Necrosis Following Dermal Injection of Lyophilized Exosomes: A Case Report

Exosomes are extracellular vesicles produced by virtually all cell types. In dermatology, exosomes have garnered significant attention for their potential applications in skin restoration and rejuvenation. Despite their widespread marketing in aesthetic medicine, no exosome product is currently approved for dermal injection, and their safety profile remains unclear.

To report a rare case of ischemic necrosis following dermal injection of lyophilized exosomes for acne scar treatment and to emphasize the potential risks of unregulated aesthetic products.

A 38-year-old male presented with painful ulcerated papules and dusky discoloration on both cheeks 3 days after receiving multiple intradermal injections of Korean-manufactured exosomes. Clinical findings were consistent with ischemic necrosis. Laboratory tests including ANA, CBC, and LFTs were unremarkable. The patient declined biopsy. Supportive care and subsequent laser treatments were performed to manage the resulting atrophic scars and pigmentation.

At 2 weeks, eschars spontaneously sloughed off without secondary infection. However, the patient developed significant atrophic scarring with hyperpigmentation. Three laser sessions (CO₂ followed by Er:YAG) yielded only modest improvement. The clinical progression and absence of systemic findings indicated localized vascular compromise, likely due to the exosome product.

This case highlights a serious, underreported complication of unapproved exosome-based injectable therapies. The ischemic necrosis and resulting scarring underscore the importance of regulatory oversight and clinical caution when using such products. Further research and safety evaluation are essential before exosomes can be routinely used in dermatologic practice.