Ferroptosis, a recently discovered form of iron-dependent cell death, is implicated in various diseases. Exosome therapy, known for its low immunogenicity and ability to cross biological barriers, has emerged as a promising therapeutic approach. This review highlights the mechanisms by which exosomes regulate ferroptosis through the system Xc1/GSH/GPX4 axis, NAD(P)H/F5P1/COQ10 axis, iron metabolism pathway, and lipid metabolism pathway. Exosomes derived from different sources can target ferroptosis in various diseases, such as liver disease, neurological diseases, lung injury, heart injury, and cancer. The role of exosome-regulated ferroptosis as a potential repair mechanism for damaged tissues and cells is also discussed, suggesting its potential as a treatment for various diseases. The review emphasizes the importance of understanding the mechanisms and applications of exosome-regulated ferroptosis to develop effective therapeutic strategies.Ferroptosis, a recently discovered form of iron-dependent cell death, is implicated in various diseases. Exosome therapy, known for its low immunogenicity and ability to cross biological barriers, has emerged as a promising therapeutic approach. This review highlights the mechanisms by which exosomes regulate ferroptosis through the system Xc1/GSH/GPX4 axis, NAD(P)H/F5P1/COQ10 axis, iron metabolism pathway, and lipid metabolism pathway. Exosomes derived from different sources can target ferroptosis in various diseases, such as liver disease, neurological diseases, lung injury, heart injury, and cancer. The role of exosome-regulated ferroptosis as a potential repair mechanism for damaged tissues and cells is also discussed, suggesting its potential as a treatment for various diseases. The review emphasizes the importance of understanding the mechanisms and applications of exosome-regulated ferroptosis to develop effective therapeutic strategies.