Expert Consensus On The Clinical Application Of PDRN Acid In Dermatology 

In recent years, polydeoxyribonucleic acid (PDRN) has received widespread attention and application in the field of dermatology, but there is still a lack of unified understanding regarding the standardization of its application. The Laser Cosmetology Group of the Chinese Medical Association’s Branch of Aesthetic and Plastic Surgeons and the Medical Cosmetology Group of the Chinese Association of Integrative Medicine jointly issued the “Expert Consensus on the Clinical Application of Polydeoxyribonucleic Acid in Dermatology,” aiming to provide clinicians with scientific and objective advice to guide them in the rational and effective application of PDRN in practice.

Pharmacokinetics and Mechanism of Action of PDRN

PDRN exists in plasma in a free form and does not bind to plasma apolipoproteins. Its distribution is positively correlated with tissue blood flow. This drug is not metabolized by the liver; it is mainly degraded by non-specific plasma DNA nucleases or cell membrane nucleases to form the active ingredient, mononucleotide. Ultimately, most of it is excreted in the urine (approximately 65%), with a small amount excreted in the feces.

PDRN degradation produces nucleotides and nucleosides, providing raw materials for DNA damage repair and rapidly promoting the repair of damaged cell DNA and cell proliferation.

Clinical Application of PDRN in Dermatology

1. Wound Healing

Current research has found that PDRN participates in the wound healing process from multiple angles, including inhibiting excessive inflammatory responses, accelerating epidermal and dermal renewal, promoting collagen deposition, and upregulating angiogenesis and other regulatory factors such as VEGF. In autologous skin graft patients, intramuscular, subcutaneous, or topical PDRN injections at the wound site can accelerate wound re-epithelialization and healing time. Furthermore, PDRN application after CO2 fractional laser treatment can accelerate wound healing; therefore, PDRN can be considered after ablative laser treatment to promote wound healing and restore skin barrier function.

2. Melasma and Post-inflammatory Hyperpigmentation:

The common causes of melasma and post-inflammatory hyperpigmentation mainly include abnormal activation of melanocytes and persistent inflammatory responses. PDRN can regulate kinase and protein kinase B pathways by activating extracellular signaling in melanocytes, downregulating the levels of dysplastic angiotensin-related transcription factors, inhibiting the expression of tyrosinase and melanin synthesis-related proteins, and reducing the melanin content of melanocytes. Clinically, PDRN can be considered in combination with other methods to treat refractory pigmentary disorders such as melasma or post-inflammatory hyperpigmentation. 3. Skin Aging:

PDRN activates adenosine A2A receptors or salvage pathways, upregulates cyclic adenosine monophosphate (cAMP) concentration, inhibits MMPs and elastase secretion, remodels the extracellular matrix, reduces wrinkles, restores skin elasticity, and improves skin texture. Furthermore, multiple studies have found that PDRN can downregulate the levels of various pro-inflammatory factors such as IL-6, IL-1β, TNF-α, and IL-12, and upregulate the secretion of inflammatory factors such as IL-10. This indicates that PDRN may simultaneously delay the occurrence and development of skin photoaging by inhibiting SASP secretion, improving skin elasticity, roughness, and enlarged pores, and reducing transepidermal water loss, thus addressing skin aging problems.

4. Scarring:

In an SD rat incision healing model, PDRN was found to reduce inflammatory cell infiltration in scar tissue and inhibit excessive scar proliferation by inhibiting HMGB-1 expression. International clinical studies have found that early use of PDRN after thyroidectomy can significantly improve the texture, color, and size of hypertrophic scars, with good safety and no adverse reactions. Therefore, early intervention with PDRN can be considered for wounds at risk of scarring. Currently, there are no studies on the efficacy of PDRN in keloids.

5. Androgenetic Alopecia:

Patients with androgenetic alopecia exhibit scalp changes such as reduced and miniaturized blood vessels. PDRN can regulate the Wnt signaling pathway, promote hair follicle proliferation, and upregulate VEGF and other vasoactive agents, thereby improving androgenetic alopecia. Prospective studies have found that for patients with androgenetic alopecia who do not respond to conventional drug therapy, the use of PDRN combined with PRP or 1927nm thulium fractional laser treatment may be a potential option. However, larger sample sizes are still needed to assess safety.

6. Other Skin Diseases:

Patients with androgenetic alopecia exhibit scalp changes such as reduced and miniaturized blood vessels. PDRN can regulate the Wnt signaling pathway, promote hair follicle proliferation, and upregulate VEGF and other vasoactive agents, thereby improving androgenetic alopecia. Current prospective studies have suggested that PDRN combined with PRP or 1927nm thulium fractional laser treatment may be a potential option for patients with androgenetic alopecia who do not respond to conventional drug therapy. However, larger sample sizes are still needed to assess its safety.

Recommended Usage

The usage of PDRN varies considerably across different diseases, and a unified application protocol is still lacking.

Currently, domestic and international literature reports PDRN administration methods including topical application, intradermal delivery, intradermal injection, subcutaneous injection, and intramuscular injection. Dosage frequencies range from once daily to once weekly, and dosing durations range from several days to several weeks. However, specific usage methods must be strictly followed according to the product’s (drug or medical device) classification.

Safety and Precautions

1. PDRN has a DNA purity >95% and does not contain pharmacologically active proteins or peptides, therefore its immunogenicity is low.
2. Multiple clinical studies have also confirmed that PDRN has good safety and tolerability regardless of the administration route. No significant toxic reactions or serious adverse reactions have been observed after topical application, although occasional mild adverse reactions such as skin redness, itching, and stinging may occur. These symptoms usually subside rapidly after discontinuation of the drug or with symptomatic treatment.
3. There is a possibility of adverse events such as foreign body granulomas and specific infections when PDRN is administered by injection. Therefore, caution should be exercised when using this drug intradermally or subcutaneously.
4. PDRN is contraindicated in pregnant and lactating women, those with infected wounds, and those allergic to PDRN.

Summary and Outlook

1. In China, PDRN is mainly applied topically and through microneedling mesotherapy. Given PDRN’s anti-inflammatory effects and tissue repair-promoting capabilities, future research can explore its potential for innovative applications.
2. Furthermore, the administration strategies for PDRN in the treatment of various skin problems, including determining the optimal route of administration, frequency, and concentration, as well as its synergistic effects with other therapies, require further investigation.