The ANOVA Hair Loss Stem Cell Secretome Treatment Programme Germany

You have tried a lot. We listen first, examine thoroughly, and then tell you honestly whether a stem cell-based therapy, one of our programmes or another option could be right for you. Each option is discussed as an addition to your current treatment, never as a replacement.

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Hair loss, medically called alopecia, has several forms. The most common is androgenetic alopecia (AGA), or pattern hair loss: in men, the hairline recedes and the crown thins. In women, this is called female pattern hair loss: the hair becomes thinner over the top of the head.^[8] It is caused by hereditary sensitivity of the hair follicles to male hormones, which makes the follicles shrink step by step.^[8]

Alopecia areata is a different condition. Here the immune system attacks the hair follicles, and round bald patches appear, sometimes the loss of all scalp or body hair.^[1] The diagnosis is usually made by a dermatologist from the pattern of hair loss and an examination of the scalp with a magnifying device (trichoscopy).^[7] To date, no cure is known for androgenetic alopecia or alopecia areata; approved treatments can slow hair loss or help hair regrow while they are used.^[8],[1]

Common signs include a receding hairline, thinning at the crown or along the parting, a wider parting, more hair on the pillow or in the brush, and round bald patches.

More details can be found below in our scientific section on hair loss.

ANOVA offers autologous mesenchymal stem cell secretome (MSEC) for adults with hair loss, including androgenetic alopecia and alopecia areata. The programme combines a review of your dermatological diagnosis and previous treatment with repeated injections of MSEC into the affected areas of the scalp. Each component is selected individually; the programme is not a fixed package.

Stem cells are thought to act mainly through soluble factors, together called the secretome, which includes exosomes and many other factors. In external laboratory and animal studies, such factors stimulated the cells at the base of the hair follicle that control hair growth.^[14],[15] MSEC aims to support these cells in the scalp.

ANOVA IRM has not yet tested MSEC in a clinical study. The current state of research is described in the clinical and scientific section below.

Before any application, we check that your hair loss has been diagnosed by a dermatologist and which form it is. We look at the treatments you have used so far, and at blood values such as ferritin and thyroid hormones, to rule out causes that can be treated directly. The physician also examines your scalp. MSEC is considered only where hair follicles are still present.

MSEC is the cell-free mixture of signalling molecules released by your own mesenchymal stromal cells from fat tissue. For hair loss it is injected into the skin of the affected scalp areas. In small external clinical studies, a case series and a randomised trial, preparations from fat-derived stem cells were injected into or applied to the scalp, and hair counts rose more than with placebo.^[16],[17] These were not ANOVA products; the details are summarised in the clinical and scientific section below.

ANOVA IRM does not perform hair transplantation. Medicines prescribed by your dermatologist and cosmetic measures are not part of our programme either; they remain with your own doctors.

Which tests are used to diagnose hair loss?

Most forms of hair loss are recognised by their pattern and by a close look at the scalp. A dermatologist uses a magnifying device (trichoscopy) to see shrunken hairs or the typical signs of alopecia areata.^[7] A gentle pull test shows whether hair is currently falling out in larger numbers. Blood tests for iron stores (ferritin) and thyroid function help to find other causes. If the diagnosis remains unclear, a small skin sample (scalp biopsy) is examined.^[7]

What do we review before hair loss treatment at ANOVA IRM?

Before any treatment decision we review your dermatologist’s diagnosis, the treatments you have used and for how long, and recent blood values. We ask how your hair loss has developed and since when. The physician examines your scalp and records its condition in standardised photographs for your medical record. We also check that you are fit for the brief sedation required for tissue collection.

• Standard: an MRI of the abdominal wall to exclude a hernia is required before the liposuction, taken no more than four weeks beforehand. It can be done at home or at ANOVA IRM.

Imaging can be carried out in-house; all examinations can also be done by your own doctors. The full diagnostic pathway is described on our diagnostics page.

We make MSEC ourselves in Offenbach, in-house since 2018 (see our regulatory status). The review of your previous findings, the tissue collection and the scalp injections take place in one building. Your dermatologist remains the basis of your care.

You can start with a remote assessment, by phone or video, so no journey to Germany is needed at first. Treatment itself takes place in person in Offenbach am Main, less than 20 minutes from Frankfurt Airport. Before you decide, you receive an individual written cost estimate; the services of our patient care team are free of charge. If you would like your existing findings reviewed independently, we also offer a second opinion.

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In this section you will find everything about treatment for hair loss (alopecia) at ANOVA IRM: who is eligible, the process step by step and the cost.

1. 01
   Initial evaluation

   Remote, by phone or video — typically 2 weeks to a few months

2. 02
   Preliminary screening

   In your home country, to avoid an unnecessary journey

3. 03
   First visit — bloodwork and tissue collection

   Two-day outpatient visit to Offenbach: bloodwork first, then — if the results are in order — mini-liposuction under brief sedation

4. 04
   Production and quality control

   Approximately 4 weeks; yields 10 doses

5. 05
   Storage

   Up to 2 years, allowing an extended personalised schedule

6. 06
   Application schedule

   Number of doses per application according to the size of the treated scalp area; interval set individually, according to where you live

We consider adults with any form of hair loss, men and women alike: androgenetic alopecia (male and female pattern hair loss), alopecia areata and other non-scarring forms. Your diagnosis should have been made by a dermatologist. Hair follicles should still be present in the affected areas, because a treatment cannot act where they have been lost. Where iron deficiency or thyroid disease contributes, it should be examined and treated as well. You need to be well enough for mini-liposuction under brief sedation and able to travel to Offenbach for repeated applications. Every treatment recommendation follows a full clinical evaluation in which the treating physician weighs benefit and risk. Applying for an evaluation does not mean that treatment will be offered.

What are the contraindications for hair loss treatment?

Our treatments are experimental. We treat only people for whom, after medical assessment, we consider the benefit-risk balance to support treatment.

Applies to all ANOVA treatments:

• Active cancer within the last two years
• Under the age of legal majority
• Pregnancy or breastfeeding
• Active infectious disease (hepatitis A, B, C, HIV, syphilis or other)

Specific to hair loss:

• Infection or inflammation of the scalp in the area to be treated
• Scarring hair loss, in which the hair follicles have been destroyed
• Blood test results that speak against treatment
• Psychiatric disorder that would prevent informed consent or cooperation

What screening is needed before you travel for hair loss treatment?

A preliminary screening in your home country helps you avoid an unnecessary journey. It usually consists of a blood test for HIV, hepatitis A, B or C, syphilis and other active infections. Together with your dermatologist’s report and recent blood values, such as ferritin and thyroid hormones, it shows early whether medical factors would rule out treatment.

What happens at your first visit to Offenbach for hair loss treatment?

The first treatment visit takes about two days in Offenbach and is outpatient. On the first day, bloodwork is repeated at ANOVA IRM as German medical rules require. The physician then examines your scalp and completes the final assessment, including your fitness for sedation. If the results are in order, a small amount of abdominal fat tissue is collected the next day by mini-liposuction under brief sedation. The first secretome application usually follows four to six weeks later.

How is your MSEC for hair loss produced and quality-controlled?

In our own facility in Offenbach, mesenchymal stromal cells are isolated from the collected fat tissue and expanded. This takes place under official authorisation and officially inspected good professional practice (GFP). From these cells we obtain your MSEC — the signalling molecules they release, not the living cells. Production and quality control take approximately four weeks and yield 10 doses per production cycle. Every patient batch is tested with methods validated according to the European Pharmacopoeia (Ph. Eur.) and GMP and released under a documented procedure. The released secretome is stored at −80 °C and keeps for up to two years.

How often is MSEC applied for hair loss?

Most forms of hair loss are long-term conditions, and there is currently no cure. We therefore recommend a longer-term treatment using all 10 doses produced rather than a single application; see the timeline above.

The number of doses per application depends on the size of the scalp area to be treated. The interval between applications is then set individually, mainly according to where you live, for example:

• If you live close by: an MSEC application every 4 to 6 weeks.
• If you live further away: an application about every 3 months.
• Standard route for hair loss: a series of small injections into the skin of the affected scalp areas (intradermal), under local anaesthesia of the scalp and under medical supervision in Offenbach. This is intended to bring the secretome close to the hair follicles. For hair loss, MSEC is not given as an infusion.

All doses must be used within the two-year shelf life of the stored MSEC; continuing after that requires a new tissue collection and production cycle. Each session takes about one hour, including preparation and a short period of observation.

MSEC treatment costs approximately €20,000–€36,000, depending on the number of doses (three to ten), and requires a two-day visit for tissue collection, followed by further visits. It is billed according to the German Medical Fee Schedule (GOÄ). The base package — the mini-liposuction and the first three MSEC doses — costs approximately €20,000; each further dose costs approximately €2,250. How many doses are used depends mainly on the size of the scalp area to be treated. Because we recommend using all 10 doses over a longer period, most treatment plans reach the upper end of this range.

A double liposuction can be recommended if you wish to continue for longer: it yields 20 doses, which can be used over the current shelf life of two years from a single collection. The cost is correspondingly higher and is shown in your individual estimate.

Further examinations and your sedation preferences also affect the total, and you receive an individual written estimate before any treatment decision. Our blog post on treatment cost explains what drives the cost of stem cell treatment in general. Travel, accommodation and other personal expenses, including those of an accompanying person, are not included. MSEC treatment for hair loss is self-funded. All prices are subject to change.

Why does the cost of hair loss treatment vary with the treated area?

All treatments at ANOVA IRM are billed according to the German Medical Fee Schedule (Gebührenordnung für Ärzte, GOÄ); within it, the cost depends mainly on the number of doses used. For hair loss we administer MSEC only by injection into the scalp, because in our assessment it is most likely to act there: the hair follicles sit directly in the treated skin. The larger the affected area, the more doses are needed per application; the price per dose stays the same. The exact cost of your treatment plan is set out in your individual written cost estimate.

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Each hair follicle is a small organ that passes through repeated cycles: a growth phase (anagen), a short phase of regression (catagen) and a resting phase (telogen), after which the hair is shed.^[5] At the base of the follicle sits the dermal papilla, a group of specialised cells that controls hair growth. Its signals, among them the Wnt/β-catenin pathway, keep the follicle in the growth phase.^[6]

In androgenetic alopecia (AGA), hair follicles in certain scalp areas are genetically sensitive to androgens, in particular dihydrotestosterone. With each cycle the growth phase becomes shorter and the follicles shrink (miniaturisation), so that thick hairs are gradually replaced by fine, short ones.^[8] In affected scalp, the Wnt inhibitor DKK-1 is raised, and androgens dampen Wnt signalling in dermal papilla cells.^[6] In men, the pattern is graded with the Hamilton–Norwood scale; in women, separate scales describe the thinning over the crown.^[3],[8]

Alopecia areata is an autoimmune disease. The hair follicle normally hides from the immune system (immune privilege); when this protection collapses, immune cells attack the follicle in the growth phase. The follicle itself is preserved, which is why hair can regrow.^[1] The lifetime risk is about 2%.^[2] Its extent is measured with the Severity of Alopecia Tool (SALT), which gives the percentage of scalp hair lost.^[4]

What causes hair loss, and what are the risk factors?

The causes differ by form; in many people, more than one factor plays a part.

• Heredity and androgens: the main causes of androgenetic alopecia in men and women.^[8]
• Age: pattern hair loss becomes more common with every decade, in men and women.^[8]
• Autoimmunity: in alopecia areata, often together with other autoimmune conditions such as thyroid disease; a family history increases the risk.^[1]
• Other causes: iron deficiency, thyroid disease, certain medicines, severe illness or stress can cause diffuse shedding (telogen effluvium), which usually recovers once the cause is treated.^[7]
• Scarring alopecias: rare inflammatory diseases that destroy the follicle; they need dermatological treatment and are not treated with MSEC.^[7]

What drives the progression of hair loss?

In androgenetic alopecia, miniaturisation continues as long as the androgen effect on the follicle persists. Over many years, more follicles produce only fine hairs, and some stop producing visible hair. Treatments therefore aim to stop or slow this process; they work best while follicles are still present.^[8] Our programme aims to support follicles that are still present.

Alopecia areata follows an unpredictable course. Many patches regrow on their own, but relapses are common, and extensive forms that affect the whole scalp (alopecia totalis) or all body hair (alopecia universalis) are less likely to recover.^[1]

For androgenetic alopecia, the European evidence-based (S3) guideline describes treatment for men and women.^[8] In men, minoxidil solution or foam applied to the scalp (2% to 5%) and finasteride tablets (1 mg daily) are recommended. In women, topical minoxidil is recommended; finasteride is not.^[8] Dutasteride can be considered as a second option in men; in Europe it is not approved for this use.^[8] An international expert consensus has described how to start low-dose minoxidil tablets.^[9]

Platelet-rich plasma (PRP), injected into the scalp, increased hair density in a meta-analysis, but the studies were small and differed widely.^[10] Hair transplantation moves follicles from the back of the head to thinning areas; it needs enough donor hair and stable hair loss.

For alopecia areata, the German S3 guideline of 2025 recommends corticosteroids applied to or injected into the skin.^[11] For severe forms in adults, it recommends the JAK inhibitors baricitinib and ritlecitinib.^[11] In two phase 3 trials, 38.8% and 35.9% of patients on baricitinib 4 mg had 20% or less scalp hair loss after 36 weeks, compared with 6.2% and 3.3% on placebo.^[12] Baricitinib has been approved in the EU since 2022 and ritlecitinib since 2023; in the EU, both are now also approved for adolescents aged 12 and over (baricitinib since April 2026).^{[12],[13],[27]} Statutory health insurance in Germany does not cover these medicines for alopecia areata.^[11]

These treatments slow hair loss or help hair regrow in many people, but none cures it, and their effect usually ends when they are stopped. MSEC does not replace standard care.

How is hair loss diagnosed, and what do we not do ourselves?

Hair loss is diagnosed by your dermatologist, not by us. The basis is the history and the pattern of hair loss. Trichoscopy, an examination of the scalp with a dermatoscope, shows miniaturised hairs of different thickness in androgenetic alopecia and exclamation-mark hairs or yellow dots in alopecia areata.^[7],[11]

A pull test checks whether hair is currently shedding in larger numbers. A scalp biopsy is taken when the findings are unclear, for example to exclude a scarring alopecia.^[11] In alopecia areata, the SALT score records the extent, and thyroid function is checked.^[11],[4] Blood tests for blood count, iron stores (ferritin) and thyroid hormones help to identify other causes.^[7]

What we do ourselves is the MRI of the abdominal wall before the tissue collection, carried out at the Prof. Dr. Stehling Institut für Bildgebende Diagnostik GmbH in the same building, which also belongs to Dr. Stehling. We do not make the diagnosis of hair loss, take scalp biopsies or prescribe your hair loss medicines; please bring these findings from your doctors.

MSC secretome (MSEC)

The idea behind MSEC in hair loss is that the growth factors and extracellular vesicles (EVs, including exosomes) released by mesenchymal stromal cells may stimulate the dermal papilla. MSEC is made from adipose-derived mesenchymal stromal cells (AD-MSC), often called fat stem cells. Mesenchymal stem cells and mesenchymal stromal cells are two names for the same cells (MSC). The International Society for Cell & Gene Therapy recommends “stromal” for cells expanded in the laboratory, so MSEC is also called mesenchymal stromal cell secretome.^[23],[24] In an external laboratory and animal study, the conditioned medium of such cells promoted hair growth.^[14] Extracellular vesicles from mesenchymal stem cells activated dermal papilla cells in the laboratory, and injected into the skin of mice, they moved hair follicles from the resting into the growth phase.^[15]

First small external clinical studies point in the same direction. In a case series, 22 men and women received six intradermal injections of conditioned medium from fat-derived stem cells, and hair counts increased. In a half-side comparison with 10 patients, the treated side gained more than the side injected with saline.^[16] In a randomised, double-blind trial with 38 patients, a topical extract of fat-derived stem cells increased the hair count by 28.1% after 16 weeks, compared with 7.1% with the vehicle.^[17] A retrospective analysis described 39 patients treated with exosomes from fat-derived stem cells.^[18]

Two systematic reviews found that these studies were small and very different in design, and that no serious adverse events were reported.^[19],[20] Clinical studies have not yet been able to confirm an effect: in the first randomised, placebo-controlled study of exosomes from fat-derived stem cells, with 48 patients, no significant difference from the control group was found.^[21],[22]

None of these studies used ANOVA’s product, and almost all concerned androgenetic alopecia; for alopecia areata, clinical data are very limited.^[20]

What is the efficacy hypothesis behind MSC secretome in hair loss?

In androgenetic alopecia, androgens dampen Wnt signalling in dermal papilla cells, and the growth phase of the follicle becomes shorter.^[6] The hypothesis is that the growth factors and vesicles of the mesenchymal stromal cell secretome, injected close to the follicles, may support the dermal papilla and prolong the growth phase.^[14],[15]

A possible endpoint for testing this would be the change in hair density, measured by standardised trichoscopy in a defined scalp area, compared with an untreated or placebo-treated area. Our aim is to support follicles that are still present.

Talk to us about current changes or additions to the programme.

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We do not currently publish our own outcome data for hair loss. What we can say about MSEC in hair loss therefore rests on the published literature and on the rationale described above.

Stem cell-based treatment of hair loss is a young and fast-developing field, and individual results vary. Treatment goals are agreed with you individually and reviewed with standardised photographs of the scalp and your own assessment; trichoscopy can be carried out by your dermatologist.

What is the realistic goal of hair loss treatment?

Care for androgenetic alopecia aims to slow hair loss and preserve the hair you have, and in some people to thicken thinning hair.^[8] In alopecia areata, the aim is regrowth of the bald areas.^[11] For MSEC, the aim is to support the hair follicles that are still present, alongside the care of your dermatologist.

MSEC is an autologous tissue preparation, which ANOVA IRM manufactures under a collection (procurement) authorisation (Section 20b AMG) and a manufacturing authorisation under Section 20c AMG, granted in 2018 by the Darmstadt Regional Council, today the Hessian State Office for Health and Care (HLfGP), with the involvement of the Paul-Ehrlich-Institut; the HLfGP inspects the facility regularly. For hair loss, MSEC is given as an individual therapeutic attempt (individueller Heilversuch), which concerns the administration only and follows full disclosure and informed consent. Because the product is used only for ANOVA IRM’s own patients, no authorisation under Section 4b, no marketing authorisation under Section 21 and no approval under Section 21a AMG is required. The full derivation is on our regulatory status page.

Questions people usually ask next. Each is answered in full on its own page.

• Who are we?
• Is ANOVA legal?
• Is stem cell therapy safe?
• What is MSC secretome (MSEC)?
• What is BMC (Bone Marrow Concentrate)?
• What are stem cells?
• What should I ask when looking for a stem cell treatment?
• Which conditions do we treat?
• The ANOVA anti-ageing programme
• Infusion therapy programmes

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ANOVA IRM shares its premises in Offenbach with two further institutions owned by Dr. Stehling: the Institut für Bildgebende Diagnostik (IBDO), providing MRI and CT imaging, and the VITUS PRIVATKLINIK Prof. Dr. Stehling GmbH. Because imaging is carried out in the same building, the MRI of the abdominal wall required before the tissue collection can be performed in-house rather than referred elsewhere. See diagnostics at ANOVA IRM.

Literature specific to hair loss is listed here. General literature on MSC, secretome and extracellular vesicles is maintained on the MSC secretome page.

Hair loss — forms, frequency and classification

• [1] Pratt CH, King LE Jr, Messenger AG, et al. Alopecia areata. Nat Rev Dis Primers. 2017;3:17011. doi:10.1038/nrdp.2017.11. PMID: 28300084.
• [2] Mirzoyev SA, Schrum AG, Davis MDP, et al. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990–2009. J Invest Dermatol. 2014;134(4):1141–1142. doi:10.1038/jid.2013.464. PMID: 24202232.
• [3] Norwood OT. Male pattern baldness: classification and incidence. South Med J. 1975;68(11):1359–1365. doi:10.1097/00007611-197511000-00009. PMID: 1188424.
• [4] Olsen EA, Hordinsky MK, Price VH, et al. Alopecia areata investigational assessment guidelines – Part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51(3):440–447. doi:10.1016/j.jaad.2003.09.032. PMID: 15337988.

Biology of the hair follicle

• [5] Schneider MR, Schmidt-Ullrich R, Paus R. The hair follicle as a dynamic miniorgan. Curr Biol. 2009;19(3):R132–R142. doi:10.1016/j.cub.2008.12.005. PMID: 19211055.
• [6] Choi BY. Targeting Wnt/β-catenin pathway for developing therapies for hair loss. Int J Mol Sci. 2020;21(14):4915. doi:10.3390/ijms21144915. PMID: 32664659.

Diagnosis

• [7] Mubki T, Rudnicka L, Olszewska M, et al. Evaluation and diagnosis of the hair loss patient: part II. Trichoscopic and laboratory evaluations. J Am Acad Dermatol. 2014;71(3):431.e1–431.e11. doi:10.1016/j.jaad.2014.05.008. PMID: 25128119.

Guidelines and standard of care

• [8] Kanti V, Messenger A, Dobos G, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men – short version. J Eur Acad Dermatol Venereol. 2018;32(1):11–22. doi:10.1111/jdv.14624. PMID: 29178529.
• [9] Akiska YM, Mirmirani P, Roseborough I, et al. Low-dose oral minoxidil initiation for patients with hair loss: an international modified Delphi consensus statement. JAMA Dermatol. 2025;161(1):87–95. doi:10.1001/jamadermatol.2024.4593. PMID: 39565602.
• [10] Evans AG, Mwangi JM, Pope RW, et al. Platelet-rich plasma as a therapy for androgenic alopecia: a systematic review and meta-analysis. J Dermatolog Treat. 2022;33(1):498–511. doi:10.1080/09546634.2020.1770171. PMID: 32410524.
• [11] Deutsche Dermatologische Gesellschaft (DDG), coordinators Blume-Peytavi U, Wilborn D. S3-Leitlinie Diagnostik und Therapie der Alopecia areata bei Kindern, Jugendlichen und Erwachsenen. AWMF register no. 013-104, version 1.0, 18 September 2025. Accessed 22 October 2026. https://register.awmf.org/de/leitlinien/detail/013-104
• [12] King B, Ohyama M, Kwon O, et al.; BRAVE-AA Investigators. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med. 2022;386(18):1687–1699. doi:10.1056/NEJMoa2110343. PMID: 35334197.
• [13] King B, Zhang X, Harcha WG, et al. Efficacy and safety of ritlecitinib in adults and adolescents with alopecia areata: a randomised, double-blind, multicentre, phase 2b–3 trial. Lancet. 2023;401(10387):1518–1529. doi:10.1016/S0140-6736(23)00222-2. PMID: 37062298.

Stem cell secretome, conditioned medium and extracellular vesicles in hair loss

• [14] Won CH, Yoo HG, Kwon OS, et al. Hair growth promoting effects of adipose tissue-derived stem cells. J Dermatol Sci. 2010;57(2):134–137. doi:10.1016/j.jdermsci.2009.10.013. PMID: 19963355.
• [15] Rajendran RL, Gangadaran P, Bak SS, et al. Extracellular vesicles derived from MSCs activates dermal papilla cell in vitro and promotes hair follicle conversion from telogen to anagen in mice. Sci Rep. 2017;7(1):15560. doi:10.1038/s41598-017-15505-3. PMID: 29138430. PMCID: PMC5686117.
• [16] Fukuoka H, Suga H. Hair regeneration treatment using adipose-derived stem cell conditioned medium: follow-up with trichograms. Eplasty. 2015;15:e10. PMID: 25834689. PMCID: PMC4379938.
• [17] Tak YJ, Lee SY, Cho AR, et al. A randomized, double-blind, vehicle-controlled clinical study of hair regeneration using adipose-derived stem cell constituent extract in androgenetic alopecia. Stem Cells Transl Med. 2020;9(8):839–849. doi:10.1002/sctm.19-0410. PMID: 32420695. PMCID: PMC7381807.
• [18] Park BS, Choi HI, Huh G, et al. Effects of exosome from adipose-derived stem cell on hair loss: a retrospective analysis of 39 patients. J Cosmet Dermatol. 2022;21(5):2282–2284. doi:10.1111/jocd.14846. PMID: 35157363.
• [19] Krefft-Trzciniecka K, Piętowska Z, Nowicka D, et al. Human stem cell use in androgenetic alopecia: a systematic review. Cells. 2023;12(6):951. doi:10.3390/cells12060951. PMID: 36980291.
• [20] Al Ameer MA, Alnajim AT, Al Ameer A, et al. Exosomes and hair regeneration: a systematic review of clinical evidence across alopecia types and exosome sources. Clin Cosmet Investig Dermatol. 2025;18:2215–2227. doi:10.2147/CCID.S543451. PMID: 40955427.
• [21] Tang WZ, Liao CY, Xu HY, et al. Extracellular vesicles for androgenetic alopecia: current evidence, mechanisms, and clinical prospects. Int J Nanomedicine. 2026;21:621203. doi:10.2147/IJN.S621203. PMID: 42756864.
• [22] Luna-Garza DK, Lara-Arias J, Lucero-Gomez M, et al. Microneedling with adipose MSC exosomes versus monotherapy for androgenetic alopecia. J Eur Acad Dermatol Venereol. 2026 (published online 2 July 2026). doi:10.1111/jdv.70598. PMID: 42390311.
• [23] Dominici M, Le Blanc K, Mueller I, et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy. 2006;8(4):315–317. doi:10.1080/14653240600855905. PMID: 16923606.
• [24] Viswanathan S, Shi Y, Galipeau J, et al. Mesenchymal stem versus stromal cells: International Society for Cell & Gene Therapy (ISCT®) Mesenchymal Stromal Cell committee position statement on nomenclature. Cytotherapy. 2019;21(10):1019–1024. doi:10.1016/j.jcyt.2019.08.002. PMID: 31526643.

Approval status

• [25] U.S. Food and Drug Administration. Consumer alert on regenerative medicine products including stem cells and exosomes. 22 July 2020. Accessed 22 October 2026. https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes
• [26] U.S. Food and Drug Administration. Approved Cellular and Gene Therapy Products. Accessed 22 October 2026. https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/approved-cellular-and-gene-therapy-products
• [27] European Medicines Agency. Olumiant (baricitinib): EPAR — product information, extension of indication to adolescents aged 12 years and older with severe alopecia areata. Accessed 26 October 2026. https://www.ema.europa.eu/en/medicines/human/EPAR/olumiant