Potential Treatment of Steroid-Resistant Alopecia Areata Using Allogeneic Exosomes Derived From Adipose Tissue...

A 31-year-old man with severe, corticosteroid-resistant alopecia areata presented with substantial scalp hair loss (Severity of Alopecia Tool [SALT] score: 60%) despite a 1-year regimen of topical corticosteroids, 5% minoxidil, and oral prednisolone. He was treated with allogeneic exosomes derived from adipose tissue mesenchymal stromal cells (ADMSCs-Exo) at 3-week intervals over 12 weeks (four sessions; 10¹² particles each). A cessation of hair shedding was noted after the initial session, followed by progressive regrowth that led to near-complete hair restoration by Week 12. Treatment was accompanied by an increase in anti-inflammatory cytokines (IL-4, IL-6, IL-10) and a reduction of IFN-γ, TNF-α, and IL-17 toward baseline levels. No adverse effects were reported during active treatment or throughout the 18-week posttreatment follow-up period. While limited to a single patient, this case suggests that ADMSC-derived exosomes warrant further investigation as a potential cell-free therapeutic option for refractory alopecia areata.