Psoriasis and vitiligo are chronic immune mediated skin diseases that severely affect their physical appearance, emotional states, and life in general. Psoriasis is a disease marked by an overgrowth of the keratinocytes, their aberrant differentiation, and inflammatory cytokine pathways [1] whereas vitiligo is a disease that is associated with a melanocyte autoimmune destruction resulting in depigmented skin patches [2]. Both are chronic, they are relapsing and often they go hand in hand with psychological distress, social stigma, and low self-confidence [3]. Topical corticosteroids, calcineurin inhibitors, phototherapy, and systemic immunosuppressive agents are some of the conventional treatment options that are usually used to manage the activity of the disease. Nevertheless, these therapies can only offer partial or even temporary benefits and can be linked with side effects especially when used over a long period of time [4]. Besides, clinical variation in treatment response, and recurrence are also key issues and more focused as well as safer long-term treatment approaches must be considered [5]. Exosome therapies are a new development in regenerative medicine and dermatology with great potential. Exosomes refer to the nanosized extracellular vesicles that are used to communicate between cells by transfer of bioactive molecules including proteins, lipids and nucleic acids [6]. These vesicles have strong anti-inflammatory, immunomodulatory, and regenerative effects and are thus desirable for treating chronic inflammatory and autoimmune dermatological conditions [7].

Exosomes can be used in psoriasis to inhibit the activity of inflammatory cytokines, regulate immunogenic responses, and, consequently, slow disease progression and severity [8]. They can also increase melanocyte survival, proliferation, and migration in vitiligo, facilitating repigmentation and normalisation of skin architecture [9]. Moreover, exosomes can enhance the local skin microenvironment by increasing cellular repair pathways and decreasing oxidative stress [10]. The other significant benefit of exosome-based therapy is its favourable safety and delivery profile compared with conventional and cell-based therapies. Exosomes are less antigenic, pose minimal tumour formation risk, and can be stored and given with greater ease [11]. They can be localised and achieve greater therapeutic efficacy due to their small size, enabling penetration into tissues and localisation (this is also possible) [12]. Although these are encouraging results, there are still scanty clinical studies on the application of exosome-based therapies in psoriasis and vitiligo. Most of the existing information is obtained from experimental or preclinical research, and a deficiency in well-constructed patient-based research assessing their effectiveness, safety, and long-term effects has been reported [13]. Also, variations in exosome sources, preparation methods, and dosing regimens pose a problem that will necessitate standardisation and subsequent research [14]. Since the number of patients with chronic dermatological conditions is growing and current treatment options are limited, it is necessary to develop new treatment methods. Exosome-based therapies are among the few available options that integrate immunomodulatory and regenerative effects [15], which could lead to better disease control and patient outcomes [16]

Objective

To investigate the potential of exosome-based therapies in patients with psoriasis and vitiligo in terms of therapeutic effectiveness and clinical outcome

This was a hospital-based analytical cross-sectional study conducted at Multiple Tertiary Care hospitals of Pakistan from April 2025 to September 2025, including 85 patients diagnosed with psoriasis and vitiligo.

Inclusion Criteria

• Patients aged ≥18 years diagnosed clinically with psoriasis or vitiligo
• Patients with mild to moderate disease severity eligible for topical or procedural therapy
• Patients willing to undergo exosome-based therapy and follow-up assessment
• Patients with complete clinical records and baseline assessment data

Exclusion Criteria

• Patients with severe systemic illness or immunocompromised states
• Patients receiving other advanced biological or immunomodulatory therapies
• Patients with active skin infections or malignancy
• Pregnant or lactating females
• Patients with incomplete data or lost to follow-up

Data Collection

After obtaining informed consent, demographic details including age, gender, and disease duration were recorded. The standardized scoring systems like Psoriasis Area and Severity Index (PASI) that measured psoriasis and Vitiligo Area Scoring Index (VASI) that measured vitilatio were used to conduct baseline clinical assessment. Exosome-based therapy was administered to patients in standard administration protocols (topical/ intradermal as required). Therapeutic response in terms of clinical parameters was determined by re-assessment during the follow-up visits. Measures of outcomes were the decrease in the disease severity scales, is also the enhancement in lesion size, extent of repigmentation (in case of vitiligo), and patient-reported symptom improvement. The responders and non responders were cadtered into patients based on response to treatment. All the side effects of therapy were also recorded.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using Statistical Package for the Social Sciences (SPSS) version 26. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequency and percentage. Normality of data was assessed using the Shapiro–Wilk test. Comparisons between baseline and post-treatment outcomes were made using paired t-test for normally distributed data and Wilcoxon signed-rank test for non-parametric data. Associations between categorical variables were analyzed using chi-square test. Logistic regression analysis was performed to determine predictors of treatment response, and adjusted odds ratios with 95% confidence intervals were reported. A p-value <0.05 was considered statistically significant.

A total of 85 patients were included with a mean age of 36.8 ± 12.4 years. Patients with psoriasis were significantly older than those with vitiligo (39.5 ± 11.8 vs 33.2 ± 12.6 years, p = 0.01). A greater proportion of patients were aged ≥30 years (69.4%), particularly in the psoriasis group (79.2% vs 56.8%, p = 0.02). Males constituted 57.6% of the cohort, with no significant difference between groups (62.5% vs 51.4%, p = 0.31). The mean disease duration was 5.6 ± 3.2 years, significantly longer in psoriasis patients (6.2 ± 3.4 vs 4.8 ± 2.9 years, p = 0.04). Family history was present in 32.9% of patients without a significant difference between groups (37.5% vs 27.0%, p = 0.29)..

Table 1: Baseline Demographic and Clinical Characteristics

The overall baseline severity score was 11.7 ± 4.4, with psoriasis patients having higher scores compared to vitiligo (PASI: 12.8 ± 4.6 vs VASI: 10.2 ± 3.8, p = 0.01). Most patients presented with moderate disease severity (62.4%), slightly higher in psoriasis (66.7%) than vitiligo (56.8%), though not statistically significant (p = 0.38). Localized disease was observed in 54.1% of patients, with similar distribution between groups (p = 0.39). Pruritus was reported in 36.5% overall but was exclusively seen in psoriasis patients (64.6% vs 0.0%, p < 0.001). Mean depigmentation extent was 8.1 ± 9.6%, significantly higher in vitiligo patients (18.6 ± 6.2% vs 0.0 ± 0.0%, p < 0.001          

Table 2: Baseline Disease Severity and Clinical Profile

Significant clinical improvement was observed following exosome therapy. In psoriasis patients, the PASI score decreased from 12.8 ± 4.6 to 6.1 ± 3.2, with a mean reduction of 6.7 ± 2.8 (p < 0.001). Similarly, in vitiligo patients, the VASI score improved from 10.2 ± 3.8 to 5.4 ± 2.9, reflecting a mean reduction of 4.8 ± 2.3 (p < 0.001). Lesion size reduced from 14.3 ± 8.2% to 8.2 ± 5.4%, with a mean decrease of 6.1 ± 3.6 (p < 0.001). Repigmentation in vitiligo patients reached 38.2 ± 12.8%. Overall symptom improvement was reported in 68.2% of patients post-treatment (p < 0.001), indicating substantial therapeutic benefit.

Table 3: Clinical Outcomes Before and After Exosome Therapy

Overall, 68.2% of patients responded to exosome therapy, with a higher response rate in psoriasis (72.9%) compared to vitiligo (62.2%), although this difference was not statistically significant (p = 0.28). A ≥50% improvement was observed in 57.6% of patients, more frequently in psoriasis (64.6% vs 48.6%, p = 0.12). Complete or marked response was achieved in 24.7% of cases, again higher in psoriasis (29.2% vs 18.9%, p = 0.27). Partial response was seen in 43.5% of patients, while 31.8% showed no response. Overall, psoriasis patients demonstrated a trend toward better outcomes, though differences were not statistically significant.

Table 4: Treatment Response Distribution

Patients aged ≥30 years had higher odds of response (AOR 1.82, 95% CI: 1.05–3.94, p = 0.03). Moderate disease severity was also associated with better response (AOR 1.95, 95% CI: 1.12–3.76, p = 0.02). Psoriasis patients showed higher likelihood of response compared to vitiligo (AOR 1.68, 95% CI: 1.01–3.12, p = 0.04). In contrast, longer disease duration (≥5 years) was associated with reduced response (AOR 0.62, 95% CI: 0.34–0.95, p = 0.04), as was generalized disease distribution (AOR 0.58, 95% CI: 0.31–0.92, p = 0.03). Gender was not a significant predictor (p = 0.21).

Table 5: Predictors of Treatment Response (Multivariable Logistic Regression)

This paper tested the promise of exosome-based treatments in patients with psoriasis and vitiligo and showed that this treatment modality had major clinical benefits in several outcome indices. The results of the baseline revealed that the psoriasis patients were relatively older (39.5 ± 11.8 vs 33.2 ± 12.6 years, p = 0.01) and their disease duration was longer (6.2 ± 3.4 vs 4.8 ± 2.9 years, p = 0.04), which is consistent with the previous studies that indicated that psoriasis tended to develop later and had a more persistent progression as compared to vitiligo. The greater proportion of moderate severity of the disease in both groups (62.4%), is also indicative of a classic clinical presentation that has been commonly reported by other studies of outpatient dermatology cases [17]. The outcomes of the current paper indicate the high therapeutic value of exosome-based interventions. PASI score decreased significantly in psoriasis patients, i.e. 12.8 +/-4.6 to 6.1 +/-3.2 (p < 0.001), whereas VASI score improved in case of vitiligo patients, i.e. 10.2 +/-3.8 to 5.4 +/-2.9 (p < 0.001). These results are in line with the existing studies, which have found significant decreases in inflammatory indicators and clinical severities in the aftermath of exosome-based or regenerative interventions. In the same way, the reported decrease in the lesion area (14.3 ± 8.2% to 8.2 ± 5.4%, p < 0.001) and significant repigmentation in the vitiligo patients (38.2 ± 12.8%) are indicators of the regenerative and immunomodulatory effect of exosomes in the literature [18]. This response rate of 68.2% further contributes to the clinical usefulness of exosome therapy with psoriasis patients being in a relatively higher response (72.9% vs 62.2%) although non-significant (p = 0.28). The increase of 57.6% in patients was 50 percent and higher, and that is similar to response rates in other studies that have assessed advanced biologic and regenerative therapies. The observation of the tendency towards improved outcomes in psoriasis over vitiligo can be attributed to the difference between the disease pathophysiology, in which psoriasis is predominantly inflammatory, and vitiligo where irreversible loss of melanocytes occurs in some instances, which can also be observed in the past [19].

Important predictors of treatment response were found in a multivariable analysis. Recipients with the age of 30 years and above (AOR 1.82, p = 0.03) and moderate severity of the disease (AOR 1.95, p = 0.02) were more likely to respond to therapy. Quite to the contrary, poorer outcomes were attributed to longer disease duration ≥5 years (AOR 0.62, p = 0.04) and generalized disease distribution (AOR 0.58, p = 0.03). These results have been corroborated by other studies that have always indicated that disease at early and less advanced stages responds better to regenerative and immunomodulatory treatment. The fact that it was not significantly related to gender (p = 0.21) is also reflective of the results of past studies where it has been noted that treatment response would not depend on sex to a great extent [20]. On the whole, the results of the current study indicate that exosome-based treatment is a viable and promising solution to the treatment of psoriasis and vitiligo due to its combination of both the inflammatory and regenerative pathways. The outcomes are in line with earlier studies, which have shown positive associations between clinical severity, lesion characteristics, and patient outcomes when using similar therapeutic strategies. Nonetheless, the response variability according to the duration and the extent of the disease demonstrates the critical role of early intervention and patient selection in favouring the most effective treatment results,

It is concluded that exosome-based therapy demonstrates significant therapeutic potential in the management of psoriasis and vitiligo. The treatment was associated with marked reductions in disease severity scores, including improvements in PASI (12.8 ± 4.6 to 6.1 ± 3.2) and VASI (10.2 ± 3.8 to 5.4 ± 2.9), along with substantial decreases in lesion size and notable repigmentation in vitiligo patients. Overall, 68.2% of patients responded to therapy, indicating favorable clinical effectiveness. Better treatment outcomes were observed in patients with shorter disease duration, localised disease, and moderate severity, while generalised disease and longer disease duration were associated with reduced response. These findings suggest that early intervention may enhance therapeutic success.

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