Adipose-derived stem cell exosomes for treatment of dupilumab-related facial redness in patients with atopic dermatitis

Figures & data

Table 1. Rating grade for investigator global assessment score.

Grade	Description
0, clear	No inflammatory signs of atopic dermatitis
1, almost clear	Just perceptible erythema, and just perceptible papulation/infiltration
2, mild disease	Mild erythema and mild papulation/infiltration
3, moderate disease	Moderate erythema and moderate papulation/infiltration
4, severe disease	Severe erythema and severe papulation/infiltration
5, very severe disease	Severe erythema and severe papulation/infiltration with oozing /crusting

Table 2. Rating grade for clinical erythema assessment scale.

Scale	Degree of improvement
0 = clear	Clear skin with no signs of erythema
1 = almost clear	Almost clear, slight redness
2 = mild	Definite redness, very light pink, faintly detectable erythema
3 = moderate	Marked redness, dull red, clearly distinguishable erythema
4 = severe	Severe erythema, fiery redness, deep, dark red

Table 3. Rating grade for patient satisfaction.

Scale	Degree of satisfaction
1	Very unsatisfied
2	Unsatisfied
3	Fair
4	Satisfied
5	Very satisfied

Figure 1. Clinical outcomes of patients with dupilumab facial redness treated with adipose-derived stem cell exosome. Change in average investigator global assessment (IGA), clinical erythema assessment (CEA), and patient satisfaction score over time. The average IGA score decreased from week 2 and continued to decrease until week 12. The average CEA score decreased significantly from the first week after the first exosome treatment. Overall, 19 out of 20 (95%) patients had a subjective satisfaction score of 4 (satisfied) at least once during the entire clinical trial period. *p < 0.05, **<0.01, ***<0.001, compared with baseline.

Figure 2. Representative clinical photographs of patients. Photographs were taken at baseline, at week 2 (after the first treatment), and week 12 (eight weeks after final the treatment). After exosome treatment, clinical improvements of erythema on the both cheeks, forehead, and chin were noted.

Figure 3. Changes in the erythema index (EI) were measured at four different anatomical locations on the face (forehead, left and right cheek, and chin). Erythema index (EI) decreased in all four areas after exosome treatment and decreased fastest on the forehead. *p < 0.05, **<0.01, ***<0.001, compared with baseline

Figure 4. Results of the analysis of stratum corneum samples. (a) mRNA expression of interleukin-1α (IL-1α). The mRNA expression of IL-1α decreased in SC samples collected at week 8 compared with the baseline. (b) mRNA expression of vascular endothelial growth factor (VEGF). The mRNA expression of VEGF increased in SC samples collected at week 8 compared with the baseline. (c) mRNA expression of filaggrin (FLG). The mRNA expression of FLG increased in SC samples collected at week 8 compared with the baseline. (d) Western blot analysis. (e) Protein expression of filaggrin (FLG). The protein expression of FLG increased in SC samples collected at week 8 compared with the baseline. (f) Protein expression of human thymic stromal lymphopoietin (TSLP). The protein expression of TSLP decreased in SC samples collected at week 8 compared with the baseline. (g) Protein expression of interleukin-1α (IL-1α). The protein expression of IL-1α decreased in SC samples collected at week 8 compared with the baseline.

Data availability statement

The data used to support the findings of this study are available from the corresponding author upon request.