Exosome-Based Topical Therapy for Facial Atopic Dermatitis

Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition that significantly impairs quality of life. Current therapies, including corticosteroids and calcineurin inhibitors, often provide incomplete relief or have undesirable side effects. Exosome-based therapies derived from adipose-derived mesenchymal stem cells (ADMSCs) offer a novel, multifaceted approach to addressing inflammation, skin barrier dysfunction, and pruritus, presenting a promising alternative for AD management. Objective: This case series evaluates the efficacy and safety of ADMSC-derived exosome-based topical formulations (ZISHEL XOMAGE; Zishel Bio Inc., Seoul, Korea), in improving clinical and barrier-related outcomes in patients with moderate-to-severe facial AD. Methods: Twenty adults with moderate-to-severe facial AD (vIGA-AD scores 3–4) applied ADMSC-derived exosome twice daily for 6 weeks. Clinical assessments included vIGA-AD scores, transepidermal water loss (TEWL), and corneometry for hydration. Two blinded dermatologists independently assessed outcomes. Before-and-after photographs were taken under standardised conditions. Pruritus severity was evaluated using a visual analogue scale (VAS). Results: Eighty-five percent of patients achieved at least a 1-point reduction in vIGA-AD scores, with 50% achieving a 2-point reduction. Corneometry indicated a 58% improvement in hydration, while TEWL measurements demonstrated a 42% reduction, reflecting enhanced barrier integrity. Pruritus VAS scores declined by 70%. No adverse events were reported, and inter-rater reliability for vIGA-AD assessments was high (Cohen kappa=0.84). Representative cases highlighted substantial improvements in erythema, lichenification, and skin texture. Conclusion: ADMSC-derived exosome products showed significant efficacy in reducing AD severity and restoring barrier function, with excellent safety profiles. Larger, randomised controlled trials with extended follow-up are recommended to confirm these findings and establish these products as viable treatment options for AD.