This open‑access systematic review, conducted by Darwish et al. (2025) and published in Cureus, evaluates human clinical studies from 2015‑2025 that compare three major treatments for androgenetic alopecia (AGA): mesenchymal stem‑cell‑derived exosome therapy, platelet‑rich plasma (PRP), and topical minoxidil. Following PRISMA guidelines, the authors searched PubMed, Web of Science, and Cochrane, screened 173 records, and included 26 studies (14 RCTs, 10 quasi‑experimental, 3 controlled trials, 1 case series) encompassing 5‑376 participants of both sexes. Data extraction captured intervention protocols (dose, frequency), outcome metrics (hair density, thickness, anagen/telogen ratios, patient‑reported satisfaction), and safety. Risk‑of‑bias was assessed with the Cochrane ROB 2 tool, revealing 17 low‑risk, 4 moderate‑risk, and 5 high‑risk studies. Qualitative synthesis showed that exosome therapy consistently produced the greatest increases in hair density and favorable safety, often surpassing PRP and markedly outperforming minoxidil. PRP yielded moderate improvements, superior to minoxidil in many trials but with variable efficacy linked to preparation methods and patient factors. Minoxidil, while the most accessible, demonstrated the smallest effect sizes and required continuous application to maintain gains. The review highlights substantial heterogeneity in study designs, short follow‑up periods (most ≤12 weeks), lack of ethnic subgroup analyses, and limited head‑to‑head comparisons, calling for larger, standardized, multicenter RCTs and exploration of combination regimens. The authors conclude that exosome therapy holds the most promise for long‑term AGA management, PRP remains a viable second‑line option, and minoxidil serves as a baseline, low‑cost treatment.
Topics
PRISMA‑Guided Systematic Review of AGA Treatments (2015‑2025)
Methodology: database searches, inclusion/exclusion criteria, study selection flow, data extraction, and risk‑of‑bias assessment for 26 human studies on exosomes, PRP, and minoxidil.