Biosome Therapy for Androgenetic Alopecia in a Patient With Incomplete Response to Minoxidil and Finasteride: A Case Report

ABSTRACT

A 25‐year‐old man with androgenetic alopecia showed limited response to long‐term minoxidil and finasteride. Three monthly Biosome treatment sessions were associated with progressive clinical improvement in apparent hair coverage on serial follow‐up photographs, without treatment‐related adverse events during the 3‐month observation period. This case provides a hypothesis‐generating clinical observation supporting further investigation of Biosome‐based therapy using standardized and objective outcome measures.

Key Clinical Message

Serial Biosome treatment was associated with clinically apparent improvement in scalp coverage in this patient with androgenetic alopecia. Given the continued use of minoxidil and finasteride, non‐standardized photography, absence of objective hair‐density measurements, and short follow‐up, this observation should be considered hypothesis‐generating rather than evidence of treatment efficacy or safety.

1. Introduction

Androgenetic alopecia (AGA), also referred to as pattern hair loss, is a non‐scarring form of alopecia characterized by progressive miniaturization of hair follicles and gradual reduction in terminal hair growth [1]. It represents the most common cause of hair loss affecting both men and women worldwide [2, 3]. In men, AGA typically presents with frontotemporal hairline recession and vertex thinning, whereas women more commonly exhibit diffuse thinning over the central scalp with relative preservation of the frontal hairline [2, 3].

Current therapeutic strategies for androgenetic alopecia primarily focus on slowing disease progression and stimulating hair follicle activity. Topical minoxidil and oral finasteride remain the most widely used pharmacologic treatments for AGA. Minoxidil promotes hair growth through mechanisms including vasodilation and prolongation of the anagen phase of the hair cycle, while finasteride acts as a selective inhibitor of Type II 5‐α‐reductase, reducing the conversion of testosterone to dihydrotestosterone (DHT), a key mediator of follicular miniaturization. Despite their widespread use, treatment responses remain variable, and many patients experience incomplete hair regrowth or persistent hair thinning even with long‐term therapy [4].

In recent years, regenerative medicine has introduced novel therapeutic strategies for hair loss disorders. Among these emerging approaches, extracellular vesicles such as exosomes have attracted increasing attention because of their role in intercellular communication and tissue regeneration. Exosomes are nano‐sized extracellular vesicles originating from the endosomal compartment of cells and contain diverse bioactive cargo including proteins, lipids, messenger RNA, and microRNA capable of influencing cellular signaling pathways in recipient cells [5]. In dermatology, exosomes have demonstrated potential roles in wound healing, scar remodeling, anti‐inflammatory activity, and hair regeneration, although further research is required to establish standardized treatment protocols and confirm long‐term safety and efficacy [5].

Experimental studies have suggested that exosome‐mediated signaling may promote hair follicle growth and regeneration. For example, exosomes derived from platelet‐rich plasma have been shown to stimulate dermal papilla cell proliferation and enhance hair follicle development through activation of the Wnt/β‐catenin signaling pathway, a critical pathway involved in hair follicle cycling and regeneration [6]. These findings highlight the potential of exosome‐based therapies as a promising regenerative approach for the treatment of androgenetic alopecia.

Therefore, novel therapeutic strategies are being investigated for patients with androgenetic alopecia who demonstrate suboptimal response to conventional treatments. In this report, we describe the use of a Biosome‐based formulation containing 25 billion biomimetic exosome‐like vesicles administered via intradermal scalp injection in a 25‐year‐old patient with androgenetic alopecia who had persistent hair thinning despite prolonged treatment with topical minoxidil and oral finasteride.

2. Case History/Examination

A 25‐year‐old patient presented with progressive hair thinning involving the frontal scalp and vertex regions consistent with androgenetic alopecia. The patient reported long‐term medical treatment for androgenetic alopecia including topical minoxidil 5% applied for 6 years and oral finasteride 1 mg daily for 3 years. Despite therapy, the patient noted a persistent reduction in hair density.

Clinical examination demonstrated patterned hair thinning involving the frontal, midline, and vertex scalp regions. Widening of the central hair part with visible scalp exposure was observed, along with recession of the frontal hairline and reduced hair density at the vertex. These findings were consistent with androgenetic alopecia.

No evidence of scarring alopecia, erythema, perifollicular scaling, or inflammatory scalp disease was observed. Mild scalp scaling suggestive of seborrheic dermatitis was noted. Baseline clinical photographs documenting the distribution of hair thinning are presented in Figure 1.

FIGURE 1.

Baseline clinical photographs demonstrating androgenetic alopecia prior to treatment. (A) Frontal scalp view demonstrating recession of the frontal hairline. (B) Midline scalp view demonstrating widening of the central hair part with visible scalp exposure. (C) Vertex scalp view demonstrating decreased hair density at the crown.

3. Intervention

After obtaining informed consent, the patient underwent intradermal scalp injection using a Biosome‐based formulation (AnteAGE MDX Biosomes Hair Solution). A total volume of 5 mL containing 25 billion biomimetic exosome‐like vesicles was administered via multiple intradermal microinjections across the affected scalp areas.

4. Follow‐Up and Outcomes

At the 1‐month follow‐up visit after the first Biosome treatment session, clinical examination demonstrated early signs of response. Comparison with baseline photographs showed the presence of short, newly emerging hairs within the frontal and midline scalp regions. Hair thinning remained evident; however, subtle improvement in hair coverage was observed in selected treated areas. No treatment‐related adverse events were reported following treatment. Clinical photographs obtained at the 1‐month follow‐up are presented in Figure 2.

FIGURE 2.

Clinical photographs obtained one month after the first Biosome treatment session. (A) Frontotemporal scalp view demonstrating the treated frontal hairline and temporal recession region one month after treatment. (B) Midline scalp view demonstrating persistent central scalp thinning with early evidence of short hair growth within the affected area. (C) Vertex scalp view demonstrating maintained crown involvement with subtle improvement in hair coverage compared with baseline.

At the 2‐month follow‐up, continued clinical improvement was observed following the second Biosome treatment session. Comparison with baseline and 1‐month examinations demonstrated progressive improvement in apparent hair coverage across the frontal, midline, and vertex scalp regions. The frontal scalp exhibited increased coverage with the appearance of numerous short, newly growing hairs along previously thinned areas. Examination of the central scalp revealed a modest reduction in scalp visibility and an apparent improvement in overall hair coverage.

The vertex scalp also demonstrated improvement, with increased surrounding hair coverage and reduced prominence of the alopecic area compared with earlier assessments, although residual thinning remained evident. Hair shafts appeared more numerous and uniform across the treated scalp, contributing to an overall fuller appearance.

The patient reported ongoing satisfaction with treatment outcomes and denied any treatment‐related adverse effects. No erythema, tenderness, infection, or other complications were observed during follow‐up. Clinical photographs obtained at the 2‐month follow‐up are presented in Figure 3.

FIGURE 3.

Clinical photographs obtained 2 months after initiation of biosome treatment. (A) Frontotemporal scalp view demonstrating increased short hair growth and improved coverage within the frontotemporal region. (B) Midline scalp view showing apparent improvement in hair coverage with reduced scalp visibility compared with previous assessments. (C) Vertex scalp view demonstrating improvement in hair coverage with decreased scalp visibility, although mild residual thinning remains present.

At the 3‐month follow‐up after the third Biosome treatment session, continued clinical improvement was observed across all treated scalp regions. Comparison with baseline and previous follow‐up examinations demonstrated progressive improvement in apparent hair coverage within the frontal, midline, and vertex scalp regions. The frontal hairline and frontotemporal regions exhibited increased numbers of short terminal and intermediate hairs, contributing to improved hairline definition and reduced visibility of underlying scalp.

Improvement was also evident throughout the central scalp, where greater hair coverage resulted in a noticeable reduction in scalp visibility. The vertex demonstrated further improvement in apparent hair coverage with decreased crown scalp exposure compared with earlier assessments, although mild residual thinning remained present. Overall hair volume and coverage appeared enhanced, and the patient reported continued satisfaction with treatment outcomes without experiencing any treatment‐related adverse effects. Clinical photographs obtained at the 3‐month follow‐up are presented in Figure 4.

FIGURE 4.

Three‐month follow‐up after the third Biosome treatment session. Clinical photographs obtained at the 3‐month follow‐up after the third Biosome treatment session. (A) Left frontotemporal scalp demonstrating increased hair coverage with numerous short terminal and intermediate hairs along the frontal hairline and temporal recession area. (B) Frontal and midline scalp view showing improved apparent hair coverage with reduced scalp visibility compared with baseline and earlier follow‐up examinations. (C) Vertex scalp demonstrating further improvement in hair coverage with decreased crown scalp exposure, although mild residual thinning remains visible.

5. Conclusion

In this single case, serial Biosome treatment was associated with clinically apparent improvement in scalp coverage over a 3‐month observation period. Because the patient continued topical minoxidil and oral finasteride, the contribution of concomitant therapy cannot be excluded. Assessment was based on clinical examination and non‐standardized serial photographs, without objective hair‐density or trichoscopic measurements. No treatment‐related adverse events were observed during the 3‐month follow‐up. These findings should be considered hypothesis‐generating and require confirmation in controlled studies using standardized objective outcome measures and longer follow‐up.

6. Discussion

Androgenetic alopecia (AGA) is a progressive disorder characterized by gradual miniaturization of hair follicles, resulting in reduced hair density and scalp coverage [1, 2, 3]. Although topical minoxidil and oral finasteride remain the standard therapeutic options, treatment outcomes are often variable and require long‐term adherence. Consequently, regenerative approaches have attracted increasing interest as potential strategies for promoting hair follicle regeneration and improving clinical outcomes.

In the present case, serial Biosome treatments were associated with progressive clinical improvement in a patient with androgenetic alopecia. Following the first treatment session, early signs of response were observed, including the appearance of short newly emerging hairs within the frontotemporal and midline scalp regions. Continued improvement was documented after the second treatment session, with improved apparent hair coverage and reduced scalp visibility involving the frontal, midline, and vertex regions. By the third‐month follow‐up after the third treatment session, further improvement in apparent hair coverage was observed across the treated scalp regions, accompanied by improved hairline definition and reduced crown scalp exposure. The patient reported continued satisfaction with the treatment outcomes, and no treatment‐related adverse events were observed throughout the treatment course.

An important consideration in interpreting the present case is that the patient continued treatment with topical minoxidil and oral finasteride throughout the observation period. However, the patient had received topical minoxidil for 6 years and oral finasteride for 3 years before initiation of Biosome therapy, with persistent hair thinning and no reported substantial clinical improvement. The temporal association between the initiation of Biosome treatment and the subsequent clinical improvement observed during follow‐up suggests that Biosome therapy may have contributed to the observed response. Nevertheless, the potential contribution of concurrent conventional therapy cannot be completely excluded, and the observed clinical changes cannot be attributed solely to Biosome treatment.

The clinical improvement observed in this case may be relevant to the broader literature investigating extracellular vesicle and exosome‐based approaches to androgenetic alopecia. Darwish et al. [7], in a systematic review comparing exosome therapy, platelet‐rich plasma (PRP), and minoxidil, concluded that exosome therapy demonstrated promising results in terms of hair regrowth, hair density, patient satisfaction, and safety profile. The authors reported that mesenchymal stem cell‐derived exosomes produced improvements in hair growth parameters compared with conventional therapies while maintaining minimal adverse effects.

Similarly, Ersan et al. [8] demonstrated significant clinical improvement in patients with androgenetic alopecia treated with foreskin‐derived mesenchymal stromal cell exosomes. Hair density increased significantly during follow‐up, accompanied by improvements in patient‐reported outcomes and satisfaction scores. Importantly, no treatment‐related complications or serious adverse effects were reported.

Additional support for the regenerative potential of exosome therapy has been reported by Bento et al. [9], who described successful treatment of refractory alopecia areata using exosome therapy. Progressive improvement was observed throughout the treatment period, including increased hair density, restoration of hair pigmentation, and eventual complete hair regrowth. Although alopecia areata differs from androgenetic alopecia in pathogenesis, these findings provide additional context regarding the potential regenerative effects of extracellular vesicle‐based approaches in hair disorders.

The Biosome formulation used in this case is a biomimetic exosome‐like formulation and should be distinguished from the biologically derived exosome preparations described in the cited literature.

The biological mechanisms proposed for exosome‐based approaches continue to be investigated. Exosomes contain a variety of bioactive molecules, including growth factors, cytokines, messenger RNA, and microRNA, which facilitate intercellular communication and tissue regeneration. These extracellular vesicles may stimulate dermal papilla cell proliferation, enhance angiogenesis, modulate local inflammatory responses, and prolong the anagen phase of the hair cycle. Zhou et al. [10] demonstrated that activation of the Wnt/β‐catenin signaling pathway promotes proliferation, differentiation, and migration of hair follicle stem cells, leading to enhanced follicular regeneration and tissue repair. Conversely, inhibition of this pathway reduced stem cell marker expression and impaired regenerative capacity. These proposed mechanisms provide a plausible biological rationale for further investigation of Biosome‐based approaches but were not directly assessed in the present patient.

An important strength of this report is the detailed sequential photographic documentation obtained before treatment and after each treatment session. The progressive clinical improvement observed across multiple scalp regions, including the frontotemporal, midline, and vertex scalp, provides visual documentation of the observed changes in hair coverage over time. However, the serial photographs were not obtained using a fully standardized photographic protocol. Differences in camera angle, lighting, hair positioning, and scalp exposure may influence visual interpretation and should therefore be considered when assessing the apparent clinical improvement.

7. Limitations

This report has several limitations. First, it describes a single patient without a control or comparator group, limiting the ability to establish a causal relationship between Biosome treatment and the observed clinical changes. Second, topical minoxidil and oral finasteride were continued throughout the observation period, and therefore a contribution from ongoing conventional therapy cannot be excluded. Third, treatment response was assessed clinically and through serial photographs without objective hair‐density measurements or trichoscopic assessment. Fourth, the serial photographs were not obtained using a fully standardized photographic protocol, and differences in camera angle, lighting, hair positioning, and scalp exposure may influence visual interpretation. Finally, follow‐up was limited to three months, which is insufficient to determine the durability of the observed response or longer‐term safety.

No treatment‐related adverse events were observed in this patient during the treatment course; however, the single‐patient design and short follow‐up do not permit conclusions regarding the long‐term safety of Biosome treatment.

Author Contributions

Mohammed Almashali: conceptualization, investigation, funding acquisition, writing – original draft, methodology, validation, visualization, writing – review and editing, project administration, data curation, supervision, resources.

Funding

The author has nothing to report.

Ethics Statement

Ethical approval was granted by the Institutional Review Board of Imam Mohammad Ibn Saud Islamic University.

Consent

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Conflicts of Interest

The author declares no conflicts of interest.

Data Availability Statement

No research data is available outside of the manuscript.