Clinical Evidence and Commercial Landscape of Topical Exosomes for Skin Rejuvenation: A Scoping Review.

Exosomes have emerged as a novel therapeutic frontier in regenerative and aesthetic medicine. Preclinical studies suggest that exosomes may promote collagen synthesis, modulate inflammatory signaling, and enhance wound healing, supporting their potential role in skin rejuvenation. However, clinical evidence in humans remains limited. In this study, the authors conducted a scoping review to evaluate the clinical evidence and characterized the current market landscape of exosome-based products. PubMed, Embase, Web of Science, Cochrane Library, and CINAHL were searched for studies evaluating topical exosomes for skin rejuvenation. Search strategies were peer reviewed with a medical librarian following PRISMA-S and PRESS guidelines. Two independent reviewers screened articles. Additionally, an incognito Google Shopping search for "exosomes" identified the first 20 commercially available cosmetic products. Product claims and ingredient sources were analyzed. Of 2394 articles screened, 18 evaluated topical exosomes for skin rejuvenation, with sources including both human and plant-derived exosomes. Ten studies used delivery modalities alongside exosomes, and 8 used topical application alone. Reported benefits included increased collagen and elastin as well as improved wrinkles, skin elasticity, hydration, and pigmentation. Commercial cosmetic products reflected the heterogeneity in exosome sources and contained minimal information on exosome isolation, processing, or shelf life. The ambiguity in the marketplace highlights the need for standardization and stronger clinical evidence. Overall, human studies on topical exosomes remain scarce, with much of the current evidence on exosomes extrapolated from preclinical models. Further trials directly comparing sources and delivery methods are needed. Level of Evidence: 3 (Therapeutic)  For image description, please refer to the figure legend and surrounding text.