Adipose Tissue-Derived Exosomes as a Novel Therapeutic Approach for Refractory Alopecia Areata: A Report of Two Cases

Alopecia areata (AA) is an autoimmune condition with unpredictable progression, negatively impacting the quality of life. Despite various therapeutic options, refractory cases remain challenging to treat. Emerging evidence highlights the regenerative and immunomodulatory potential of exosomes, particularly in tissue repair and hair follicle regeneration. Herein, we aim to evaluate the therapeutic efficacy of adipose tissue-derived exosomes (ASC-exosomes) in two patients with severe, refractory AA. Two female patients with chronic AA resistant to multiple conventional treatments underwent a single session of intradermal administration of exosomes derived from adipose tissue. Baseline evaluations, including the Severity of Alopecia Tool (SALT) score, were conducted and reassessed 3 months posttreatment. Clinical and laboratory parameters were monitored throughout the follow-up. Both patients demonstrated significant hair regrowth and improvement in SALT scores (Case 1: 79.6-59.6; Case 2: 70.2-58.6) without adverse events. The treatment was well-tolerated, with sustained clinical benefits observed alongside adjunctive topical minoxidil. ASC-exosomes represent a promising and safe therapeutic strategy for refractory AA, combining immunomodulatory and regenerative properties. Further randomized, controlled studies are necessary to validate these findings and refine cell-free therapeutic protocols for broader clinical applications.