Advancements in Clinical Utilization of Recombinant Human Collagen: An Extensive Review

Wan, Jovian MBChB^*; Yoon, Song Eun MD^†; Song, Jong-Keun MD^‡; Wong, Isaac Kai Jie MD^§; Kim, Jin-Hyun MD^∥; Yi, Kyu-Ho MD, PhD^{∥,¶

*Medical Research Inc., Wonju, Korea†BRANDNEW Aesthetic Surgery Clinic‡Pixelab Plastic Surgery Clinic, Seoul, korea§The Artisan Clinic, Singapore∥You and I Clinic, Seoul, Korea¶Department of Oral Biology, Division of Anatomy and Developmental Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seodaemun-gu, Seoul, KoreaAddress correspondence and reprint requests to Kyu-Ho Yi, MD, Department of Oral Biology, Division of Anatomy and Developmental Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea; E-mail: kyuho90@daum.netJ.W. and K.-H.Y.: conceptualization. J.W.: writing-original draft preparation. J.W., S.E.Y., J.K.S., I.K.J.W., J.-H.K., and K.-H.Y.: writing-review and editing. J.W. and K.-H.Y.: visualization. K.-H.Y.: supervision. All authors have reviewed and approved the article for submission.The authors report no conflicts of interest. This study was conducted in compliance with the principles set forth in the Declaration of Helsinki.Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal’s website, www.jcraniofacialsurgery.com.}^{The Journal of Craniofacial Surgery}^{():10.1097/SCS.0000000000011459, May 5, 2025. |}^DOI:^{10.1097/SCS.0000000000011459}

Background:
Atopic dermatitis (AD) is a chronic inflammatory skin condition that significantly impairs quality of life. Current therapies, including corticosteroids and calcineurin inhibitors, often provide incomplete relief or have undesirable side effects. Exosome-based therapies derived from adipose-derived mesenchymal stem cells (ADMSCs) offer a novel, multifaceted approach to addressing inflammation, skin barrier dysfunction, and pruritus, presenting a promising alternative for AD management.
‍
Objective:
This case series evaluates the efficacy and safety of ADMSC-derived exosome-based topical formulations (ZISHEL XOMAGE; Zishel Bio Inc., Seoul, Korea), in improving clinical and barrier-related outcomes in patients with moderate-to-severe facial AD.

Methods:
Twenty adults with moderate-to-severe facial AD (vIGA-AD scores 3–4) applied ADMSC-derived exosome twice daily for 6 weeks. Clinical assessments included vIGA-AD scores, transepidermal water loss (TEWL), and corneometry for hydration. Two blinded dermatologists independently assessed outcomes. Before-and-after photographs were taken under standardised conditions. Pruritus severity was evaluated using a visual analogue scale (VAS).

Results:
Eighty-five percent of patients achieved at least a 1-point reduction in vIGA-AD scores, with 50% achieving a 2-point reduction. Corneometry indicated a 58% improvement in hydration, while TEWL measurements demonstrated a 42% reduction, reflecting enhanced barrier integrity. Pruritus VAS scores declined by 70%. No adverse events were reported, and inter-rater reliability for vIGA-AD assessments was high (Cohen kappa=0.84). Representative cases highlighted substantial improvements in erythema, lichenification, and skin texture.

Conclusion:
ADMSC-derived exosome products showed significant efficacy in reducing AD severity and restoring barrier function, with excellent safety profiles. Larger, randomised controlled trials with extended follow-up are recommended to confirm these findings and establish these products as viable treatment options for AD.

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By Wan, Jovian MBChB^*; Yoon, Song Eun MD^†; Pamela, Ruri MD^‡; Kai Jie Wong, Isaac MD^§; Vitale, Massimo MD^∥; Cartier, Hugues MD^¶; Garson, Sebastien MD^#; Yi, Kyu-Ho MD, PhD^**,††*Medical Research Inc., Wonju
†BRANDNEW Aesthetic Surgery Clinic, Seoul, Korea
‡CELV Dermatology Clinic, Jakarta, Indonesia
§The Artisan Clinic, Singapore
∥Private Practice, Bologna, Italy
¶Centre Médical Saint Jean, Arras, France
#Cabinet Médical, Senlis, France
**Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry
††You and I Clinic, Seoul, Korea

Objective:
This case series evaluates the efficacy and safety of LDE therapy combined with microneedling in patients with active acne, PIH, and atrophic scarring.

Methods:
Three patients with moderate to severe acne [Investigator’s Global Assessment (IGA) scores 2–4], visible PIH, and atrophic scarring underwent biweekly microneedling treatments followed by topical application of LDE (BLESKIN EXXO, Daeyang Medical) over 2 months. Assessments were conducted at baseline and 2-month post-treatment, utilizing the IGA scale for acne severity, the Postinflammatory Hyperpigmentation Area and Severity Index (PIHASI) for PIH, and the Goodman and Baron Scarring Grading System for atrophic scarring. Two independent, blinded dermatologists evaluated clinical photographs and scored all outcomes. Patient satisfaction was recorded on a 10-point Likert scale.

Results:
All patients exhibited significant improvements in acne severity, PIH, and atrophic scarring. IGA scores decreased from baseline values of 3 to 4 to 1 to 2 post-treatment. PIHASI scores were reduced by 4 to 6 points, and Goodman and Baron scores improved by one grade level. Patient satisfaction scores ranged from 8 to 9 out of 10. Minimal adverse events were noted, with only one instance of transient erythema observed during the study.

Conclusion:
LDE therapy combined with microneedling seems to be a promising treatment modality for active acne, PIH, and atrophic scarring, demonstrating significant clinical improvements with high patient satisfaction and minimal adverse effects. Further research with larger cohorts and controlled studies is warranted to validate these findings...."

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