizing the IGA scale for acne severity, the Postinflammatory Hyperpigmentation Area and Severity Index (PIHASI) for PIH, and the Goodman and Baron Scarring Grading System for atrophic scarring. Two independent, blinded dermatologists evaluated clinical photographs and scored all outcomes. Patient satisfaction was recorded on a 10-point Likert scale. Results: All patients exhibited significant improvements in acne severity, PIH, and atrophic scarring. IGA scores decreased from baseline values of 3 to 4 to 1 to 2 post-treatment. PIHASI scores were reduced by 4 to 6 points, and Goodman and Baron scores improved by one grade level. Patient satisfaction scores ranged from 8 to 9 out of 10. Minimal adverse events were noted, with only one instance of transient erythema observed during the study. Conclusion: LDE therapy combined with microneedling seems to be a promising treatment modality for active acne, PIH, and atrophic scarring, demonstrating significant clinical improvements with high patient satisfaction and minimal adverse effects. Further research with larger cohorts and controlled studies is warranted to validate these findings.