What is the efficacy and safety of using topical plant exosomes (extracellular vesicles) in dermatology?

Topical Plant Exosomes in Dermatology: Current Evidence and Limitations

Topical plant exosomes are not currently recommended for routine clinical use in dermatology due to significant methodological limitations, lack of standardization, and insufficient clinical evidence regarding their safety and efficacy. 1

Current State of Evidence

The use of plant-derived exosome-like nanovesicles (PELNs) in dermatology faces several critical limitations that prevent their clinical implementation:

• Lack of standardized protocols for isolation, characterization, and application
• Significant challenges in isolation and purification processes
• Limited stability data and unknown pharmacokinetics
• Safety concerns including potential immunogenic reactions
• Absence of robust clinical trials demonstrating efficacy 1

While exosomes in general show theoretical promise in dermatology applications such as:

• Wound healing
• Scar prophylaxis
• Photodamage prevention
• Skin regeneration
• Hair loss treatment 2, 3

The specific use of plant-derived exosomes lacks sufficient evidence compared to other sources of exosomes.

Critical Safety Concerns

Several important safety issues must be considered:

• High concentrations of EVs administered intravenously have caused rapid asphyxiation in animal models 1
• Contamination risks with proteins, lipoproteins, and other substances
• Difficulty distinguishing exosomes from non-vesicular particles
• Potential for unwanted inflammatory responses 4
• Unknown long-term effects and interactions with skin conditions

The American Academy of Dermatology guidelines note that even well-established plant-based treatments like aloe vera carry risks of contact dermatitis, highlighting the need for caution with novel plant-derived therapies 5.

Technical Challenges

The European Society of Cardiology Working Group has identified several technical challenges that apply to plant exosome research:

• Need to avoid precipitation methods for exosome isolation
• Requirement for exosome-free conditions during production
• Necessity of confirming at least 3 marker proteins for proper characterization
• Importance of assessing contaminating proteins
• Need for size distribution determination using multiple techniques 1

These technical challenges make it difficult to ensure consistency, purity, and efficacy of plant exosome preparations.

Requirements Before Clinical Implementation

Before plant exosomes could be considered for clinical use in dermatology, the following would be necessary:

1. Development of GMP-quality isolation methods and validation procedures
2. Standardized protocols for production and characterization
3. Better understanding of mechanisms of action
4. Comprehensive safety and toxicity studies
5. Detailed pharmacokinetic studies
6. Clinical trials demonstrating efficacy 1

Current Alternatives

For patients seeking plant-based treatments for mild skin conditions, the American Academy of Dermatology suggests that aloe vera may be a reasonable consideration for conditions like mild psoriasis, with an established safety profile despite limited efficacy data 5.

Conclusion

While plant exosomes represent an interesting area of research in dermatology with potential future applications, the current evidence does not support their use in clinical practice. Significant methodological, standardization, and safety concerns must be addressed through rigorous research before they can be recommended for dermatological applications.