Effectiveness and safety of the ablative fractional 2940-nm Er: YAG laser for the treatment of androgenetic alopecia.

Laser sources have established their potential effect in inducing hair regrowth. No large cohort study has evaluated the effect of ablative fractional 2940-nm erbium yttrium aluminum garnet (Er: YAG) laser in the treatment of androgenetic alopecia (AGA). To investigate the efficacy and safety of the ablative fractional 2940-nm Er: YAG laser in combination with medication therapy for the treatment of AGA. We performed a retrospective study between first July 2021 to 30th December 2021. All included patients received oral finasteride and topical minoxidil, or combined with six sessions of Er: YAG laser at 2-week intervals. Patients were divided into medication or combined therapy groups. The efficacy of the two therapies was evaluated by the investigator's Global Assessment (IGA) scores and the patient's Likert satisfaction scale at week 12 and week 24. Changes in total, terminal and villous hair count, total and terminal hair diameter, and AGA grade were also recorded. Adverse events were evaluated at each follow-up. A total of 192 male patients with AGA were included, including 67 receiving combination treatment, and 125 receiving medication treatment. At week 24, the combination treatment afforded superior outcomes in the IGA score, patient's global assessment, total and terminal hair counts, and diameters (all P<0.05). No severe adverse events were reported in both groups. The combined therapy of ablative fractional Er: YAG laser and medication was superior in treating male AGA than single medication therapy without serious adverse effects.

Use of fractionated laser therapy for the treatment of androgenetic alopecia: a systematic review and meta-analysis.

Procedural management, including fractionated laser therapy, has been increasingly investigated for the management of androgenetic alopecia (AGA). However, no comprehensive resources exist detailing the efficacy of fractionated laser therapies used for the treatment of AGA. A systematic review investigating fractionated laser use for AGA was performed, separated into each distinct fractionated laser modality. A meta-analysis was performed to examine improvement in hair counts and hair shaft diameter. Fourteen studies were included for systematic review, which identified the use of erbium-glass, thulium, erbium-ytrrium:aluminum garnet (YAG), and carbon dioxide (CO2) fractionated laser for the treatment of AGA. In the meta-analysis, fractionated laser combination therapy showed significant improvement in hair shaft diameter (2.51, 95% CI 2.37-2.65, I2 = 90.54). Fractionated laser monotherapy alone significantly improved hair shaft diameter (2.28 95% CI 2.03-2.52, I2 = 91.20%). This effect was durable on subgroup analysis for both erbium-glass (2.36 95% CI 2.01-2.71, I2 = 92.05%) and thulium (1.61 95% CI 1.08-2.15, I2 = < 0.00%). There was no improvement in hair shaft count for any laser modality. Erbium-glass laser is an effective modality as either monotherapy or combination with topical/injectable therapies to improve hair shaft diameter in AGA.

Photobiomodulation and alopecia: a crowdsourced survey study on patient preferences.

Photobiomodulation is a treatment option for hair loss and is currently FDA cleared for androgenetic alopecia. There are a variety of photobiomodulation devices intended for at-home patient use. However, data examining user preferences is lacking. A social media-based, online survey study was completed to understand patient preferences when selecting a photobiomodulation device. Secondary outcomes examined patient experience with the device. Sixty participants responded to the 21-question survey. The majority of participants had never used a photobiomodulation device (n = 50; 86.2%). Most respondents (n = 40; 67.8%) felt the efficacy of the device was the most important aspect to consider when selecting a photobiomodulation device. Additionally, a majority of participants thought 15 (n = 22; 37.3%) or 20 minutes (n = 17; 28.8%) would be a reasonable treatment duration and would prefer a hand-free device (n = 51; 86.4%). Of the eight participants who had used a photobiomodulation device, only one was dissatisfied with the device and discontinued treatment.

Experience of Novelty Laser Therapy Emission with 675 nm Wavelength for the Treatment of Androgenetic Alopecia in Male and Female Patients: A Case Series Study.

Background: Alopecia androgenetica is the most common type of hair loss. It is estimated that 60-70% of the world's population is affected, with men having a slight advantage. This condition supports a progressive hair thinning in androgen-sensitive zones, as defined by the Hamilton and Norwood classifications for men and Ludwig classifications for women. There are numerous published studies that show the effect of red light (650-675 nm) on hair growth biostimulation. Objective: To validate this correlation, the aim of this study was to assess the efficacy of 675 nm laser emission for the management of alopecia androgenetica in female and male subjects. Methods: A total of 17 subjects (6 women and 11 men) aged from 18 to 65 years, without other comorbidities, with an alopecia androgenetica grade ranges between I-II in women (according to Ludvig scale) and I-II-III in men (according to Hamilton scale) were enrolled in the study between October and December 2021. All patients underwent 10 sessions of 675 nm laser treatment, each lasting 20 min, without the use of concomitant systemic or topical therapies. Results: The results verified at epiluminescence stage, and at the third month of follow-up and at the end of treatment, showed a significant increase in the density of the hair shafts and a reduction of yellow dots and telangiectasias characteristic of alopecia androgenetica. Conclusions: The 675 nm laser showed excellent outcomes resulting in a 60% reduction of the miniaturization process in the treated areas without side effect.

Single-cell transcriptome analysis of fractional CO2 laser efficiency in treating a mouse model of alopecia.

OBJECTIVES: Hair loss, including alopecia, is a common dermatological issue worldwide. At present, the application of fractional carbon dioxide (CO2 ) laser in the treatment of alopecia has been documented; however, the results vary between reports. These varying results may be due to the limited knowledge of cellular action in laser-irradiated skin. The objective of this study was to investigate the molecular and cellular mechanisms of laser treatment under effective conditions for hair cycle initiation. METHODS: A fractional CO2 laser was applied and optimized to initiate the hair cycle in a mouse model of alopecia. Several cellular markers were analyzed in the irradiated skin using immunofluorescence staining. Cellular populations and their comprehensive gene expression were analyzed using single-cell RNA sequencing and bioinformatics. RESULTS: The effective irradiation condition for initiating the hair cycle was found to be 15 mJ energy/spot, which generates approximately 500 µm depth columns, but does not penetrate the dermis, only reaching approximately 1 spot/mm2 . The proportion of macrophage clusters significantly increased upon irradiation, whereas the proportion of fibroblast clusters decreased. The macrophages strongly expressed C-C chemokine receptor type 2 (Ccr2), which is known to be a key signal for injury-induced hair growth. CONCLUSIONS: We found that fractional CO2 laser irradiation recruited Ccr2 positive macrophages, and induced hair regrowth in a mouse alopecia model. These findings may contribute to the development of stable and effective fractional laser irradiation conditions for human alopecia treatment.

Photobiomodulation Effectiveness in Treating Androgenetic Alopecia.

Background: Androgenetic alopecia (AGA) is a genetically determined condition, which leads to progressive hair loss (HL) of the vertex, affects hair follicles, and promotes partial or total HL. It may be related to important psychological and social distress. Objective: The aim of the study was to evaluate the effects of photobiomodulation (PBM) in patients with AGA. Methods: Twenty-five men 20-54 years of age participated in this study. The irradiations were punctual, in contact mode, with 1 cm between each point covering the entire affected area. A red low-level laser (λ = 660 nm) (Recover®, MMOptics, São Carlos, Brazil) was used with 100 mW, 30 sec, and 3 J per point, twice a week on alternate days for 10 weeks. Evaluations were made by photographic records from the same area before any intervention (T1), after 5 weeks (T2), after 10 weeks (T3). Two blinded evaluators using the ImageJ® software assessed the hair density. Results: The hair density evaluation showed a significant increase in hair count between T1 and T2 (p = 0.0004) and between T1 and T3 (p = 0.0285), however between T2 and T3 no statistical difference was found (p > 0.05). Conclusions: PBM provides a stimulus for hair density in 5 weeks. After this period, we observed that after five extra sessions, it does not increase hair density in the treated region. This study showed that the PBM is effective and promoted safe results with a reduced number of sessions for the AGA treatment.

Photobiomodulation Therapy With Different Wavebands for Hair Loss: A Systematic Review and Meta-Analysis.

BACKGROUND: Photobiomodulation is a promising therapy for hair loss with negligible side effects. However, the reported effects of photobiomodulation therapy for hair loss are inconsistent. OBJECTIVE: To assess the curative effect of photobiomodulation therapy for the treatment of hair loss. METHODS: A systematic review of self-controlled studies and randomized controlled trials was conducted. ScienceDirect, PubMed, and Wiley Online Library were searched from the earliest date to May 30, 2021. RESULTS: Thirty-six studies (966 patients) were included. Two to 4 meta-analyses with different indices were performed separately on 4 groups of studies to test the effectiveness of the following hair loss treatments: ultraviolet light for alopecia areata (AA), red light for androgenetic alopecia (AGA), infrared light for AA, and infrared light for AGA. All meta-analyses showed that treatments were superior to control ( p < .05). CONCLUSION: The meta-analyses strongly suggested that photobiomodulation therapies with ultraviolet and infrared light were effective for treating AA, and photobiomodulation therapies with red light and infrared light were effective for treating AGA.

Efficacy assessment for low-level laser therapy in the treatment of androgenetic alopecia: a real-world study on 1383 patients.

Low-level laser therapy (LLLT) has been a treatment modality by many androgenetic alopecia (AGA) patients in recent years. It remained unclear as to how long the treatment regime should be maintained, and which characteristics of patients should this be recommended. A real-world study was carried out with an FDA-cleared low-level laser helmet for 1383 patients. Ordinal logistic regression analysis with propensity score matching (PSM) was used to investigate the factors related to efficacy assessment. More than 80% of users were between 18 and 40 years old. The median use times were 133 for mild AGA patients and 142 for moderate-to-severe AGA patients, which equated to 38 weeks and 40 weeks, respectively. The overall clinical effectiveness was nearly 80%. PSM analysis revealed that gender (P = 0.002), use period (P = 0.068), scalp conditions with dandruff, rash, and itchy symptoms were associated with the grading of efficacy assessment. Male users (ordinal OR: 1.35, CI: (1.01, 1.79)); use for more than 180 times or use period for 1 year (ordinal OR: 1.40, CI: (1.11, 1.96)); and those with scalp dandruff (ordinal OR: 1.34, CI: (1.01, 1.87)), rash (ordinal OR: 1.47, CI: (1.04, 2.07)), and itchy symptoms (ordinal OR: 1.51, CI: (1.12, 2.03)) had better efficacy assessments. The recommended treatment regime with low-level laser helmet was more than 1 year or 180 use times. Male patients with dandruff, rash, and itchy symptoms in scalps tended to have a better efficacy assessment.

Results of low-level laser therapy in the treatment of hair growth: An Egyptian experience.

Recently, low level laser therapy was evaluated as an effective stimulating hair growth. Hair loss is the most common complaint in dermatology (specially females). It causes a significant psychosocial distress and decreased quality of life in affected patients and exists in different types, but the most common types are androgenetic alopecia and telogen effluvium (TE). Although there are many treatments with highest levels of medical evidence, but patients who exhibit intolerance or poor response to these treatments need additional treatment modalities. To evaluate the efficacy and safety low level laser therapy for female pattern hair loss (FPHL) and TE. A prospective interventional study included 20 female patients, 13 were diagnosed as FPHL, and 7 were diagnosed TE. Patients received two sessions per week with Hair Growth System (TOPHAT655) a bicycle-helmet type device. Treatment session of 20 minutes for 16 successive weeks (total of 32 treatments) with follow-up. Patients were evaluated by software-analyzed trichoscopic images, as the primary endpoint was the percent increase in hair counts from baseline to post-treatment. Global photography and patient satisfaction were determined as a secondary end point. Twenty patients completed the study (13 FPHL, 7 TE). FPHL patients baseline hair counts were 222.3 ± 33.5 (N = 13), in TE patients baseline hair counts were 271.2 ± 39.0 (N = 7). Post-treatment hair counts were 255.3 ± 30.4 (N = 13) In FPHL patients (P = .007), and 294.2 ± 38.1 (N = 7) in TE patients (P = .143). Low level laser therapy of the scalp at 655 nm significantly improved hair counts in FPHL, and there is no significance difference in TE patients with no serious adverse events. Additional studies should be considered to determine the long-term effects of low-level laser therapy treatment on hair growth and maintenance, and to optimize laser modality.

Láser de baja potencia para tratar la alopecia androgénica / Low-Level Laser Therapy for Androgenetic Alopecia

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Photobiomodulation for the management of hair loss.

Photobiomodulation, otherwise known as low-level laser (or light) therapy, is an emerging modality for the management of hair loss. Several randomized trials have demonstrated that it is safe and potentially effective on its own or in combination with standard therapies. These devices come in many forms including wearable caps or helmets that afford hands-free and discreet use. Models with light-emitting diodes (LEDs) are less expensive compared to laser-based devices and do not require laser safety considerations, thus facilitating ease of home use. Limitations include cost of the unit, risk of information bias, and lack of standardized protocols. Finally, as with any hair loss treatment, patients' expectations with regards to therapeutic outcomes must be managed.

Meta-analysis of photobiomodulation for the treatment of androgenetic alopecia.

BACKGROUND: Androgenetic alopecia (AGA) is a condition that affects most people at some point in their life, yet few treatments are available. Use of photobiomodulation is ideal due to the safety profile and lack of serious adverse effects. Therefore, the efficacy of photobiomodulation for AGA therapy was investigated. METHODS: A meta-analysis was used to elucidate treatment efficacy. Additionally, a sub-analysis was performed to determine if the type of device used or if use of lasers versus light emitting diodes (LEDs) significantly impacted results. RESULTS: Using hair density (hairs/cm2) as a measure of efficacy, the standardized mean difference (SMD) was 1.02 (95% CI: 0.68, 1.36) in favor of treatment over control (15 studies, pooled N = 795, p < .00001). Subgroup analysis comparing comb-style devices versus helmet/hat-style devices did not reveal a significant difference (p = .08). A second subgroup analysis suggested that laser treatment was significantly more effective (p = .009) than a combination of laser/LED treatment although the combination treatment was still significantly better than control treatment. DISCUSSION: Meta-analysis results suggest that photobiomodulation could be used to effectively treat AGA. Specific device recommendations should be based on use of lasers versus LEDs and not the style (comb/hat/helmet) of the device.

Comparison of low-level light therapy and combination therapy of 5% minoxidil in the treatment of female pattern hair loss.

This study was conducted in order to compare the safety and efficacy of LLLT, 5% minoxidil, and combination therapy in the treatment of FPHL. A randomized controlled trial was developed to study the effect of LLLT on FPHL using a device called iHelmet®, which is equipped with 200 5mW laser diode source (650 nm) arrays. Ninety Ludwig's types II-III FPHL patients were randomly divided into 3 groups: LLLT group (A), 5% minoxidil group (B), and combination group(C). Hair density, hair diameter, and scalp oil-secretion were detected to evaluate the treatment effect. Significant improvement of hair density and hair diameter was observed in all stages of FPHL after treatment. Oil-secretion of the three groups was decreased after treatment. The effectiveness of reducing oil-secretion in LLLT group and combination group was higher than minoxidil group (P < 0.05). For improving hair diameter and hair density, combination group was better than LLLT and minoxidil groups. No side effects were reported. Our study illustrated that LLLT is a safe and effective treatment for FPHL. Besides, LLLT can significantly improve its efficacy when used in combination with 5% minoxidil.

Proposed mechanisms of low-level light therapy in the treatment of androgenetic alopecia.

Androgenetic alopecia (AGA) is a global challenge, affecting a large number of people worldwide. Efficacy of the existed treatments can barely meet the demands of patients. Patients who are poorly responding to those treatments are seeking for a more effective and suitable technique to treat their disease. Low-level light therapy (LLLT) is a newly developed technique, which has been proved to stimulate hair growth. Based on the function principle of LLLT in other domains and refer to the published literatures, we write this review to neaten and elucidate the possible mechanism of LLLT in the treatment of AGA. A review of published literature which is associated with keywords LLLT, photobiomodulation, AGA, treatment, hair growth, and mechanism was performed to elucidate the proposed mechanism of LLLT in the treatment of AGA. The present study shows that LLLT can accelerate hair growth in AGA patients. The proposed mechanism of LLLT in treating AGA may vary among different specialists. But we can summarize the consensual mechanisms as follows; low-level light absorbed by chromophores can lead to the production of nitric oxide (NO) and the modulation of reactive oxygen species (ROS). These mobilized molecules subsequently activate redox-related signaling pathways in hair follicle cells and perifollicular cells. Finally, these activated cells participate in the regrowth of hair follicle. Even though the efficacy of LLLT in the treatment of AGA in both men and women has already been confirmed, the present studies focusing on discovering LLLT are still inadequate and unsystematic. More studies are needed to standardize the optimum treatment parameters applied in promoting hair growth and determine the long-term safety and efficacy of LLLT. Current recognitions about the mechanisms of LLLT, mainly focused on the molecules that may take effect, neglected different cellular components that are functional in the hair follicle macro-environment.

Factors influencing the effect of photobiomodulation in the treatment of androgenetic alopecia: A systematic review and analyses of summary-level data.

Low-level laser therapy (LLLT) is used to treat androgenetic alopecia (AGA). The therapeutic effect of LLLT on AGA has been evaluated; however, there is a paucity of studies that investigated device- and usage-related factors that may influence the effect of LLLT on hair regrowth. The literature was systematically searched to identify eligible studies; PubMed, Scopus, EMBASE and clinicaltrials.gov databases were searched on 30 April 2020. Eligible studies were randomized trials that investigated the effect of LLLT on hair density in AGA. Robust linear regressions were used to make comparisons. An increase in the per-session energy fluence by 1 J/cm2 is significantly associated with an increase in hair density by 0.23 hairs/cm2 (95% CI: 0.21 hairs/cm2 , 0.25 hairs/cm2 ). The number of laser or light-emitting diodes is not significantly associated with change in hair density. Increasing the total duration of exposure to treatment is associated with a significant increase in hair density (ß = .53, P < .05). Switching from continuous to pulse irradiation was associated with a significant increase in hair density (ß = 10.11, P < .01). Energy fluence, irradiation session duration, and light pulsing have a significant therapeutic effect on AGA, while the number of diodes does not.

A randomized blinded retrospective study: the combined use of micro-needling technique, low-level laser therapy and autologous non-activated platelet-rich plasma improves hair re-growth in patients with androgenic alopecia.

INTRODUCTION: Mini-invasive therapies based on autologous non-activated Platelet-Rich Plasma (ANA-PRP), Low-Level Laser Therapy (LLL-T), and Micro-Needling Technique (MN-T) used in combining for hair re-growth need to be standardized. OBJECTIVES: The work aims to show in vivo outcomes resulted from retrospective case-series study in which ANA-PRP + MN-T + LLL-T were used in combined in patients affected by Androgenic alopecia. METHODS: 23 patients were treated, of which 13 males were classified in stage I-V by the Norwood-Hamilton scale, and 10 females were classified in stage I-III by the Ludwig scale. Assessment of hair re-growth was evaluated with photography, physician's and patient's global assessment scale, and standardized phototrichograms during a follow-up: T0 - baseline, T1 - 12 weeks, T2 - 23 weeks, T3 - 44 weeks, T4 - 58 weeks. RESULTS: Interesting outcomes represented by a hair density increase of 81 ± 5 hairs/cm2 and 57 ± 7 hairs/cm2 respectively at T1 and T2 compared with baseline (173 ± 5 hairs/cm2 at T1 and 149 ± 9 hairs/cm2 at T2 versus 92 ± 2 hairs/cm2 at baseline) were observed using computerized trichograms. EXPERT OPINION: The main limitation in the autologous regenerative therapies and biotechnologies in hair-regrowth is the extreme variability of PRP products used, in the absence of standardized protocols and widely shared. Appropriate PRP preparations have to be pick after carefully thinking about their bio-molecular specifications and intended indications for use in patients. This approach will aid in matching the optimal PRP product to specific patient factors, leading to improved outcomes and the elucidation of the cost-effectiveness of this treatment. The combined use of biotechnologies as the association of PRP with micro-needling and low-level laser therapy may improve the results in terms of hair count and hair density compared with those obtained by alone PRP. All the procedures must be performed in the full respect of international and local rules. CONCLUSIONS: The effect of the combined use of MN-T, LLL-T, and ANA-PRP has been demonstrated.

Low-level laser therapy and narrative review of other treatment modalities in androgenetic alopecia.

Androgenetic alopecia (AGA), also termed as androgenic alopecia or common baldness, is a condition where there is androgen mediated conversion of susceptible terminal hair into vellus hair. Although it is reported more commonly in males, it also affects females but the incidence is relatively unknown. AGA tremendously affects the psychology of the patient due to its chronicity of treatment and cosmetic implications. There are numerous treatment options available for AGA but the choice of treatment has to often be tailored according to the patient's needs, affordability, and compliance. This review focusses on the various treatment options available, with special emphasis on the role of low-level laser therapy (LLLT) in the management of AGA. The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Only articles available in English were considered for this review.

A review of the treatment of male pattern hair loss

Introduction: Androgenetic alopecia is a common hair loss disorder affecting up to 80% of males by the age of 80. It is characterized by androgen related progressive thinning of hair in a defined pattern. It results in diminished self-esteem, reduced confidence and distress in affected men, irrespective of age or stage of baldness. An effective treatment for hair baldness is needed.Areas covered: In androgenetic alopecia, hair follicles undergo progressive miniaturization. Genetic factors and androgens are key role-players in disease pathogenesis. Herein the authors review the pharmacologic treatment of androgenetic alopecia, which involves 5 alpha reductase inhibitors, minoxidil and prostaglandins. Non-pharmacologic approaches are also explored.Expert opinion: Androgenetic alopecia progresses over time and although the current available medical treatments like finasteride and minoxidil are effective in arresting the progression of the disease, they allow only partial regrowth of hair at its best. Early treatment achieves a more optimal outcome. Non-pharmacologic treatments like PRP can be considered in patients refractory to medical treatment.Abbreviations: MPHL: male pattern hair loss; AGA: androgenetic alopecia; DHT: dihydrotestosterone; 5AR: 5-alpha-reductase; VEGF: vascular endothelial growth factor; PG's: prostaglandins (PG's); PGD2R: prostaglandin D2 receptor; VPA: valproic aid; SR: Serenoa Repens; PRP: platelet-rich plasma; PDGF: platelet derived growth factor; TGF: transforming growth factor; ERK: extracellular signal-regulated kinase; PKB: protein kinase B; LLLT: low-level laser therapy; ROS: reactive oxygen species; RCT: randomized control trial; SFRP1: secreted frizzled related protein 1; DP: dermal papilla; PDE5: phosphodiesterase 5.

The effect of 1540-nm fractional erbium-glass laser in the treatment of androgenic alopecia.

BACKGROUND: Androgenic alopecia is common, chronic dermatologic disorder. A variety of lasers and light sources appear to be safe and effective in the treatment of AGA. AIMS: To evaluate the efficacy and safety of 1540-nm fractional erbium glass laser in the treatment of AGA. PATIENTS/METHODS: This was an interventional therapeutic study for the treatment of patients with AGA. The patients received 10 sessions with 1540-nm fractional erbium glass laser at 2-week intervals. The assessment of the response was done before and at the end of follow-up period, both objectively (the change in the density of terminal hair and the diameter of the hair shaft) and subjectively (patient satisfaction). Any adverse effects were documented during the study. RESULTS: Forty-seven out of 51 patients completed the study. After 5 months of laser treatment, the density of hair and hair thickness was significantly increased in both males and females (P value .001). CONCLUSION: The 1540-nm fractional erbium-glass laser seems to be an effective and safe option for treatment of patients with AGA. The improvement was accomplished in a short period.