Polynucleotides and Exosomes: Evidence and Marketing
What research suggests about polynucleotides and exosomes for skin quality, where evidence remains uncertain and why choosing a procedure begins with assessment.
Polynucleotides and exosomes differ in how well their clinical effects are established. Polynucleotides have evidence supporting improvements in some skin characteristics; evidence for exosomes remains uneven. Scientific potential should be distinguished from benefits demonstrated in people, and neither a product label nor a laboratory result establishes what a procedure will achieve.
What do studies suggest about polynucleotides for skin?
Studies of polynucleotides suggest potential improvements in skin hydration, elasticity, texture and fine lines, although studies are relatively few and protocols differ. Polynucleotides, or PN, and PDRN are preparations based on fragments of nucleic acids. In aesthetic medicine, they are used primarily to improve skin quality. I therefore do not promise patients that a treatment will make them “10 years younger” or “restart their cells.” A more accurate description is that polynucleotides may improve skin quality and support tissue repair processes.
For example, a woman aged 40–45 may have thin, dry skin, fine lines and reduced elasticity without marked tissue sagging. Polynucleotides may be a reasonable part of a broader treatment plan in that situation. When pronounced sagging is the main problem, they do not replace methods that directly address lifting.
Are blood tests needed first?
A large laboratory panel is not required before a routine local aesthetic procedure. We do not request dozens of tests simply because someone wants polynucleotides. If there is a medical concern, however, it should be assessed first.
For significant hair loss, an initial assessment may include a complete blood count, ferritin, iron and total iron-binding capacity or transferrin saturation, and TSH. Vitamin D, B12, folate, zinc, a hormone assessment or other investigations may be added when indicated. There is no universal ferritin value at which polynucleotide treatment becomes automatically unsuitable.
A ferritin level of 26 ng/mL alone, for example, is not enough to diagnose iron deficiency in every patient. Hemoglobin, other iron markers and possible causes of deficiency must be considered alongside symptoms and the clinical picture.
What are exosomes?
Exosomes are involved in communication between cells and can carry biologically active molecules. This makes them an active area of regenerative medicine research, but an interesting scientific concept should not be confused with a proven clinical benefit.
Dermatology studies report promising results for skin repair, healing, pigmentation and some hair concerns. However, the sources of exosomes and the methods used to isolate, purify and concentrate them vary. A product labelled “Exosomes” does not automatically have proven efficacy, and different products cannot be assumed to be equivalent.
Where does marketing go beyond the evidence?
Claims such as “repairs DNA,” “restarts stem cells,” “rejuvenates the body at a cellular level” or “completely restores the skin” go beyond what can currently be confidently promised to a patient. I approach such statements cautiously.
An effect in a laboratory cell culture is not the same as a demonstrated effect in people. Showing that a substance influences a cellular process does not establish that a patient's skin will become several years younger after a procedure.
How do we choose a procedure in the clinic?
Choosing a procedure starts with assessing dryness, pigmentation, hair loss or another skin concern. Dryness calls for a review of the skin barrier and daily care. Pigmentation requires assessment of its type and possible causes. With hair loss, we look for triggers and deficiencies before recommending a regenerative procedure.
Active inflammation, infection or impaired healing should be addressed first. Only then do we choose a procedure. Polynucleotides may form part of a combined treatment plan when this is justified by the condition of the skin.
Why address skin care and sun protection first?
Dryness, sun damage and a compromised skin barrier may need basic skin care and photoprotection before a procedure. For example, a patient may request exosomes for skin that has deteriorated, while examination reveals these problems and very little use of sun protection. Beginning with an expensive cellular treatment is not always the logical first step.
We first work on basic skin care and photoprotection. A single procedure cannot compensate for substantial daily ultraviolet exposure.
Someone who has lost a significant amount of weight and has reduced skin density or quality may need a different, combined approach. Polynucleotides could be one part of that plan.
Polynucleotides and exosomes: what can patients expect?
Polynucleotides have clinical evidence supporting improvements in some skin characteristics, but they are not a miracle treatment or a substitute for surgical lifting. Exosomes remain a promising area, with uneven evidence and unresolved questions about product standardization, treatment amounts and long-term safety.
My approach is to choose treatment according to the patient's needs rather than the newest trend. The aim is a considered plan with realistic expectations about benefits, limitations and lasting skin care.
Our Molecular Derma page describes the clinic’s approach to skin assessment. To understand another group of substances used in medicine, read what peptides are and how they are considered.
Author: Dr. Yulia Kliakhina — General Practitioner, Aesthetic Physician.