|
 |
| ORIGINAL ARTICLE |
|
| Year : 2014 | Volume
: 6
| Issue : 2 | Page : 45-49 |
|
|
Use of low-level laser therapy as monotherapy or concomitant therapy for male and female Androgenetic alopecia
Andréia Munck1, Maria Fernanda Gavazzoni1, Ralph M Trüeb2
1 Institute of Dermatology Prof. R.D. Azulay, Rio de Janeiro, Brazil
2 Center for Dermatology and Hair Diseases, Bahnhofplatz, Wallisellen, Switzerland
| Date of Web Publication | 13-Aug-2014 |
Correspondence Address:
Ralph M Trüeb
Center for Dermatology and Hair Diseases, Bahnhofplatz 1A, CH - 8304 Wallisellen, Switzerland
 Source of Support: None, Conflict of Interest: Ralph M. Trüeb
performs consultant activity for Lexington International LLC. This
study represents an integral part of Andréia Munck’s traineeship
in trichology at the Center for Dermatology and Hair Diseases
Prof. Trüeb.  | Check |
DOI: 10.4103/0974-7753.138584
 Abstract | | |
Background: Androgenetic alopecia (AGA) is the most common form of hair loss in men and in women. Currently, minoxidil and finasteride are the treatments with the highest levels of medical evidence, but patients who exhibit intolerance or poor response to these treatments are in need of additional treatment modalities. Objective: The aim was to evaluate the efficacy and safety of low-level laser therapy (LLLT) for AGA, either as monotherapy or as concomitant therapy with minoxidil or finasteride, in an office-based setting. Materials and Methods: Retrospective observational study of male and female patients with AGA, treated with the 655 nm-HairMax Laser Comb ® , in an office-based setting. Efficacy was assessed with global photographic imaging. Results: Of 32 patients (21 female, 11 male), 8 showed significant, 20 moderate, and 4 no improvement. Improvement was seen both with monotherapy and with concomitant therapy. Improvement was observed as early as 3 months and was sustained up to a maximum observation time of 24 months. No adverse reactions were reported. Conclusions: LLLT represents a potentially effective treatment for both male and female AGA, either as monotherapy or concomitant therapy. Combination treatments with minoxidil, finasteride, and LLLT may act synergistic to enhance hair growth. Keywords: Androgenetic alopecia, concomitant therapy, HairMax Laser Comb ® , low level laser therapy, monotherapy
How to cite this article:
Munck A, Gavazzoni MF, Trüeb RM. Use of low-level laser therapy as monotherapy or concomitant therapy for male and female Androgenetic alopecia. Int J Trichol 2014;6:45-9 |
How to cite this URL:
Munck A, Gavazzoni MF, Trüeb RM. Use of low-level laser therapy as monotherapy or concomitant therapy for male and female Androgenetic alopecia. Int J Trichol [serial online] 2014 [cited 2023 May 31];6:45-9. Available from: https://www.ijtrichology.com/text.asp?2014/6/2/45/138584 |
| Introduction | |  |
The ability of lasers to induce hair growth was incidentally noted as early as 1967 when Mester et al. used low-level laser therapy (LLLT) to treat cancer in mice with shaved backs. [1] Since then, hypertrichosis has been recognized to be a possible side-effect of laser treatment. First described in 2002 with intense pulsed light therapy, [2] this phenomenon has now been widely acknowledged to occur with an incidence rate ranging from 0.6% to 10% with low fluences and all laser types. [3] It is thought to be the result of suboptimal fluences that are too low to induce thermolysis, but high enough to stimulate follicular growth.
Eventually, LLLT has been developed for the treatment of androgenetic alopecia (AGA). As opposed to other currently marketed systems, the laser comb utilizes hair parting teeth for optimal delivery of laser energy to the exposed scalp. In 2007, the HairMax Laser Comb ® (Lexington International, LLC) received 510 (k) clearance from the Food and Drug Administration (FDA) for the treatment of AGA for men, and 2011 for women. This clearance means that the device is considered a moderate-risk medical device by the FDA and is thereby solely screened for safety. The HairMax Laser Comb ® has been tested in a company-sponsored study of 110 male patients with the claim of a significant increase in mean terminal hair density when compared to a sham device. [4] Avram and Rogers conducted the first independent blinded study of LLLT and hair growth with seven patients and found that on average, there was a decrease in the number of vellus hairs, an increase in the number of terminal hairs, and an increase in shaft diameter. [5] A consensus written by hair loss experts states that based on anecdotal experience, LLLT, particularly 650-900 nm wavelengths at 5 mW, may be an effective treatment option for patients with AGA. [6] In recent times, Kim et al. reported an increase of hair density with the use of LLLT, when compared to the sham device in a 24-week, randomized, double-blind, sham-device-controlled trial. [7]
To evaluate efficacy of the 655 nm-HairMax Laser Comb ® either as monotherapy or as concomitant therapy for treatment of male and female AGA, we performed a retrospective observational study of global photographic assessments of patients in an office-based setting.
| Materials and Methods | | |
The study design was retrospective and observational. Patients who had purchased a HairMax Laser Comb ® between July 2011 and July 2013 for treatment of AGA at the Center for Dermatology and Hair Diseases Prof. Trόeb were retrieved for assessment of global photographic images performed at follow-up visits. Patients on concomitant treatment had been treating with topical minoxidil or oral finasteride for at least 9 months, before starting therapy with the HairMax Laser Comb ® . Patients used the HairMax Laser Comb ® at home according to instructions 3 times weekly between 8 and 15 min depending on the model purchased (Advanced 7, Lux 9, or Professional 12). Global photographs were performed at 3, 6, 12, and 24 months of treatment follow-up in a standardized manner with a stereotactic camera device of Canfield Scientific Inc., in which the patient's chin and forehead are fixed and on which digital camera and flash device are mounted, ensuring that view and lighting are the same at consecutive visits, thus enabling precise follow-up of the same scalp area of interest with frontal and vertex views. Global photographs were evaluated by two of the authors (AM and RMT), and scored as significant, moderate, or no improvement. In the case of diverging opinions, the inferior score was given.
| Results | | |
In total, 32 patients with AGA were involved in the study, of which 21 were females, aged 22-73 (mean: 43.6 ± 15.19 standard deviation [SD]), and 11 were males, aged 20-70 (mean: 39 ± 15.01 SD) total mean: 42 ± 15.1 SD. The duration of hair loss in years for men and women was mean 7.1 ± 5.2 SD. The duration of LLLT in months for men and women was mean 8.7 ± 5.2 [Table 1]. The patient characteristics, with respect to gender, age, classification of AGA according to Ludwig and Hamilton-Norwood scales, duration of hair loss, and concomitant treatments are recorded in [Table 2].
The results for the scoring of the global photographic assessment in relation to treatment duration with the HairMax Laser Comb ® are demonstrated in [Table 3]. In summary, eight patients (three female, five male) showed significant improvement, 20 patients (14 female, six male) moderate improvement, and four patients (four female, zero male) no improvement [Figure 1]. Of 32 patients, the HairMax Laser Comb ® was used as monotherapy in six patients (two female, four male), and as a concomitant therapy in 26 patients (19 female, seven male). In the monotherapy group, two patients (one female, one male) showed significant improvement [Figure 2], four patients (one female, three male) moderate improvement, and zero patients no improvement [Table 3]. In the concomitant therapy group, six patients (two female, four male) showed significant improvement [Figure 3] and [Figure 4], 16 patients (13 female, three male) moderate improvement, and four patients (four female, zero male) no improvement. There was no statistical significant difference between LLLT monotherapy and concomitant therapy with either minoxidil and/or finasteride (P = 0.829), and regarding male or female AGA (P = 0.091) [Table 4]. | Figure 2: Monotherapy in a 54-year-old male (a) Before treatment, and improvement after (b) 6 months, and (c) 12 months of low-level laser therapy
Click here to view |
 | Figure 3: Concomitant treatment with topical 5% minoxidil in a 55-year-old male adding on low-level laser therapy (LLLT) to 4 year pretreatment with 5% topical minoxidil solution (a) Before, and (b) After 3 months of added LLLT
Click here to view |
 | Figure 4: Concomitant treatment with topical 5% minoxidil and 1 mg oral finasteride in a 34-year-old male (a) Before, (b) After 9 months treatment with 1 mg oral finasteride and topical 5% minoxidil solution bid, and (c) After 3 months after adding on low-level laser therapy
Click here to view |
 | Table 1: Improvement of alopecia in relation to the variables: Age, duration of hair loss, and duration of LLLT
Click here to view |
 | Table 3: Scoring of global photographic assessment in relation to treatment duration
Click here to view |
 | Table 4: Comparative assessment of efficacy between monotherapy and concomitant for male and female androgenetic alopecia
Click here to view |
Treatment was well tolerated and no serious adverse events were reported.
| Discussion | | |
Androgenetic alopecia is the most common form of hair loss in men and in women. Currently, topical 2% and 5% minoxidil solution and 1 mg oral finasteride are the treatments with the highest levels of medical evidence, [8] but patients who exhibit intolerance or poor response to these treatments are in need of additional treatment modalities. Although low-level energy lasers have been therapeutically used in medicine for photobiostimulation in a variety of indications more than 30 years, [9] it has only recently found the attention of the scientific community for the treatment of AGA. [6],[10],[11]
We have chosen the 655 nm-HairMax Laser Comb ® for several reasons: First, it represents the device with the most clinical study reports regarding its efficacy, [4],[5],[12] secondly, the cost of the device is affordable, and thirdly, the device is simple enough for patients to use at home. Finally, the fact that the device is safe, for which it received 510 (k) clearance from the FDA for the treatment of AGA, was also an important consideration.
Our study demonstrates clinical efficacy of the device for treatment of male and female AGA, both as monotherapy and as concomitant therapy, in terms of clinically relevant improvement of appearance of hair. Of 32 patients, eight patients (25%) showed significant improvement, and 20 patients (62.5%) showed moderate improvement in global photographic assessments. The effect was observed as early as 3 months of treatment, and was sustained up to a maximum observation time of 24 months. The technology appears to work better for some than for others, and predictive factors which will most benefit from LLLT are to be determined. It seems though, that patients with intermediate alopecia (Hamilton-Norwood III and IV, and Ludwig I and II, respiratory) respond best, since effective photobiostimulation depends on a minimum of hair for effective photobiostimulation, and on a maximum of hair for the laser beam to reach the scalp without absorption or interference from existing hairs.
The hypothesized mechanisms of action of LLLT are increased adenosine tri-phosphate (ATP) production, modulation of reactive oxygen species (ROS), and induction of transcription factors. The proposed cellular chromosphere responsible for the effect of visible light is cytochrome c oxidase (COX) with absorption peaks in the near infrared, and mitochondria the likely site for the initial effects. It is believed that LLLT displaces nitric oxid from COX allowing an influx of oxygen to bond to COX and progress forward in the respiratory process to ATP production and ROS signaling. These effects in turn lead to increased cellular proliferation, modulation in levels of cytokines, growth factors and inflammatory mediators, and increased tissue oxygenation. While the effects of these biochemical and cellular changes have broadly been studied in both animal models and clinical studies with patients, and have shown benefits in diverse conditions, such as increased healing in chronic wounds, improvements in sports injuries and carpal tunnel syndrome, pain reduction in arthritis and neuropathies, and amelioration of damage after heart attacks, stroke, nerve injury and retinal toxicity, [7],[9] the effects on hair growth stimulation have only recently gained the attention of the scientific community.
| Conclusion | | |
From our own observations, we share with other authors the opinion that LLLT represents a safe and potentially effective treatment option for patients with AGA who do not respond or are not tolerant to standard treatment of AGA. [6],[7] Moreover, combining LLLT with topical minoxidil solution and oral finasteride may act synergistic to enhance hair growth. Due to the known beneficial effect on wound healing, it is conceivable that LLLT as an adjunctive therapy in hair transplant surgery may also reduce postoperative shedding, reduce healing time, and increase graft patency. The scientific basis for such an approach is given, but there is a need for controlled studies with a higher number of patients to establish an increase in efficacy of combination regimens. [13]
| References | | |
| 1. | Mester E, Szende B, Gärtner P. The effect of laser beams on the growth of hair in mice. Radiobiol Radiother (Berl) 1968;9:621-6. 
|
| 2. | Moreno-Arias G, Castelo-Branco C, Ferrando J. Paradoxical effect after IPL photoepilation. Dermatol Surg 2002;28:1013-6.
|
| 3. | Bernstein EF. Hair growth induced by diode laser treatment. Dermatol Surg 2005;31:584-6.
[PUBMED] |
| 4. | Leavitt M, Charles G, Heyman E, Michaels D. HairMax LaserComb laser phototherapy device in the treatment of male androgenetic alopecia: A randomized, double-blind, sham device-controlled, multicentre trial. Clin Drug Investig 2009;29:283-92.
|
| 5. | Avram MR, Rogers NE. The use of low-level light for hair growth: Part I. J Cosmet Laser Ther 2009;11:110-7.
|
| 6. | Avram MR, Leonard RT Jr, Epstein ES, Williams JL, Bauman AJ. The current role of laser/light sources in the treatment of male and female pattern hair loss. J Cosmet Laser Ther 2007;9:27-8.
|
| 7. | Kim H, Choi JW, Kim JY, Shin JW, Lee SJ, Huh CH. Low-level light therapy for androgenetic alopecia: A 24-week, randomized, double-blind, sham device-controlled multicenter trial. Dermatol Surg 2013;39:1177-83.
|
| 8. | Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, et al. European Dermatology Forum (EDF) Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges 2011;9 Suppl 6:S1-57.
|
| 9. | Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 2012;40:516-33.
|
| 10. | Gupta AK, Daigle D. The use of low-level light therapy in the treatment of androgenetic alopecia and female pattern hair loss. J Dermatolog Treat 2014;25:162-3.
|
| 11. | Ghanaat M. Types of hair loss and treatment options, including the novel low-level light therapy and its proposed mechanism. South Med J 2010;103:917-21.
[PUBMED] |
| 12. | Satino JL, Markou M. Hair regrowth and increased hair tensile strength using Hair Max Laser Comb for low-level laser therapjy. Int J Cosmet Surg Aesthet Dermatol 2003;5:113-7.
|
| 13. | Rajput RJ. Controversy: Is there a role for adjuvants in the management of male pattern hair loss? J Cutan Aesthet Surg 2010;3:82-6.
[PUBMED]  |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]
| This article has been cited by | | 1 |
Androgenetic Alopecia: Therapy Update |
|
| Shivali Devjani, Ogechi Ezemma, Kristen J. Kelley, Emma Stratton, Maryanne Senna | | Drugs. 2023; | | [Pubmed] | [DOI] | | | 2 |
Efficacy assessment for low-level laser therapy in the treatment of androgenetic alopecia: a real-world study on 1383 patients |
|
| Jun Qiu, Yanhua Yi, Linlang Jiang, Yong Miao, James Jia, Jian Zou, Zhiqi Hu | | Lasers in Medical Science. 2022; | | [Pubmed] | [DOI] | | | 3 |
Photobiomodulation Effectiveness in Treating Androgenetic Alopecia |
|
| Ana Cláudia Scarpim, Alessandra Baptista, Daniel Souza Ferreira Magalhães, Silvia Cristina Nunez, Ricardo Scarparo Navarro, Amanda Farage Frade-Barros | | Photobiomodulation, Photomedicine, and Laser Surgery. 2022; 40(6): 387 | | [Pubmed] | [DOI] | | | 4 |
Results of low-level laser therapy in the treatment of hair growth: An Egyptian experience |
|
| Mohamed Amer, Amany Nassar, Heba Attallah, Amin Amer | | Dermatologic Therapy. 2021; 34(3) | | [Pubmed] | [DOI] | | | 5 |
Usefulness of home-use microneedle devices in the treatment of pattern hair loss |
|
| Chihyeon Sohng, Eun Hye Lee, Soo Kyeong Woo, Jun Young Kim, Kyung Duck Park, Seok-Jong Lee, Weon Ju Lee | | Journal of Cosmetic Dermatology. 2021; 20(2): 591 | | [Pubmed] | [DOI] | | | 6 |
Non-ablative Er:YAG laser is an effective tool in the treatment arsenal of androgenetic alopecia |
|
| Doris Day, Madison McCarthy, Iva Talaber | | Journal of Cosmetic Dermatology. 2021; | | [Pubmed] | [DOI] | | | 7 |
Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics |
|
| Mark S. Nestor, Glynis Ablon, Anita Gade, Haowei Han, Daniel L. Fischer | | Journal of Cosmetic Dermatology. 2021; | | [Pubmed] | [DOI] | | | 8 |
Photobiomodulation for the management of hair loss |
|
| Angeli Eloise Torres, Henry W. Lim | | Photodermatology, Photoimmunology & Photomedicine. 2021; 37(2): 91 | | [Pubmed] | [DOI] | | | 9 |
Photobiomodulation Therapy in Plastic Surgery and Dermatology |
|
| Eiko Nakayama, Toshihiro Kushibiki, Yoshine Mayumi, Masato Tsuchiya, Ryuichi Azuma, Tomoharu Kiyosawa, Miya Ishihara | | Nippon Laser Igakkaishi. 2021; 41(4): 370 | | [Pubmed] | [DOI] | | | 10 |
Regenerative Biotechnologies in Plastic Surgery: A Multicentric, Retrospective, Case-Series Study on the Use of Micro-Needling with Low-Level Light/Laser Therapy as a Hair Growth Boost in Patients Affected by Androgenetic Alopecia |
|
| Pietro Gentile, Simone Garcovich, Soo-Ik Lee, Sangbum Han | | Applied Sciences. 2021; 12(1): 217 | | [Pubmed] | [DOI] | | | 11 |
Low-Level Light Therapy Downregulates Scalp Inflammatory Biomarkers in Men With Androgenetic Alopecia and Boosts Minoxidil 2% to Bring a Sustainable Hair Regrowth Activity |
|
| Yann F. Mahe, Ahsène Cheniti, Charlotte Tacheau, Rosaria Antonelli, Lien Planard-Luong, Simon Bernard, Laurent Buffat, Philippe Barbarat, Leila Kanoun-Copy | | Lasers in Surgery and Medicine. 2021; 53(9): 1208 | | [Pubmed] | [DOI] | | | 12 |
Efficacy of Minoxidil Combined With Photobiomodulation for the Treatment of Male Androgenetic Alopecia. A Double-Blind Half-Head Controlled Trial |
|
| Fernanda Ferrara, Priscila Kakizaki, Fernanda Freitas Brito, Leticia Arsie Contin, Carla Jorge Machado, Aline Donati | | Lasers in Surgery and Medicine. 2021; 53(9): 1201 | | [Pubmed] | [DOI] | | | 13 |
Comparison of low-level light therapy and combination therapy of 5% minoxidil in the treatment of female pattern hair loss |
|
| Yang Liu, Lin-lang Jiang, Fang Liu, Qian Qu, Zhe-xiang Fan, Zhi Guo, Yong Miao, Zhi-qi Hu | | Lasers in Medical Science. 2021; 36(5): 1085 | | [Pubmed] | [DOI] | | | 14 |
Láser de baja potencia para tratar la alopecia androgénica |
|
| S. Martínez-Pizarro | | Actas Dermo-Sifiliográficas. 2021; 112(2): 99 | | [Pubmed] | [DOI] | | | 15 |
Low-level laser therapy for androgenetic alopecia |
|
| S Martínez-Pizarro | | Actas Dermo-Sifiliográficas (English Edition). 2021; 112(2): 99 | | [Pubmed] | [DOI] | | | 16 |
Meta-analysis of photobiomodulation for the treatment of androgenetic alopecia |
|
| A. K. Gupta, J. L. Carviel | | Journal of Dermatological Treatment. 2021; 32(6): 643 | | [Pubmed] | [DOI] | | | 17 |
The Effectiveness of Low-Level Light/Laser Therapy on Hair Loss |
|
| Pietro Gentile, Simone Garcovich | | Facial Plastic Surgery & Aesthetic Medicine. 2021; | | [Pubmed] | [DOI] | | | 18 |
Evaluation of Efficacy of Low-Level Laser Therapy |
|
| Vahid Mansouri, Babak Arjmand, Mostafa Rezaei Tavirani, Mohammadreza Razzaghi, Mohammad Rostami-Nejad, Mostafa Hamdieh | | Journal of Lasers in Medical Sciences. 2020; 11(4): 369 | | [Pubmed] | [DOI] | | | 19 |
Effects of photobiomodulation therapy for androgenic alopecia: A meta-analysis of randomized controlled trials |
|
| Xianfu Meng, Fang Xie, Wenjuan Wang, Rui Wang, Biwen Lin, Zigang Zhao, Tian Hao, Xiaoning Zhang, Chengxin Li | | Journal of Laser Applications. 2020; 32(2): 022009 | | [Pubmed] | [DOI] | | | 20 |
Visible red light enhances physiological anagen entry in vivo and has direct and indirect stimulative effects in vitro |
|
| Yi-Shuan Sheen,Sabrina Mai-Yi Fan,Chih-Chieh Chan,Yueh-Feng Wu,Shiou-Hwa Jee,Sung-Jan Lin | | Lasers in Surgery and Medicine. 2015; 47(1): 50 | | [Pubmed] | [DOI] | |
|
 |
|
|
|
