Resumo

Objectives: We aimed to assess the efficacy of combining platelet-rich fibrin (PRF) and synthetic exosome therapy in the management of refractory androgenetic alopecia. By combining PRF, characterized by its fibrin network and distinctive orange-gold hue, with the containment and concentration effects of exosomes, this dual approach may surmount therapeutic resistance. Introduction: Recalcitrant AGA is a form of chronic hair loss that exhibits resistance to conventional therapies such as minoxidil and finasteride, often necessitating a combination of therapeutic approaches for effective management. The three-dimensional fibrin matrix of PRF extends the release of growth factors. Exosomes are microscopic cellular communicators that carry a range of growth factors, which promote hair growth. Both methods exhibit promise for hair regeneration; however, their combined application in the treatment of resistant AGA cases has not yet been investigated. Materials / method: The wound healing assay was used to identify the exosomes with the greatest efficacy and dosage for application. 1 ml of the selected synthetic exosomes was administered to each patient's scalp using the eclipse method. Additionally, 1 ml of autologous PRF was administered via injection into the scalp along the midline, extending from the frontal hairline to the vertex. Three sessions were held at monthly intervals. The definitive evaluation was conducted one month after the final therapy session. Trichoscopic images were examined utilizing the videodermoscope with fixed reference points. Results: Ten AGA patients who had been on minoxidil for six months without response were offered our therapeutic plan following treatment failure. The terminal to vellus hair ratio (T/V) showed a significant increase after three sessions, rising from 34.30 ± 127.66 to 53.87 ± 282.30 (P-value = 0.027, paired t-test). The mean patient satisfaction with treatment outcomes was 7 ± 2.26 on a scale of 1 to 10. There have been no reports of side effects. The selected synthetic exosomes demonstrated the highest efficacy at a concentration of 10 μg/ml (skin healing percentage = 63.33 ± 1.57%). Conclusion: This study signifies the first extensive combination therapy of PRF and synthetic exosomes (Exo-gold) for the treatment of refractory cases of AGA. Our data demonstrate trichoscopic enhancement using this combination in AGA recalcitrant cases, with high patient satisfaction and no adverse effects. Synthetic exosomes deliver growth factors and proteins directly to follicles, while the fibrin of PRF sustains and stores these given growth factors, providing an additional advantage. Further investigation with a larger sample size is essential to evaluate the additive impact of Exo-gold in AGA.