Exosomes versus Platelet-rich Plasma in Hair Loss Therapy: A Comprehensive Literature Review

Hair loss, or alopecia, encompasses a diverse range of conditions including both cicatricial (scarring) and non-cicatricial (non-scarring) forms, with significant implications for patients’ physical appearance, psychological well-being and overall quality of life. The limitations of traditional therapies such as topical agents, oral medications and hair transplantation have led to increasing interest in regenerative approaches. Amongst these, platelet-rich plasma (PRP) and exosome-based therapies have emerged as promising biologic interventions. PRP, derived from autologous blood, contains a high concentration of platelets rich in growth factors that support hair follicle regeneration, angiogenesis and cellular proliferation. Evidence suggests its potential benefits in various types of hair loss particularly androgenetic alopecia, alopecia areata and telogen effluvium, although standardised protocols, optimal dosing and long-term outcomes remain uncertain. Exosomes are small extracellular vesicles secreted by stem cells that offer a novel cell-free alternative capable of delivering complex molecular signals to modulate inflammation, stimulate follicular stem cells, and promote dermal remodeling. Early findings indicate possible applications across a range of alopecias including chemotherapy-induced hair loss, autoimmune related alopecia and structural hair shaft disorders such as trichorrhexis nodosa and monilethrix. This narrative review provides an updated overview of PRP and exosome-based therapies, outlining their mechanisms of action, clinical applications and current limitations. While both modalities show therapeutic promise, their biologic variability, lack of regulatory standardisation and need for comparative trials highlight critical gaps in evidence. Further research is warranted to establish reproducible treatment protocols and determine long-term efficacy and safety for clinical use.