Low level laser therapy and hair regrowth: an evidence-based review

ArticleinLasers in Medical Science 31(2) · December 2015with 2,355 Reads 
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Abstract
Despite the current treatment options for different types of alopecia, there is a need for more effective management options. Recently, low-level laser therapy (LLLT) was evaluated for stimulating hair growth. Here, we reviewed the current evidence on the LLLT effects with an evidence-based approach, focusing more on randomized controlled studies by critically evaluating them. In order to investigate whether in individuals presenting with hair loss (male pattern hair loss (MPHL), female pattern hair loss (FPHL), alopecia areata (AA), and chemotherapy-induced alopecia (CIA)) LLLT is effective for hair regrowth, several databases including PubMed, Google Scholar, Medline, Embase, and Cochrane Database were searched using the following keywords: Alopecia, Hair loss, Hair growth, Low level laser therapy, Low level light therapy, Low energy laser irradiation, and Photobiomodulation. From the searches, 21 relevant studies were summarized in this review including 2 in vitro, 7 animal, and 12 clinical studies. Among clinical studies, only five were randomized controlled trials (RCTs), which evaluated LLLT effect on male and female pattern hair loss. The RCTs were critically appraised using the created checklist according to the Critical Appraisal for Therapy Articles Worksheet created by the Center of Evidence-Based Medicine, Oxford. The results demonstrated that all the performed RCTs have moderate to high quality of evidence. However, only one out of five studies performed intention-to-treat analysis, and only another study reported the method of randomization and subsequent concealment of allocation clearly; all other studies did not include this very important information in their reports. None of these studies reported the treatment effect of factors such as number needed to treat. Based on this review on all the available evidence about effect of LLLT in alopecia, we found that the FDA-cleared LLLT devices are both safe and effective in patients with MPHL and FPHL who did not respond or were not tolerant to standard treatments. Future randomized controlled trials of LLLT are strongly encouraged to be conducted and reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement to facilitate analysis and comparison.

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  • ... Present conventional treatments like surgical hair transplant [3], drugs (Finasteride, Dutasteride and Minoxidil) [4] and laser therapy [5] have their inherent side effects and limitations which will be discussed in detail at the appropriate place in this article. ...
    Article
    Full-text available
    The present treatment options for hair loss are drugs (Finasteride and Minoxidil), laser therapy, follicular hair transplant, and serum therapy. These treatments have their own side effects and contraindications with appropriate alerts from regulatory authorities. The side effects imposed by these treatment options cannot be neglected and demands alternate therapy approach with less or no side effects. Hair loss can have major psychological impact on affected individuals belonging to varied ethnicity. Hair itself is a mini organ and serves many significant functions like maintaining body temperature and promoting social interactions. Hair recycling is continuous process governed by hair growth cycle consisting of three phases viz. anagen, catagen and telogen. Imbalance of any sort in the normal cycle due to any reason results into unhealthy hair or complete stagnation of hair growth. Major factor contributing to hair loss is androgenic alopecia. Hair follicles possess receptor for androgen and DHT (Dihydrotestosterone) in excess results into shrinkage of hair follicle affecting hair growth adversely. Stem cell therapy is one of the promising therapeutic modality in near future. Use of stem cells as a therapeutic strategy has many advantages over conventional therapies for hair growth. Adult human possess stem cells in body parts like bone marrow and adipose tissue. Stem cells extracted from patient for hair regeneration application rules out immunological rejection and other side effects. If fact, mesenchymal stem cells are immune privileged and hence devoid of any histocompatibility requirements. The present article reviews reasons for hair loss, conventional treatment options and their side effects, unique properties of stem cells, growth factors secreted by stem cells for hair regeneration and experimental strategies to up-regulate secretion of favourable growth factors for hair regeneration.
  • ... 28 Zareiet al reviewed the FDA cleared LLLT devices, and concluded that thee devices did not have adverse effects and were effective for both AAI and FPHL. 29 van Zuurenet al did an extensive literature review, and concluded that LLLT devices show some efficacy in FPHL by increasing hair count, however, the studies thus far have moderate to low quality evidence. 30 However, Gupta et al compared none trials on LLLT for hair loss and concluded that the weakness of the evidence hindered a conclusive result. ...
    Article
    Full-text available
    Low level laser therapy (LLLT) uses a monochromatic and coherent beam in the red or near infrared wavelength. We asked whether the literature supports the effectiveness of LLLT for androgenic and female patter hair loss? The logic behind the use of LLLT comes from observation of paradoxical hypertrichosis while attempting laser hair removal, especially in skin of color. The mechanism of this is unknown. We conducted a systematic review of the literature on the topic of LLLT and phototherapy for hairgrowth. The overwhelming results show that light in the red spectrum is effective in hair growth, but larger case-controlled studies are required to back up this conclusion.
  • ... Global assessment of hair growth and hair thickness was generally found to be greater in the LLLT group as well, but not consistently amongst all of the treatment groups. Our findings are in accordance with other similar reviews on this subject matter (2,29,30). ...
    Article
    Alopecia is a common disorder affecting over half of the world’s population. Within this condition,androgenic alopecia (AA) is the most common type, affecting 50% of males over 40 and 75% of females over 65. Anecdotal paradoxical hypertrichosis noted during laser epilation has generated interest in thepossibility of using laser to stimulate hair growth. In this study, we aimed to critically appraise the application of low-level laser therapy for the treatment of AA in adults. A systematic review was performed on studies identified on Medline, EMBASE, Cochrane database, and clinicaltrials.org. Double-blinded randomized controlled trials were selected and analyzed quantitatively (meta-analysis) and qualitatively (quality of evidence, risk of bias). Low-level laser therapy appears to be a promising noninvasive treatment for AA in adults that is safe for self-administration in the home setting. Although shown to effectively stimulate hair growth when compared to sham devices, these results must be interpreted with caution. Further studies with larger samples, longer follow-up, and independent funding sources are necessary to determine the clinical effectiveness of this novel therapy.
  • ... The available treatment options are drugs (Finasteride, Dutasteride and Minoxidil) [5,6], surgical hair transplant [7] and laser therapy [8]. However, these treatments have their own set of adverse effects which will be discussed in the following sections in detail. ...
    Article
    Hair loss can have major psychological impact on affected population belonging to varied ethnic background. Hair is a mini organ in itself and serves many distinguishing functions ranging from maintaining body temperature to promoting social interactions. Major cause of hair loss is androgenic alopecia. Hair follicles possess receptor for androgen. However, DHT (Dihydrotestosterone) in excess results into shrinkage of hair follicle affecting hair growth adversely.
  • ... Identifier: NCT02528552) is underway. An evidence-based review of LLLT for hair regrowth suggests that FDA-cleared LLLT devices are both safe and effective in men and women who did not respond, or were not tolerant to, standard treatments [154]. ...
    Article
    Full-text available
    Introduction: Treatments for androgenetic alopecia constitute a multi-billion-dollar industry, however, currently available therapeutic options have variable efficacy. Consequently, in recent years small biotechnology companies and academic research laboratories have begun to investigate new or improved treatment methods. Research and development approaches include improved formulations and modes of application for current drugs, new drug development, development of cell-based treatments, and medical devices for modulation of hair growth. Areas covered: Here we review the essential pathways of androgenetic alopecia pathogenesis and collate the current and emerging therapeutic strategies using journal publications databases and clinical trials databases to gather information about active research on new treatments. Expert opinion: We propose that topically applied medications, or intra-dermal injected or implanted materials, are preferable treatment modalities, minimizing side effect risks as compared to systemically applied treatments. Evidence in support of new treatments is limited. However, we suggest therapeutics which reverse the androgen-driven inhibition of hair follicle signaling pathways, such as prostaglandin analogs and antagonists, platelet-rich plasma (PRP), promotion of skin angiogenesis and perfusion, introduction of progenitor cells for hair regeneration, and more effective ways of transplanting hair, are the likely near future direction of androgenetic alopecia treatment development.
  • ... Zarei et al. noted that there is a need for more effective management options for male pattern hair loss (MPHL), FPHL, alopecia areata (AA) and chemotherapy-induced alopecia (CIA) [53]. Zarei et al. reviewed 21 relevant studies on alopecia, hair loss and regrowth, LLLT and photobiomodulation (2 were in-vitro, 7 on animal models and 12 were clinical studies). ...
    Chapter
    Full-text available
    Low Level Laser Therapy (LLLT) known as “cold or soft laser” represents a therapeutic method used since 1964, when the Nobel Prize for Physics was won for MASER (microwave amplification by stimulated emission of radiation) and the acronym LASER was described (Light Amplification by Stimulated Emission of Radiation). In 1967 LLLT was used by a Hungarian physician, Dr. Endre Mester, on a rat model of carcinogenesis, but proved an unexpected hair regrowth effect, becoming since then a promising treatment option in alopecia.
  • ... Low-level laser/light therapy devices have been used to induce a variety of biomodulatory effects associated with a diverse range of wavelengths, including antiinflammatory activity, pain reduction, wound healing, anti-edematous effects, immunomodulatory effects, and improvement of local blood circulation. [15][16][17] Recently, paradoxical hair growth has been noted at or around sites treated for hair removal using most laser types and intense pulsed light sources at low fluency. 18,19 Thus, it has been proposed that such an increase in hair growth is caused by the use of suboptimal fluencies that are too low to induce thermolysis, but high enough to stimulate follicular hair growth. ...
    Article
    Background: Previous studies have reported the benefits of low-level/light laser therapy (LLLT) for the promotion of hair regrowth. However, the effectiveness of LLLT for the treatment of androgenetic alopecia (AGA) is still a topic of debate. Objective: To investigate the efficacy and safety of LLLT on hair regrowth in patients with AGA. Methods: This 24-week, randomized, double-blind, self-comparison, sham device-controlled trial enrolled 100 patients with AGA. All participants were randomly assigned to receive the investigational LLLT on one side of the head and sham light treatment on the contralateral side, 3 times weekly for 30 minutes each, over a 24-week period. Global scalp photography, phototrichogram assessment, the investigator's global assessment (IGA) of hair regrowth, and the subject's assessment of the treatment satisfaction were used for evaluation. Results: After 24 weeks of treatment, the LLLT-treated scalp exhibited significantly greater hair coverage than the sham light-treated side (14.2% vs. 11.8%, p < .001). A significantly greater improvement from baseline in hair thickness, hair count, hair coverage, and IGA were also observed in the LLLT-treated side than in the sham light-treated side at the 12- and 24-week visits. No serious adverse events were observed. Conclusion: The use of LLLT might be an effective, safe, well-tolerated treatment for AGA.
  • ... Low-level laser therapy is a relatively new FDA cleared device with postulated efficacy in promoting hair growth in both men and women with androgenetic alopecia (AGA) and FPHL, respectively [5]. Among various mechanisms of action, the main one hypothesized that LLLT activates epidermal stem cells in the hair follicle bulge with a shift toward the anagen phase [6,7]. ...
    Article
    Background: Female pattern hair loss (FPHL) is the most common form of hair loss in women. Nevertheless, its management represents a real challenge. Among the FDA approved therapeutic modalities for FPHL are topical minoxidil and more recently low-level light therapy (LLLT). Aim of work: Assess the efficacy and safety of LLLT in comparison to topical minoxidil 5% and to a combination of both therapies in the treatment of FPHL. Patients and methods: This study included 45 female patients with proven FPHL. They were randomly divided into three equal groups, where group (i) patients were instructed to apply topical minoxidil 5% twice daily, group (ii) patients received LLLT using the helmet iGrow® device for 25 minutes 3 days weekly, and group (iii) patients received a combination of both topical minoxidil 5% twice daily and LLLT for 25 minutes 3 days weekly for 4 months (study duration). Evaluation was done according to clinical, dermoscopic (folliscopic), and ultrasound bio-microscopic (UBM) parameters. Patient satisfaction and side effects were reported. Results: The efficacy and safety of both topical minoxidil and LLLT were highlighted with comparable results in all parameters. The combination group (iii) occupied the top position regarding Ludwig classification and patient satisfaction. UBM and dermoscopic findings showed significant increase in the number of regrowing hair follicles at 4 months in all groups, whereas only UBM showed such significant increase at 2 months in the combination group (iii). A non-significant increase in the hair diameter was also documented in the three groups. Conclusion: LLLT is an effective and safe tool with comparable results to minoxidil 5% in the treatment of FPHL. Owing to the significantly better results of combination therapy, its usage is recommended to hasten hair regrowth. Lasers Surg. Med. © 2017 Wiley Periodicals, Inc.
  • ... Activation of the Wnt10b/β-catenin pathway has been seen to result in regeneration of hair follicles [76]. Based on a recent evidence-based review on LLLT devices for treating alopecia, it was found that FDA-cleared devices are effective for patients with pattern hair loss, with low incidence of adverse effects [77]. ...
  • ... After these initial observations on PBM, extensive research on the biological effects of NIR and red light has been performed. Currently, NIR and red light are used in the medical field for the treatment of a variety of conditions such as muscle pain [17], wounds [18], neuropathic pain [19], headache [20], periorbital wrinkles [21,22], and alopecia [23]. ...
    Chapter
    Photobiomodulation (PBM) is a novel device-based treatment for major depressive disorder (MDD). PBM delivers near-infrared (NIR) or red light transcranially or systemically, aiming to modulate mitochondrial bioenergetics metabolism via the delivery of energy to the cytochrome c oxidase (CCO) enzyme. This primary action on mitochondria can lead to secondary effects on other pathways relevant for MDD such as oxidative stress, inflammation, and neurogenesis. Evidence supports that a fraction of the light delivered transcranially can reach the brain and modulate cortical activity and that light delivered in the periphery can exert systemic effects that include the brain. Preclinical studies indicate that PBM can treat depression-like behaviors in animal models of depression and also give some guidance on the optimal stimulation parameters. According to these studies, repeated sessions are more effective than a single session, and pulsed wave is more effective than continuous wave. Clinical studies also support the antidepressant effect of PBM and reinforce the need of repeated sessions. Clinical evidence also indicates that PBM can induce mild adverse effects, but the incidence of serious adverse effects is not different from that observed in sham (i.e., placebo) treatment. At this moment, PBM is an over-the-counter treatment for MDD and can be considered an alternative for patients who do not respond, tolerate, or accept antidepressant medication, evidence-based psychotherapies, or other FDA-approved device-based treatments.
  • ... No cancer formed; instead, they reported the laser radiation increased hair growth, a finding since confirmed for low-dose irradiation. 12 In a second study (for an account, see the study by Gáspár 13 ), the same group sought to use the same wavelength to destroy experimentally implanted tumors. The tumors seemed unaffected, but the irradiation accelerated the healing of the implantation wound, a finding extensively confirmed. ...
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    Full-text available
    This review brings together observations on the stress-induced regulation of resilience mechanisms in body tissues. It is argued that the stresses that induce tissue resilience in mammals arise from everyday sources: sunlight, food, lack of food, hypoxia and physical stresses. At low levels, these stresses induce an organised protective response in probably all tissues; and, at some higher level, cause tissue destruction. This pattern of response to stress is well known to toxicologists, who have termed it hormesis. The phenotypes of resilience are diverse and reports of stress-induced resilience are to be found in journals of neuroscience, sports medicine, cancer, healthy ageing, dementia, parkinsonism, ophthalmology and more. This diversity makes the proposing of a general concept of induced resilience a significant task, which this review attempts. We suggest that a system of stress-induced tissue resilience has evolved to enhance the survival of animals. By analogy with acquired immunity, we term this system ‘acquired resilience’. Evidence is reviewed that acquired resilience, like acquired immunity, fades with age. This fading is, we suggest, a major component of ageing. Understanding of acquired resilience may, we argue, open pathways for the maintenance of good health in the later decades of human life.
  • ... In the previous studies, red light was reported to be able to promote the wound healing and hair regeneration [16][17][18][19] . Besides, red light was used to promote tissue regeneration in burn and dermatology department 16,20 . ...
    Article
    Full-text available
    Currently, light pollution has become a nonnegligible issue in our daily life. Artificial light sources with high color temperature were deem to be the major pollution source, which could induce several adverse effects on human’s health. In our previous research, we have firstly developed an artificial indoor light with low color temperature (1900 K). However, the biological effects of this artificial light on human’s health are unclear. Here, four artificial lights (1900 K, 3000 K, 4000 K and 6600 K) were used to evaluate some biological changes in both human (in total 152 person-times) and murine models. Compared with other three high color temperature artificial lights, our lights (1900 K) presented a positive effect on promoting the secreting of melatonin and glutamate, protecting human’s eyes, accelerating would healing and hair regeneration. These systematical studies indicated that the proposed low color temperature (1900 K) light could provide several significant benefits in human’s daily life.
  • ... The history of the investigation and clinical use of laser therapy in medicine goes back to the late 1960s [20]. Recently, laser therapy is clinically accepted in medical fields and practices as part of physical therapy for many diseases such as hair regrowth, infantile hemangioma, incontinent great saphenous vein, and diabetic foot ulcer [21][22][23][24]. Besides, it has been applied in dental diseases such as periodontics and peri-implantitis, dentinal hypersensitivity, and dental movement [25][26][27][28][29][30]. ...
    Article
    Full-text available
    Objectives. Laser therapy is a promising new treatment for patients with recurrent aphthous stomatitis (RAS). However, the clinical effect and security issue of laser therapy remain controversial. This systematic review was conducted to evaluate the clinical effectiveness and security of laser treatment in RAS patients. Methods. Five electronic databases were searched (MEDLINE (PubMed), EMBASE, ScienceDirect, the Cochrane Library, and Web of Science) to identify all studies that were about randomized controlled clinical trials, involving the effect of laser therapy in RAS patients. Conclusion. Twenty-three studies were retained for full-text analysis after screening the titles and abstracts of potential articles, but only 10 studies satisfied the inclusion criteria after the full texts were reviewed. The included studies reported a comparison of the effectiveness between the laser treatment and placebo laser therapy (or conventional drug therapy) when managing the RAS patients. It can be concluded that laser therapy has the superiority in relieving ulcer pain and shortening healing time when compared with placebo group or medical treatment group. Although laser therapy is a promising effective treatment for RAS, high-quality clinical studies with large sample size must be further performed to confirm the effectiveness of this therapy.
  • ... Computer-aided drug discovery process 27 3.1.5 Structural considerations in drug discovery 29 3.1.6 Bioinformatics and genomics 32 3.1.7 ...
    Chapter
    Alopecia or hair loss is a worldwide unisex dermatological problem which affects aesthetic lifestyle qualities in humans. In recent years, drug discovery for hair loss has gained significant pharmaceutical research attention. Synthetic drugs such as minoxidil, oral finasteride, anthralin cream and ketoconazole based antifungal shampoos are some of the commercially available product formulations for hair loss treatment. As these products are mostly chemically derived, their long-term exposure to the skin could result in various side effects and skin disorders. Since traditional medicine relies on herbs to treat alopecia, in recent times, different species of herbs are being extracted to generate functional bioactive chemicals as active ingredients to treat hair loss. These biologically derived phytochemicals may offer improved long-term biocompatibility with the skin. This chapter presents an overview of various phytochemicals with anti-alopecia properties and discusses their modes of action. Additionally, the efficiency of flavonoids, which is a major phytochemical constituent of several herbs and a potential 5α reductase enzyme inhibitor, as a potential drug for alopecia treatment is also discussed.
  • ... The absorption and utilization of vitamins, circadian rhythms, and sleep-wake cycles are examples of the lightdependent systems that show the role of the light in the biological systems. 1 The invention of the LASER (light amplification with stimulated emission of radiation) provided the opportunity to obtain high-power light at specific wavelengths and facilitated its application in biology and allowed a new field of research into the biological effects of radiation on animals and humans. 2 Low-level laser therapy (LLLT) was discovered in the 1960s and was first used by the National Aeronautics and Space Administration (NASA) in order to accelerate wound healing in the space. 3 PBM, or phot-modulation or a low-power laser is a non-invasive and non-toxic phototherapy that its wavelength is within the region of the red to near-infrared spectrum in the range of 600 to 1000 nm. Its beneficial effects have been observed in a variety of diseases and physiological processes, including wound healing, hypoxic damage, and cerebral regeneration. ...
    Article
    Full-text available
    Introduction: The purpose of this study is to investigate the effect of a low-power laser on the proliferation, migration, differentiation of different types of mesenchymal stem cells (MSCs) in different studies. Methods: The relevant articles that were published from 2004 to 2019 were collected from the sources of PubMed, Scopus, and only the articles specifically examining the effect of a lowpower laser on the proliferation, differentiation, and migration of the MSCs were investigated. Results: After reviewing the literature, only 42 articles were found relevant. Generally, most of the studies demonstrated that different laser parameters increased the proliferation, migration, and differentiation of the MSCs, except the results of two studies which were contradictory. In fact, changing the parameters of a low-power laser would affect the results. On the other hand, the source of the stem cells was reported as a key factor. In addition, the combination of lasers with other therapeutic approaches was found to be more effective. Conclusion: The different parameters of lasers has been found to be effective in the proliferation, differentiation, and migration of the MSCs and in general, a low-power laser has a positive effect on the MSCs, helping to improve different disease models.
  • ... It uses a lowintensity Laser to provide a potential treatment. This approach has been used to treat hair loss, rheumatic problems, pain relief, and enhance muscle strength [97,98]. Like other modalities, the LA has advantages and limitations in some applications. ...
    Article
    Full-text available
    Thermal therapy is a promising treatment for many patients particularly those with surgery intolerance. It has been used since the early age of humanity. Nowadays, the thermal therapy has proved its efficacy, especially in Oncology. In fact, the tumor ablation using a different modality of heating or cooling presents a therapeutic method to ablate the extra mass and eradicate the malignant it. The administration of the energy is performed in various ways using an energy source. Following the level of the used temperature and the nature of the used heating or cooling source, many modalities have been developed. Hyperthermia uses the lowest temperature among them. Other modalities use an elevated temperature to kill and destroy the tumors. These ablative therapies are Radio Frequency Ablation (RFA), Micro Wave Ablation (MWA), High Intensity Focused Ultrasound (HIFU), LASER Ablation (LA), and Cryoablation(CA). With the purpose of doing a general state of the art of the thermal therapies applied in Oncology and enlightening their advantages and limitations, we reviewed many recent and pertinent published works in different databases. We also investigated the cell destruction mechanism due to temperature. We exposed the recent advances and the limitations of these modalities. However, to improve the quality of the treatment and increase the rate of survival, the research is still investigating these modalities. We discussed the future challenges and perspectives of the thermal therapies. Propositions to overpass the limitations of some techniques were introduced.
  • Chapter
    Laser therapy has become a standard of care in treating musculoskeletal, neurological, and general soft-tissue conditions in veterinary medicine. More and more dermatological and non-musculoskeletal conditions are being treated with laser therapy, reaping the benefits of photobiomodulation. This chapter focuses on dermatological and non-musculoskeletal soft-tissue conditions representative of those that are good candidates for laser therapy.
  • Article
    Background: Outer root sheath cells (ORSCs) play important roles in maintaining hair follicle structure and provide support for the bulge area. The hair growth promoting effects of photobiomodulation therapy (PBMT) have been reported, but the mechanisms for this in human ORCs (hORSCs) have rarely been studied. Objective: The aim of this study was to investigate the effect of various wavelengths of light-emitting diode (LED) irradiation on human ORSCs (hORSCs). Methods: LED irradiation effects on hORSC proliferation and migration were examined with MTT assay, BrdU incorporation assay and migration assays. hORSCs were irradiated using four LED wavelengths (415, 525, 660, and 830 nm) with different low energy levels. LED irradiation effects on the expression of molecules associated with the Wnt/β-catenin signaling and ERK pathway, hair stem cell markers, and various growth factors and cytokines in hORSCs were examined with real-time PCR and Western blot assay. The effect of the LED-irradiated hORSCs on cell proliferation of human dermal papilla cells (hDPCs) was examined with co-culture and MTT assay. Results: PBMT with LED light variably promoted hORSC proliferation and suppressed cell apoptosis depending on energy level. LED irradiation induced Wnt5a, Axin2, and Lef1 mRNA expression and β-catenin protein expression in hORSCs. Phosphorylation of ERK, c-Jun, and p38 in hORSCs was observed after LED light irradiation, and ERK inhibitor treatment before irradiation reduced ERK and c-Jun phosphorylation. Red light-treated hORSCs showed substantial increase in IL-6, IL-8, TNF-a, IGF-1, TGF-β1, and VEGF mRNA. Light irradiation at 660 and 830 nm projected onto hORSCs accelerated in vitro migration. LED-irradiated hORSCs increased hDPCs proliferation when they were co-cultured. The conditioned medium from LED-irradiated hORSCs was sufficient to stimulate hDPCs proliferation. Conclusion: These results demonstrate that LED light irradiation induced hORSC proliferation and migration and inhibited apoptosis in vitro. The growth-promoting effects of LEDs on hORSCs appear to be associated with direct stimulation of the Wnt5a/β-catenin and ERK signaling pathway. Lasers Surg. Med. © 2017 Wiley Periodicals, Inc.
  • Article
    The treatment of hair loss is an important part of clinical dermatology given the prevalence of the problem and great impact on patients’ quality of life. Many new treatments have been introduced in recent years. This review summarizes the main ones in 4 groups: a) For androgenetic alopecia, we discuss new excipients for oral minoxidil, dutasteride, and finasteride as well as new forms of application; prostaglandin agonists and antagonists; low-level laser therapy; and regenerative medicine with Wnt signaling activators and stem cell therapy. b) For alopecia areata, Janus kinase inhibitors are reviewed. c) For frontal fibrosing alopecia, we discuss the use of antiandrogens and, for some patients, pioglitazone. d) Finally, we mention new robotic devices for hair transplant procedures and techniques for optimal follicular unit extraction.
  • Chapter
    A 62-year-old postmenopausal woman presents with a complaint of scalp hair loss. It has been present for several years, but worsened recently several months after a hospital admission for pneumonia, prompting the visit. She noticed an abrupt onset of hair shedding beginning 3 months after her hospitalization, and which lasted for almost 3 months. She reports that her shedding has since slowed and is back to baseline. She is otherwise healthy except for a history of recently diagnosed mild hypertension and osteoarthritis. Her medications include lisinopril, which she has been on for 6 months, and ibuprofen. She reports that her father became bald at a young age, but denies any hair loss complaint among women in her family.
  • Article
    Low-level laser or light therapy (LLLT) was used to accelerate wound healing without the use of thermal effects in the early days. Although the exact mechanism of LLLT is still unclear, it has been recognized as a photo-biomodulation process. Today, LLLT is being credited as a non-invasive treatment modality, and in particular, being widely applied in the field of dermatology. In this review, we summarize the basic principles and clinical applications of LLLT to provide an up-to-date guidance on its practical and safe uses. Further studies are needed to elucidate the mechanism of action of LLLT in various indications, and to determine the wavelength and dose for optimal clinical use.
  • Chapter
    Alopecia is a common disorder affecting more than half of the population worldwide. There is an urgent need to investigate alternative treatment options, while there are still a few therapeutics options for different types of alopecia in the market. The photobiomodulation phenomenon followed by hair growth was first described in 1967 by Professor Endre Mester, an Hungarian physician, the pioneer of laser medicine. For decades, clinical studies have been conducted to evaluate the efficacy, mechanism of action, and risks of using LLLT (collimated or non-collimated) in different forms of hair loss as a further treatment option. This chapter will present the clinical studies conducted with LLLT on female pattern hair loss (FPHL), male pattern hair loss (MPHL), alopecia areata (AA), and chemotherapy-induced alopecia (CIA) investigated in several databases including PubMed, Google Scholar, Medline, Embase, and Cochrane. At the end of this chapter, the authors concluded that LLLT may be a promising treatment option for patients who do not respond to conventional treatments and who do not want to undergo hair transplantation. This technology appears to work better for some people than others. Factors predicting who will get the most benefit need to be determined. Larger, longer-term placebo-controlled studies are needed to confirm these findings and reinforce the efficacy of the LLLT in those patients, generating, therefore, more consistent protocols.
  • Article
    Background: Hair loss is a common condition among women with a range of causes including nutritional deficiencies. Aims: To review the clinical data supporting the use of an oral marine supplement designed to promote hair growth. Patients/methods: Adult women with temporary thinning hair. Following an initial pilot study, five randomized, double-blind studies assessed the effectiveness of the oral marine supplement for promoting hair growth. Each study was approved by one or more institutional review boards. Results: Together, these studies demonstrated the ability of oral marine supplements to increase the growth of terminal and vellus hairs, increase the diameter of terminal and vellus hairs, and decrease hair loss. This product is beneficial for men as well as women. Conclusions: A dietary supplement containing a marine complex and other natural ingredients can safely and effectively promote hair growth and decrease hair shedding in women and men with thinning hair.
  • Article
    The treatment of hair loss is an important part of clinical dermatology given the prevalence of the problem and great impact on patients' quality of life. Many new treatments have been introduced in recent years. This review summarizes the main ones in 4 groups: a) For androgenetic alopecia, we discuss new excipients for oral minoxidil, dutasteride, and finasteride as well as new forms of topical application; prostaglandin agonists and antagonists; low-level laser therapy; and regenerative medicine with Wnt signaling activators and stem cell therapy. b) For alopecia areata, Janus kinase inhibitors are reviewed. c) For frontal fibrosing alopecia, we discuss the use of antiandrogens and, for some patients, pioglitazone. d) Finally, we mention new robotic devices for hair transplant procedures and techniques for optimal follicular unit extraction. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.
  • Chapter
    Each machine has its predefined protocols for the number of ideal sessions to be performed and for the interval between them.
  • Article
    The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code “OAP” to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, wavelength, light sources, technical features, price, and level of clinical evidence. To date, there are no head-to-head studies comparing the efficacy of these devices. Photobiomodulation therapy devices have an excellent safety profile and mounting evidence supporting their efficacy. However, long-term, high quality studies comparing these devices in diverse populations are lacking. As these devices become increasingly popular, dermatologists should be familiar with this treatment modality to add to their therapeutic armamentarium. Abbreviations: AGA, androgenetic alopecia; FDA, Food and Drug Administration; IEC, International Electrotechnical Commission; LED, light-emitting diode; PBMT, photobiomodulation therapy.
  • Article
    Background: Hair transplant surgery creates consistently natural appearing transplanted hair for men. It is increasingly popular procedure to restore natural growing hair for men with hair loss. Objective: To review some current controversies in hair transplant surgery. Materials and methods: Review of the English PubMed literature and specialty literature in hair transplant surgery. Results: Some of the controversies in hair transplant surgery include appropriate donor harvesting technique including elliptical donor harvesting versus follicular unit extraction whether manual versus robotic, the role of platelet-rich plasma and low-level light surgery in hair transplant surgery. Conclusion: Hair transplant surgery creates consistently natural appearing hair. As with all techniques, there are controversies regarding the optimal method for performing the procedure. Some of the current controversies in hair transplant surgery include optimal donor harvesting techniques, elliptical donor harvesting versus follicular unit extraction, the role of low-level light therapy and the platelet-rich plasma therapy in the procedure. Future studies will further clarify their role in the procedure.
  • Article
    Full-text available
    Photobiomodulation (PBM), the therapeutic use of low intensity light, typically in the visible and infrared (IR) wavelengths, has been demonstrated to be efficacious in the treatment and prevention of numerous skin conditions. The PBM biological response begins with chromophores, photon accepting molecules which convert light into signals that can stimulate certain biological processes. Important chromophores initiating the PBM response are Cytochrome C Oxidase (CCO), with absorption peaks in the red and near IR wavelengths, opsins absorbing blue and green wavelengths and intracellular water acting at specific sites in the cell. PBM can activate cell signaling processes. The increase in electron transport, oxygen consumption, mitochondrial membrane potential, and ATP synthesis, particularly in hypoxic or stressed cells, can lead to the up-regulation of cell repair and survival pathways. In PBM, the light delivery parameters which maximize the therapeutic response are defined within specific ranges, with total fluence and irradiance being of particular importance. PBM emerges as a valuable complementary treatment modality in dermatology. In terms of tissue repair, wound healing is accelerated by PBM. Cutaneous wounds, erosive mucositis in oncology, leg ulcers, as well as burns and radiodermatitis all benefit from PBM treatment. Widely used to accelerate healing after aggressive aesthetic treatments, PBM reduces inflammation following treatments like skin resurfacing, vascular and benign pigmented lesions, or chemical peels. It has also been shown to be effective in treating dyspigmentation. In the case of hyperpigmentation, melanin synthesis is inhibited with IR light. Additionally, PBM has shown benefits in the treatment of acne and the prevention / treatment of hypertrophic scars. It has shown promise in skin rejuvenation, the treatment of alopecia, cellulite, as well as other skin diseases. The discovery of new applications for PBM, already an effective form of treatment and prevention for many skin conditions, is continually expanding. Medical Research Archives, Vol 6, No 1, p 1-30.
  • Chapter
    The mechanism of light therapy is called phototherapy [3, 4]. It requires absorption of a specific wavelength by a light-absorbing molecule (chromophore), which can be produced and synthesized endogenously or applied exogenously to the receptor in cell tissues [3, 9, 12]. Irradiation in the photoreceptor generates a cascade of responses from the cells that leads to modulation of the cell function, proliferation, and repair of damaged cells [3, 9, 12]. The term that describes this “potentiation/cell function modulation” process is called photobiomodulation [3, 4, 9, 12] (Figs.109.1, 109.2, 109.3, and 109.4).
  • Article
    Activation of the Wnt/β-catenin signaling pathway plays an important role in hair follicle morphogenesis and hair growth. Recently, low-level laser therapy (LLLT) was evaluated for stimulating hair growth in numerous clinical studies, in which 655-nm red light was found to be most effective and practical for stimulating hair growth. We evaluated whether 655-nm red light + light-emitting diode (LED) could promote human hair growth by activating Wnt/β-catenin signaling. An in vitro culture of human hair follicles (HFs) was irradiated with different intensities of 655-nm red light + LED, 21 h7 (an inhibitor of β-catenin), or both. Immunofluorescence staining was performed to assess the expression of β-catenin, GSK3β, p-GSK3β, and Lef1 in the Wnt/β-catenin signaling. The 655-nm red light + LED not only enhanced hair shaft elongation, but also reduced catagen transition in human hair follicle organ culture, with the greatest effectiveness observed at 5 min (0.839 J/cm2). Additionally, 655-nm red light + LED enhanced the expression of β-catenin, p-GSK3β, and Lef1, signaling molecules of the Wnt/β-catenin pathway, in the hair matrix. Activation of Wnt/β-catenin signaling is involved in hair growth-promoting effect of 655-nm red light and LED in vitro and therefore may serve as an alternative therapeutic option for alopecia.
  • Article
    Background: Topical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). Material and methods: Descriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. Results: The responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%). A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. Conclusions: The most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.
  • Chapter
    Since the initial Food and Drug Administration clearance of the first photobiomodulation device for androgenetic alopecia in 2007, the market for these devices has rapidly expanded. Sixteen unique devices are currently available to consumers with varying designs, treatment durations and frequency. While the precise mechanism for hair growth stimulation remains to be elucidated, current evidence suggests the laser light alters hair cycle duration to promote the anagen growth phase. Photobiomodulation devices have an excellent safety profile with pruritus and skin dryness reported to be the most common side effects. Overall, research has demonstrated clinical efficacy of these devices, including randomized controlled studies. As photobiomodulation continues to emerge as a treatment modality for androgenetic alopecia, additional information on the most effective light sources, precise light wavelength, treatment schedule, and effectiveness on various hair diseases is still needed.
  • Article
    Background Currently, low‐level laser therapy (LLLT) has been approved as a new treatment for androgenetic alopecia (AGA). However, it has not been elucidated how LLLT promotes hair growth in vivo. Objectives To investigate the change in protein expression from dermal papilla (DP) tissues in male AGA patients after LLLT treatment using liquid chromatography tandem mass spectrometry (LC‐MS/MS) analysis. Methods This is an open‐label, prospective, single‐arm study obtained punch scalp biopsy specimens from patients with AGA before and after LLLT treatment. Each subject was self‐treated with helmet type of LLLT (655 nm, 5 mW) device at home for 25 minutes per treatment every other day for 24 weeks. LC‐MS/MS analysis based on the dimethyl labeling strategy for protein quantification was used to identify proteins expressed in DP tissues from AGA patients. Results Proteomic analysis revealed 11 statistically significant up‐regulated and 2 down‐regulated proteins in LLLT treated DP compared with baseline (P < 0.05). A bioinformatic analysis signifies that these proteins are involved in several biological processes such as regulation of cellular transcription, protein biosynthesis, cell energy, lipid homeostasis, extracellular matrix (ECM), ECM structural constituent, cell‐cell/cell‐matrix adhesion as well as angiogenesis. ATP‐binding cassette sub‐family G member, a transporter involved in cellular lipid homeostasis, was the most up‐regulated protein. Additionally, LLLT increased the main ECM proteins in DP which results in a bigger volume of DP and a clinical improvement of hair diameter in AGA patients. Conclusion We identified the proteome set of DP proteins of male patients with AGA treated with LLLT which implicates the role of LLLT in promoting hair growth and reversing of miniaturization process of AGA by enhancing DP cell function. Our results strongly support the benefit of LLLT in the treatment of AGA. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
  • Article
    Background While dermatologists focus on practices to promote anti‐aging, thinning hair that frames a more rejuvenated face can affect age perception and cosmesis. Objectives To characterize the effects of age‐related hair changes on age determination and perceived attractiveness. Methods A search was conducted for articles on intrinsic and extrinsic aging as it relates to hair. Key studies on the hair aging process and its effects on self‐perception, confidence, and anti‐aging were reviewed. Results According to several studies, hair density peaks about 27 years of age or earlier and then decreases from the mid‐thirties onward. This serves as an opportunity to prevent or treat hair loss in a similar way we treat aging skin. Without optimizing appearance of hair, overall cosmesis to foster self‐perception can be curtailed despite multiple efforts to rejuvenate and restore the aging face. Conclusion The discrepancy between rejuvenated faces and thinner appearing hair that frames the face highlights the importance of a holistic approach to the anti‐aging consultation. To more comprehensively address the aesthetic patient, we need to promote awareness of the onset of these hair changes in order to incorporate prevention and therapeutic strategies to preserve hair to complement overall appearance.
  • Chapter
    Androgenetic alopecia (AGA) is a common, non-scarring form of hair loss characterized by progressive miniaturization of terminal hair follicles on the scalp. First-line therapy for AGA consists of medical therapy with topical minoxidil and oral anti-androgens. Two emerging procedural therapies, platelet-rich plasma (PRP) injections and low-level light therapy (LLLT), represent novel therapeutics for the management of AGA. The details of these procedural treatment modalities are discussed within this chapter.
  • Article
    Full-text available
    Photobiomodulation (PBM) describes the application of light at wavelengths ranging from 400-1100nm to promote tissue healing, reduce inflammation and promote analgesia. Traditionally, red and near-infra red (NIR) light have been used therapeutically, however recent studies indicate that other wavelengths within the visible spectrum could prove beneficial including blue and green light. This review aims to evaluate the literature surrounding the potential therapeutic effects of PBM with particular emphasis on the effects of blue and green light. In particular focus is on the possible primary and secondary molecular mechanisms of PBM and also evaluation of the potential effective parameters for application both in vitro and in vivo. Studies have reported that PBM affects an array of molecular targets, including chromophores such as signalling molecules containing flavins and porphyrins as well as components of the electron transport chain. However, secondary mechanisms tend to converge on pathways induced by increases in reactive oxygen species (ROS) production. Systematic evaluation of the literature indicated 72% of publications reported beneficial effects of blue light and 75% reported therapeutic effects of green light. However, of the publications evaluating the effects of green light, reporting of treatment parameters was uneven with 41% failing to report irradiance (mW/cm²) and 44% failing to report radiant exposure (J/cm²). This review highlights the potential of PBM to exert broad effects on a range of different chromophores within the body, dependent upon the wavelength of light applied. Emphasis still remains on the need to report exposure and treatment parameters, as this will enable direct comparison between different studies and hence enable the determination of the full potential of PBM.
  • Article
    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 low-power laser on the murine hair growth
    • Ps Chung
    • Yc Kim
    • Ms Chung
  • OCEBM Levels of Evidence Working Group*The Oxford 2011 levels of evidence
    • J Howick
    • I Chalmers
    • P Glasziou
  • Oxford Centre for Evidence-Based Medicine
    • Rct Appraisal
    • Sheet
  • Evaluation of activity of laser doses on ex-vivo hair growth
    • M Hamblin
  • Phototherapy of androgenetic alopecia with low level narrow band 655-nm red light and 780-nm infrared light
    • Ss Kim
    • Mw Park
    • Cj Lee
  • Evaluation of the activity of laser light doses compared to an inactive control dose on ex vivo hair growth
    • M Leavitt
  • Biostimulation of wound healing by low-energy laser irradiation
    • Mj Conlan
    • Jw Rapley
    • Cm Cobb
  • Article
    BACKGROUND: Intense pulsed light (IPL) is an effective and safe hair removal method. However, it is not exempt from side effects. OBJECTIVE: To evaluate clinical and hormonal characteristics of females with facial hirsutism that developed hair growth in untreated areas close to the area submitted to IPL photoepilation (“paradoxical effect”). METHODS: A total of 49 females with facial hirsutism were included in a protocol of photoepilation with an IPL source. Hyperandrogenism of tumoral origin was excluded in all subjects. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-OH-progesterone (OHP), and sex hormone binding globulin (SHBG) were determined prior to IPL treatment. Clinical and photographic evaluation was performed immediately before each treatment session and 2, 6, and 9 months after the last treatment session. Only cases with “paradoxical effect” were included in this study. RESULTS: A total of five patients with “paradoxical effect” were identified. The patients' ranged in age from 13 to 44 years and all of them had skin phototype III (Fitzpatrick scale). All these subjects were diagnosed with polycystic ovarian syndrome and presented ovarian hyperandrogenism. Patients underwent six to nine IPL sessions, and “paradoxical effect” appeared at different times during the protocol, between treatment session 3 and 6 months after the conclusion of treatment. CONCLUSION: IPL may induce activation of dormant hair follicles in untreated areas close to hirsute-treated areas.
  • Article
    The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials.Kenneth Schulz and colleagues describe the latest version,CONSORT 2010,which updates the reporting guideline based on new methodological evidence and accumulating experience.To encourage dissemination of the CONSORT 2010 Statement,this article is freely accessible on bmj.com and will also be published in the Lancet,Obstetrics and Gynecology,PLoS Medicine,Annals of Internal Medicine,Open Medicine,Journal of Clinical Epidemiology,BMC Medicine,and Trials.
  • Article
    Background: Canine noninflammatory alopecia (CNA) is a heterogeneous group of skin diseases with different underlying pathogenesis. The therapeutic approach is challenging, and new options for treatment are desirable. Hypothesis/objectives: To test the clinical efficacy of low-level laser therapy (LLLT) on hair regrowth in CNA. Animals: Seven dogs of different ages, breeds and genders with a clinical and histopathological diagnosis of noninflammatory alopecia. Methods: Each dog was treated twice weekly for a maximum of 2 months with a therapeutic laser producing the following three different wavelengths emerging simultaneously from 21 foci: 13 × 16 mW, 470 nm; 4 × 50 mW, 685 nm; and 4 × 200 mW, 830 nm. The fluence given was 3 J/cm(2) , frequency 5 Hz, amplitude of the irradiated area was 25 cm(2) and application time was 1.34 min. A predetermined alopecic area was left untreated and served as a control area. From one dog, post-treatment biopsies of treated and untreated sites were obtained for histological evaluation of hair density and the percentage of haired and nonhaired follicles. Results: At the end of the study, coat regrowth was greatly improved in six of seven animals and improved in one of seven. By morphometry, the area occupied by hair follicles was 18% in the treated sample and 11% in the untreated one (11%); haired follicles were (per area) 93% in the treated sample and only 9% in the control sample. Conclusions and clinical importance: Our clinical and histological data document promising effects of LLLT on hair regrowth in CNA. Further studies investigating the biological mechanism underlying the effect of LLLT on hair follicle cycling are warranted.
  • Article
    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.
  • Article
    Full-text available
    Background and objectives: Low level laser (light) therapy (LLLT) has been demonstrated to promote hair growth in males. A double-blind randomized controlled trial was undertaken to define the safety and physiologic effects of LLLT on females with androgenic alopecia. Methods: Forty-seven females (18-60 years old, Fitzpatrick I-IV, and Ludwig-Savin Baldness Scale I-2, I-3, I-4, II-1, II-2 baldness patterns) were recruited. A transition zone scalp site was selected; hairs were trimmed to 3 mm height; the area was tattooed and photographed. The active group received a "TOPHAT655" unit containing 21, 5 mW diode lasers (655 ± 5 nm) and 30 LEDS (655 ± 20 nm), in a bicycle-helmet like apparatus. The placebo group unit appeared identical, containing incandescent red lights. Patients treated at home every other day × 16 weeks (60 treatments, 67 J/cm(2) irradiance/25 minute treatment, 2.9 J dose), with follow up and photography at 16 weeks. A masked 2.85 cm(2) photographic area was evaluated by another blinded investigator. The primary endpoint was the percent increase in hair counts from baseline. Results: Forty-two patients completed the study (24 active, 18 sham). No adverse events or side effects were reported. Baseline hair counts were 228.2 ± 133.4 (N = 18) in the sham and 209.6 ± 118.5 (N = 24) in the active group (P = 0.642). Post Treatment hair counts were 252.1 ± 143.3 (N = 18) in the sham group and 309.9 ± 166.6 (N = 24) in the active group (P = 0.235). The change in hair counts over baseline was 23.9 ± 30.1 (N = 18) in the sham group and 100.3 ± 53.4 (N = 24) in the active group (P < 0.0001). The percent hair increase over the duration of the study was 11.05 ± 48.30 (N = 18) for the sham group and 48.07 ± 17.61 (N = 24) for the active group (P < 0.001). This demonstrates a 37% increase in hair growth in the active treatment group as compared to the placebo group. Conclusions: LLLT of the scalp at 655 nm significantly improved hair counts in women with androgenetic alopecia at a rate similar to that observed in males using the same parameters.
  • Article
    Full-text available
    Male and female pattern hair loss are common, chronic dermatologic disorders with limited therapeutic options. In recent years, a number of commercial devices using low-level laser therapy have been promoted, but there have been little peer-reviewed data on their efficacy. To determine whether treatment with a low-level laser device, the US FDA-cleared HairMax Lasercomb(®), increases terminal hair density in both men and women with pattern hair loss. Randomized, sham device-controlled, double-blind clinical trials were conducted at multiple institutional and private practices. A total of 146 male and 188 female subjects with pattern hair loss were screened. A total of 128 male and 141 female subjects were randomized to receive either a lasercomb (one of three models) or a sham device in concealed sealed packets, and were treated on the whole scalp three times a week for 26 weeks. Terminal hair density of the target area was evaluated at baseline and at 16- and 26-week follow-ups, and analyzed to determine whether the hypothesis formulated prior to data collection, that lasercomb treatment would increase terminal hair density, was correct. The site investigators and the subjects remained blinded to the type of device they dispensed/received throughout the study. The evaluator of masked digital photographs was blinded to which trial arm the subject belonged. Seventy-eight, 63, 49, and 79 subjects were randomized in four trials of 9-beam lasercomb treatment in female subjects, 12-beam lasercomb treatment in female subjects, 7-beam lasercomb treatment in male subjects, and 9- and 12-beam lasercomb treatment in male subjects, compared with the sham device, respectively. Nineteen female and 25 male subjects were lost to follow-up. Among the remaining 122 female and 103 male subjects in the efficacy analysis, the mean terminal hair count at 26 weeks increased from baseline by 20.2, 20.6, 18.4, 20.9, and 25.7 per cm(2) in 9-beam lasercomb-treated female subjects, 12-beam lasercomb-treated female subjects, 7-beam lasercomb-treated male subjects, and 9- and 12-beam lasercomb-treated male subjects, respectively, compared with 2.8 (p < 0.0001), 3.0 (p < 0.0001), 1.6 (p = 0.0017), 9.4 (p = 0.0249), and 9.4 (p = 0.0028) in sham-treated subjects (95 % confidence interval). The increase in terminal hair density was independent of the age and sex of the subject and the lasercomb model. Additionally, a higher percentage of lasercomb-treated subjects reported overall improvement of hair loss condition and thickness and fullness of hair in self-assessment, compared with sham-treated subjects. No serious adverse events were reported in any subject receiving the lasercomb in any of the four trials. We observed a statistically significant difference in the increase in terminal hair density between lasercomb- and sham-treated subjects. No serious adverse events were reported. Our results suggest that low-level laser treatment may be an effective option to treat pattern hair loss in both men and women. Additional studies should be considered to determine the long-term effects of low-level laser treatment on hair growth and maintenance, and to optimize laser modality.
  • Article
    Full-text available
    Low level laser therapy (LLLT) has been used to promote hair growth. A double-blind randomized controlled trial was undertaken to define the safety and physiologic effects of LLLT on males with androgenic alopecia. Forty-four males (18–48 yo, Fitzpatrick I–IV, Hamilton–Norwood IIa–V) were recruited. A transition zone scalp site was selected; hairs were trimmed to 3 mm height; the area was tattooed and photographed. The active group received a “TOPHAT655” unit containing 21, 5 mW lasers (655 ± 5 nm), and 30 LEDS (655 ± 20 nm), in a bicycle-helmet like apparatus. The placebo group unit appeared identical, containing incandescent red lights. Patients treated at home every other day × 16 weeks (60 treatments, 67.3 J/cm2 irradiance/25 minute treatment), with follow up and photography at 16 weeks. A masked 2.85 cm2 photographic area was evaluated by another blinded investigator. The primary endpoint was the percent increase in hair counts from baseline. Forty-one patients completed the study (22 active, 19 placebo). No adverse events or side effects were reported. Baseline hair counts were 162.7 ± 95.9 (N = 22) in placebo and 142.0 ± 73.0 (N = 22) and active groups respectively (P = 0.426). Post Treatment hair counts were 162.4 ± 62.5 (N = 19) and 228.7 ± 102.8 (N = 22), respectively (P = 0.0161). A 39% percent hair increase was demonstrated (28.4 ± 46.2 placebo, N = 19; 67.2 ± 33.4, active, N = 22) (P = 0.001) Deleting one placebo group subject with a very high baseline count and a very large decrease, resulted in baseline hair counts of 151.1 ± 81.0 (N = 21) and 142.0 ± 73.0 (N = 22), respectively (P = 0.680). Post treatment hair counts were 158.2 ± 61.5 (N = 18) and 228.7 ± 102.8 (N = 22) (P = 0.011), resulting in a 35% percent increase in hair growth (32.3 ± 44.2, placebo, N = 18; 67.2 ± 33.4, active, N = 22) (P = 0.003). LLLT of the scalp at 655 nm significantly improved hair counts in males with androgenetic alopecia. Lasers Surg. Med. 45:487–495, 2013.
  • The authors wished to confirm the efficacy of low level laser therapy (LLLT) using a Hair- Max LaserComb for the stimulation of hair growth and also to determine what effect LLLT with this device had on the tensile strength of hair. Thirty-five patients, 28 males and 7 fe- males, with androgenetic alopecia (AGA) underwent treatment for a six-month period. Both the hair counts and tensile strength of the hair were affected very beneficially in both sexes in the temporal and vertex regions, with the males and vertex areas showing the most im- provement.
  • Article
    BACKGROUND: Androgenetic alopecia (AGA) is a common disorder affecting men and women. Finasteride and minoxidil are well-known, effective treatment methods, but patients who exhibit a poor response to these methods have no additional adequate treatment modalities. OBJECTIVE: To evaluate the efficacy and safety of a low-level light therapy (LLLT) device for the treatment of AGA. METHODS: This study was designed as a 24-week, randomized, double-blind, sham device-controlled trial. Forty subjects with AGA were enrolled and scheduled to receive treatment with a helmet-type, home-use LLLT device emitting wavelengths of 630, 650, and 660 nm or a sham device for 18 minutes daily. Investigator and subject performed phototrichogram assessment (hair density and thickness) and global assessment of hair regrowth for evaluation. RESULTS: After 24 weeks of treatment, the LLLT group showed significantly greater hair density than the sham device group. Mean hair diameter improved statistically significantly more in the LLLT group than in the sham device group. Investigator global assessment showed a significant difference between the two groups, but that of the subject did not. No serious adverse reactions were detected. CONCLUSION: LLLT could be an effective treatment for AGA.
  • Article
    Background and Objective It is unknown if pro- and anti-inflammatory mediators in acute lung inflammation induced by intestinal ischemia and reperfusion (i-I/R) can be modulated by low-level laser therapy (LLLT).Study Design/Material and MethodsA controlled ex vivo study was developed in which rats were irradiated (660 nm, 30 mW, 0.08 cm2 of spot size) on the skin over the right upper bronchus 1 hour post-mesenteric artery occlusion and euthanized 4 hours later. For pretreatment with anti-tumor necrosis factor (TNF) or IL-10 antibodies, the rats received either one of the agents 15 minutes before the beginning of reperfusion.Methods Lung edema was measured by the Evans blue extravasation and pulmonary neutrophils influx was determined by myeloperoxidase (MPO) activity. Both TNF and IL-10 expression and protein in lung were evaluated by RT-PCR and ELISA, respectively.ResultsLLLT reduced the edema (80.1 ± 41.8 µg g−1 dry weight), neutrophils influx (0.83 ± 0.02 × 106 cells ml−1), MPO activity (2.91 ± 0.60), and TNF (153.0 ± 21.0 pg mg−1 tissue) in lung when compared with respective control groups. Surprisingly, the LLLT increased the IL-10 (0.65 ± 0.13) in lung from animals subjected to i-I/R. Moreover, LLLT (0.32 ± 0.07 pg ml−1) reduced the TNF-α level in RPAECs when compared with i-I/R group. The presence of anti-TNF or IL-10 antibodies did not alter the LLLT effect on IL-10 (465.1 ± 21.0 pg mg−1 tissue) or TNF (223.5 ± 21.0 pg mg−1 tissue) in lung from animals submitted to i-I/R.Conclusion The results indicate that the LLLT attenuates the i-I/R-induced acute lung inflammation which favor the IL-10 production and reduce TNF generation. Lasers Surg. Med. 43:410–420, 2011. © 2011 Wiley-Liss, Inc.
  • Article
    Chemotherapy-induced alopecia (CIA) is one of the most distressing side effects of antineoplastic chemotherapy for which there is no effective interventional approach. A low-level laser (LLL) device, the HairMax LaserComb®, has been cleared by the FDA to treat androgenetic alopecia. Its effects may be extended to other settings; we have demonstrated that LaserComb treatment induced hair regrowth in a mouse model for alopecia areata. In the current study, we tested whether LLL treatment could promote hair regrowth in a rat model for CIA. Chemotherapy agents cyclophosphamide, etoposide, or a combination of cyclophosphamide and doxorubicin were administered in young rats to induce alopecia, with or without LLL treatment. As expected, 7-10 days later, all the rats developed full body alopecia. However, rats receiving laser treatment regrew hair 5 days earlier than rats receiving chemotherapy alone or sham laser treatment (with the laser turned off). The accelerated hair regrowth in laser-treated rats was confirmed by histology. In addition, LLL treatment did not provide local protection to subcutaneously injected Shay chloroleukemic cells. Taken together, our results demonstrated that LLL treatment significantly accelerated hair regrowth after CIA without compromising the efficacy of chemotherapy in our rat model. Our results suggest that LLL should be explored for the treatment of CIA in clinical trials because LLL devices for home use (such as the HairMax LaserComb®) provide a user-friendly and noninvasive approach that could be translated to increased patient compliance and improved efficacy.
  • Article
    Full-text available
    It was the aim of the present study to evaluate whether the laser irradiation of osteoblasts could enhance the release of growth factors including basic fibroblast growth factor (bFGF), insulin-like growth factor-I (IGF-I), and receptor of IGF-I (IGFBP3). Low-level laser therapy (LLLT) has been shown to have biostimulatory effects on various cell types by enhancing production of some cytokines and growth factors. Human mesenchymal stem cells (MSCs) were seeded in osteogenic medium and differentiated into osteoblasts. Three groups were formed: in the first group (single dose group), osteoblasts were irradiated with laser (685 nm, 25 mW, 14.3 mW/cm(2), 140 sec, 2 J/cm(2)) for one time; and in the second group, energy at the same dose was applied for 2 consecutive days (double dose group). The third group was not irradiated with laser and served as the control group. Proliferation, viability, bFGF, IGF-I, and IGFBP3 levels were compared between groups. Both of the irradiated groups revealed higher proliferation, viability, bFGF, IGF-I, and IGFBP3 expressions than did the nonirradiated control group. There was increase in bFGF and IGF-I expressions and decrease in IGFBP3 in the double dose group compared to single dose group. The results of the present study indicate that LLLT increases the proliferation of osteoblast cells and stimulates the release of bFGF, IGF-I, and IGFBP3 from these cells. The biostimulatory effect of LLLT may be related to the enhanced production of the growth factors.
  • Article
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    Alopecia areata (AA) is a common autoimmune disease that presents with non-scarring alopecia. It is characterized by intra- or peri-follicular lymphocytic infiltrates composed of CD4+ and CD8+ T-cells on histology. To this day, few treatments are effective for AA. Here we present findings of using a low-level laser comb to alleviate the symptoms of AA in a C3H/HeJ mouse model for AA. Fourteen C3H/HeJ mice with induced AA were used in this study. Two were killed to confirm AA through histology. The remaining 12 mice were randomized into two groups; group I received HairMax LaserComb (wavelength: 655 nm, beam diameter <5 mm; divergence 57 mrad; nine lasers) for 20 s daily, three times per week for a total of 6 weeks; group II was treated similarly, except that the laser was turned off (sham-treated). After 6 weeks of LaserComb treatment, hair regrowth was observed in all the mice in group I (laser-treated) but none in group II (sham-treated). On histology, increased number of anagen hair follicles was observed in laser-treated mice. On the other hand, sham-treated mice demonstrated hair follicles in the telogen phase with no hair shaft. LaserComb seems to be an effective and convenient device for the treatment of AA in the C3H/HeJ mouse model. Human studies are required to determine the efficacy and safety of this device for AA therapy.
  • Article
    It has been suggested that low intensity laser therapy (LILT) acts on pulmonary inflammation. Thus, we investigate in this work if LILT (650nm, 2.5mW, 31.2mW/cm(2), 1.3J/cm(2), laser spot size of 0.08cm(2) and irradiation time of 42s) can attenuate edema, neutrophil recruitment and inflammatory mediators in acute lung inflammation. Thirty-five male Wistar rats (n=7 per group) were distributed in the following experimental groups: control, laser, LPS, LPS+laser and dexamethasone+LPS. Airway inflammation was measured 4h post-LPS challenge. Pulmonary microvascular leakage was used for measuring pulmonary edema. Bronchoalveolar lavage fluid (BALF) cellularity and myeloperoxidase (MPO) were used for measuring neutrophil recruitment and activation. RT-PCR was performed in lung tissue to assess mRNA expression of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin (IL-10), cytokine-induced neutrophil chemoattractant-1 (CINC-1), macrophage inflammatory protein-2 (MIP-2) and intercellular adhesion molecule-1 (ICAM-1). Protein levels in both BALF and lung were determined by ELISA. LILT inhibited pulmonary edema and endothelial cytoskeleton damage, as well as neutrophil influx and activation. Similarly, the LILT reduced the TNF-α and IL-1β, in lung and BALF. LILT prevented lung ICAM-1 up-regulation. The rise of CINC-1 and MIP-2 protein levels in both lung and BALF, and the lung mRNA expressions for IL-10, were unaffected. Data suggest that the LILT effect is due to the inhibition of ICAM-1 via the inhibition of TNF-α and IL-1β.
  • Article
    Androgenetic alopecia (AGA) is the most common form of hair loss in men, and female pattern hair loss (FPHL) is the most common form of hair loss in women. Traditional methods of treating hair loss have included minoxidil, finasteride, and surgical transplantation. Currently there is a myriad of new and experimental treatments. In addition, low-level light therapy (LLLT) has recently been approved by the United States Food and Drug Administration (FDA) for the treatment of hair loss. There are several theories and minimal clinical evidence of the safety and efficacy of LLLT, although most experts agree that it is safe. More in vitro studies are necessary to elucidate the mechanism and effectiveness at the cellular level, and more controlled studies are necessary to assess the role of this new treatment in the general population.
  • Article
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    The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.
  • Article
    Laser hair removal is a safe and effective procedure for the treatment of unwanted body hair but is not exempt from side effects. A rare but significant adverse effect with this treatment modality is paradoxical hypertrichosis. To evaluate the potential etiologies, risk factors, related laser types, and treatment options for the development of excess hair after laser therapy. An analysis of previously published case studies and review articles along with our own experience was used to gather information regarding this phenomenon. Paradoxical hypertrichosis has a low incidence, ranging from 0.6% to 10%, and most commonly occurs on the face and neck. All laser and light sources have the potential to cause hair induction, especially in individuals with darker skin types (III-VI); with dark, thick hair; and with underlying hormonal conditions. Possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Treatment for paradoxical hypertrichosis is laser therapy of the affected area. Paradoxical hypertrichosis is a rare side effect of laser hair removal; the pathogenesis of this event remains widely unknown. We recommend further large-scale studies to investigate this effect. The authors have indicated no significant interest with commercial supporters.
  • Article
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    We report the results of a study carried out to investigate the effect of helium-neon (He-Ne) laser (632.8 nm) irradiation on the hair follicle growth cycle of testosterone-treated and untreated mice. Both histology and optical coherence tomography (OCT) were used for the measurement of hair follicle length and the relative percentage of hair follicles in different growth phases. A positive correlation (R = 0.96) was observed for the lengths of hair follicles measured by both methods. Further, the ratios of the lengths of hair follicles in the anagen and catagen phases obtained by both methods were nearly the same. However, the length of the hair follicles measured by both methods differed by a factor of 1.6, with histology showing smaller lengths. He-Ne laser irradiation (at approximately 1 J/cm(2)) of the skin of both the control and the testosterone-treated mice was observed to lead to a significant increase (p < 0.05) in % anagen, indicating stimulation of hair growth. The study also demonstrates that OCT can be used to monitor the hair follicle growth cycle, and thus hair follicle disorders or treatment efficacy during alopecia.
  • Article
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    It has been speculated that the biostimulatory effect of Low Level Laser Therapy could cause undesirable enhancement of tumor growth in neoplastic diseases. The aim of the present study is to analyze the behavior of melanoma cells (B16F10) in vitro and the in vivo development of melanoma in mice after laser irradiation. We performed a controlled in vitro study on B16F10 melanoma cells to investigate cell viability and cell cycle changes by the Tripan Blue, MTT and cell quest histogram tests at 24, 48 and 72 h post irradiation. The in vivo mouse model (male Balb C, n = 21) of melanoma was used to analyze tumor volume and histological characteristics. Laser irradiation was performed three times (once a day for three consecutive days) with a 660 nm 50 mW CW laser, beam spot size 2 mm(2), irradiance 2.5 W/cm(2) and irradiation times of 60s (dose 150 J/cm(2)) and 420s (dose 1050 J/cm(2)) respectively. There were no statistically significant differences between the in vitro groups, except for an increase in the hypodiploid melanoma cells (8.48 +/- 1.40% and 4.26 +/- 0.60%) at 72 h post-irradiation. This cancer-protective effect was not reproduced in the in vivo experiment where outcome measures for the 150 J/cm(2) dose group were not significantly different from controls. For the 1050 J/cm(2) dose group, there were significant increases in tumor volume, blood vessels and cell abnormalities compared to the other groups. LLLT Irradiation should be avoided over melanomas as the combination of high irradiance (2.5 W/cm(2)) and high dose (1050 J/cm(2)) significantly increases melanoma tumor growth in vivo.
  • Article
    Low-level laser therapy (LLLT) is a new therapy for the treatment of hair loss. It has received enormous media attention and tremendous marketing budgets from companies that sell the devices, but no independent, peer-reviewed studies have demonstrated its efficacy in this application. Here we investigate the efficacy of LLLT in enhancing hair growth. A total of seven patients were exposed to LLLT twice weekly for 20 minutes each time over a period of 3-6 months. Five patients were treated for a total of 3 months and two were treated for 6 months. Videomicroscopic images were taken at baseline, 3 months, and 6 months, and analyzed for changes in vellus hair counts, terminal hair counts, and shaft diameter. Both videomicroscopic and global images underwent blinded review for evidence of subjective improvement. Patients also answered questionnaires assessing hair growth throughout the study. Neither patients nor physicians conducting the study received any financial compensation. The results indicate that on average patients had a decrease in the number of vellus hairs, an increase in the number of terminal hairs, and an increase in shaft diameter. However, paired i-testing indicated that none of these changes was statistically significant. Also, blinded evaluation of global images did not support an improvement in hair density or caliber. LLLT may be a promising treatment option for patients who do not respond to either finasteride or minoxidil, and who do not want to undergo hair transplantation. This technology appears to work better for some people than for others. Factors predicting who will most benefit are yet to be determined. Larger, longer-term placebo-controlled studies are needed to confirm these findings, and demonstrate statistical significance, or refute them altogether.
  • Article
    Background and objective: The use of low levels of visible or near infrared light for reducing pain, inflammation and oedema, promoting healing of wounds, deeper tissue and nerves, and preventing tissue damage has been known for almost 40 years since the invention of lasers. The HairMax LaserComb® is a hand-held Class 3R lower level laser therapy device that contains a single laser module that emulates 9 beams at a wavelength of 655 nm (±5%). The device uses a technique of parting the user’s hair by combs that are attached to the device. This improves delivery of distributed laser light to the scalp. The combs are designed so that each of the teeth on the combs aligns with a laser beam. By aligning the teeth with the laser beams, the hair can be parted and the laser energy delivered to the scalp of the user without obstruction by the individual hairs on the scalp. The primary aim of the study was to assess the safety and effectiveness of the HairMax LaserComb® laser phototherapy device in the promotion of hair growth and in the cessation of hair loss in males diagnosed with androgenetic alopecia (AGA). Methods: This double-blind, sham device-controlled, multicentre, 26-week trial randomized male patients with Norwood-Hamilton classes IIa-V AGA to treatment with the HairMax LaserComb® or the sham device (2: 1). The sham device used in the study was identical to the active device except that the laser light was replaced by a non-active incandescent light source. Results: Of the 110 patients who completed the study, subjects in the HairMax LaserComb® treatment group exhibited a significantly greater increase in mean terminal hair density than subjects in the sham device group (p
  • Article
    Fifteen out of twenty-three female patients (65%) receiving PUVA therapy showed signs of moderate to severe hypertrichosis. Only two out of fourteen patients (14%) on UV-A therapy without systemic psoralens developed hypertrichosis. We conclude that hypertrichosis may develop in many patients treated with photochemotherapy.
  • Article
    This paper reviews studies on the basic principles of biostimulation of wound healing by various low-energy lasers. It looks at the mechanism of action of biostimulation as well as the laser's effect on cell proliferation, collagen synthesis, and would healing.
  • Article
    It has been reported that lipopolysaccharide (LPS) from periodontal pathogens can penetrate gingival tissues and stimulate the production of prostaglandin E2 (PGE2), which is known as a potent stimulator of inflammation and bone resorption. Although biostimulatory effects of low-level laser irradiation such as anti-inflammatory results have been reported, the physiological mechanism is not yet clarified. The purpose of the present study was to determine the effect of laser irradiation on PGE2 production and cyclooxygenase (COX)-1 and COX-2 gene expression in LPS-challenged human gingival fibroblast (hGF) cells in vitro. hGF cells were prepared from healthy gingival tissues and challenged with LPS, and Ga-Al-As diode laser was irradiated to the hGF cells. The amount of PGE2 released in the culture medium was measured by radioimmunoassay, and mRNA levels were analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). Irradiation with Ga-Al-As diode low-level laser significantly inhibited PGE2 production in a dose-dependent manner, which led to a reduction of COX-2 mRNA levels. In conclusion, low-level laser irradiation inhibited PGE2 by LPS in hGF cells through a reduction of COX-2 mRNA level. The findings suggest that low-level laser irradiation may be of therapeutic benefit against the aggravation of gingivitis and periodontitis by bacterial infection.
  • Article
    EBM is the use of the best current evidence in making decisions about the care of individual patients. Practicing EBM requires five steps: (1) formulating well-built clinical questions, (2) finding the best evidence to answer the questions, (3) critically appraising the evidence, (4) applying the evidence to specific patients, and (5) saving the critically appraised evidence. The Cochrane Library is the best source for finding the best evidence about treatment. The second best method for finding evidence about treatment and the best source for finding most other types of best evidence in dermatology is by searching the MEDLINE database using the PubMed Clinical search engine of the National Library of Medicine (http://++www.ncbi.nlm.nih.gov/PubMed/clin ica l.html). MEDLINE searches have inherent software and operator limitations that make their reliability quite variable. The quality (strength) of evidence is based on a hierarchy of evidence: results of systematic reviews of well-designed clinical studies, results of one or more well-designed clinical studies, results of large case series, and expert opinion. Once the best evidence has been found, the EBM approach involves critically appraising the quality of the evidence, determining its magnitude and precision, and applying it to the specific patient. Guidelines to appraise critically and apply evidence are available. The clinical question, best evidence, and its critical appraisal should be saved in a format that can be easily retrieved for future use.
  • Article
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    This is the first in a series of four articlesThe quality of controlled trials is of obvious relevance to systematic reviews. If the “raw material” is flawed then the conclusions of systematic reviews cannot be trusted. Many reviewers formally assess the quality of primary trials by following the recommendations of the Cochrane Collaboration and other experts. 1 2 However, the methodology for both the assessment of quality and its incorporation into systematic reviews and meta-analysis are a matter of ongoing debate.3-5 In this article we discuss the concept of study quality and the methods used to assess quality. Components of internal and external validity of controlled clinical trials Internal validity—extent to which systematic error (bias) is minimised in clinical trials Selection bias: biased allocation to comparison groupsPerformance bias: unequal provision of care apart from treatment under evaluationDetection bias: biased assessment of outcomeAttrition bias: biased occurrence and handling of deviations from protocol and loss to follow upExternal validity—extent to which results of trials provide a correct basis for generalisation to other circumstancesPatients: age, sex, severity of disease and risk factors, comorbidityTreatment regimens: dosage, timing and route of administration, type of treatment within a class of treatments, concomitant treatmentsSettings: level of care (primary to tertiary) and experience and specialisation of care providerModalities of outcomes: type or definition of outcomes and duration of follow up Quality is a multidimensional concept, which could relate to the design, conduct, and analysis of a trial, its clinical relevance, or quality of reporting.6 The validity of the findings generated by a study clearly is an important dimension of quality. In the 1950s the social scientist Campbell proposed a useful distinction between internal and external validity (see box below). 7 8 Internal validity implies that the differences observed between groups of patients allocated to different …
  • Article
    Low-energy helium-neon lasers (632.8 nm) have been employed in a variety of clinical treatments including vitiligo management. Light-mediated reaction to low-energy laser irradiation is referred to as biostimulation rather than a thermal effect. This study sought to determine the theoretical basis and clinical evidence for the effectiveness of helium-neon lasers in treating vitiligo. Cultured keratinocytes and fibroblasts were irradiated with 0.5-1.5 J per cm2 helium-neon laser radiation. The effects of the helium-neon laser on melanocyte growth and proliferation were investigated. The results of this in vitro study revealed a significant increase in basic fibroblast growth factor release from both keratinocytes and fibroblasts and a significant increase in nerve growth factor release from keratinocytes. Medium from helium-neon laser irradiated keratinocytes stimulated [3H]thymidine uptake and proliferation of cultured melanocytes. Furthermore, melanocyte migration was enhanced either directly by helium-neon laser irradiation or indirectly by the medium derived from helium-neon laser treated keratinocytes. Thirty patients with segmental-type vitiligo on the head and/or neck were enrolled in this study. Helium-neon laser light was administered locally at 3.0 J per cm2 with point stimulation once or twice weekly. The percentage of repigmented area was used for clinical evaluation of effectiveness. After an average of 16 treatment sessions, initial repigmentation was noticed. Marked repigmentation (>50%) was observed in 60% of patients with successive treatments. Basic fibroblast growth factor is a putative melanocyte growth factor, whereas nerve growth factor is a paracrine factor for melanocyte survival in the skin. Both nerve growth factor and basic fibroblast growth factor stimulate melanocyte migration. It is reasonable to propose that helium-neon laser irradiation clearly stimulates melanocyte migration and proliferation and mitogen release for melanocyte growth and may also rescue damaged melanocytes, therefore providing a microenvironment for inducing repigmentation in vitiligo.
  • Article
    Super Lizer trade mark is a linear polarized light instrument, which has been used with good effect in orthopedics and anesthesiology to treat arthralgia and neuralgia with a high output of infrared radiation. To test Super Lizer trade mark 's efficacy for the treatment of alopecia areata. Fifteen patients over 18 years of age, diagnosed with alopecia areata and displaying symptoms of patchy hair loss, were topically irradiated with infrared radiation using the Super Lizer trade mark. The patients were irradiated intermittently for an interval of 3 min once every week or every 2 weeks. Seven of 15 (46.7%) of the irradiated areas showed hair regrowth 1.6 months earlier than the nonirradiated areas (chi2 official approval, P = 0.003). With regard to adverse effects caused by Super Lizer trade mark treatment, only one patient complained of a sensation of heat in the irradiated area. These findings suggest that Super Lizer trade mark, with its noninvasive properties, is a useful apparatus for the treatment of mild forms of alopecia areata.
  • Article
    Although hair reduction by long-pulsed red and infrared lasers and light sources is generally quite effective, paradoxical hair growth has rarely been observed following treatment. To report a case of thick hair growth following 810 nm diode laser treatment and its subsequent treatment. METHODS. A 24-year-old man who had previously had laser hair reduction on his posterior neck was treated to a test area on his upper back. Thick terminal hair developed in the treated area subsequent to laser treatment. Further treatment of this area removed the terminal hair but resulted in terminal hair growth in an annular distribution surrounding the treatment site. Diode laser treatment rarely stimulates terminal hair growth. This phenomenon should be studied to better understand hair growth cycles and to help develop more effective treatments for hair loss and hair growth.
  • Article
    Alopecia areata is a rapid and complete loss of hair in one or several patches, usually on the scalp, affecting both males and females equally. It is thought to be an autoimmune disease which is treated with different modalities with variable success. Laser treatment of different wavelengths has been used in the management of this problem. To study the effect of the pulsed infrared diode laser (904 nm) in the treatment of alopecia areata.Methods. Sixteen patients with 34 resistant patches that had not responded to different treatment modalities for alopecia areata were enrolled in this study. In patients with multiple patches, one patch was left as a control for comparison. Patients were treated on a four-session basis, once a week, with a pulsed diode laser (904 nm) at a pulse rate of 40/s. A photograph was taken of each patient before and after treatment. The treated patients were 11 males (68.75%) and five females (31.25%). Their ages ranged between 4 and 50 years with a mean of 26.6+/-SD of +/-13.8, and the durations of their disease were between 12 months and 6 years with a mean of 13.43+/-SD of +/-18.34. Regrowth of hair was observed in 32 patches (94%), while only two patches (6%) failed to show any response. No regrowth of hair was observed in the control patches. The regrowth of hair appeared as terminal hair with its original color in 29 patches (90.6%), while three patches (9.4%) appeared as a white villous hair. In patients who showed response, the response was detected as early as 1 week after the first session in 24 patches (75%), while eight patients (25%) started to show response from the second session. The pulsed infrared diode laser is an effective mode of therapy with a high success rate for resistant patches of alopecia areata.
  • Article
    Intense pulsed light (IPL) is an effective and safe hair removal method. However, it is not exempt from side effects. To evaluate clinical and hormonal characteristics of females with facial hirsutism that developed hair growth in untreated areas close to the area submitted to IPL photoepilation ("paradoxical effect"). A total of 49 females with facial hirsutism were included in a protocol of photoepilation with an IPL source. Hyperandrogenism of tumoral origin was excluded in all subjects. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-OH-progesterone (OHP), and sex hormone binding globulin (SHBG) were determined prior to IPL treatment. Clinical and photographic evaluation was performed immediately before each treatment session and 2, 6, and 9 months after the last treatment session. Only cases with "paradoxical effect" were included in this study. A total of five patients with "paradoxical effect" were identified. The patients' ranged in age from 13 to 44 years and all of them had skin phototype III (Fitzpatrick scale). All these subjects were diagnosed with polycystic ovarian syndrome and presented ovarian hyperandrogenism. Patients underwent six to nine IPL sessions, and "paradoxical effect" appeared at different times during the protocol, between treatment session 3 and 6 months after the conclusion of treatment. IPL may induce activation of dormant hair follicles in untreated areas close to hirsute-treated areas.
  • Article
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    The term Laser "Photobiomodulation" was coined to encompass the pleiotropic effects of low-power lasers on biological processes. The purpose of this study was to investigate whether transforming growth factor (TGF)-beta had a role in mediating the biological effects of low-power far-infrared laser irradiation. We assayed for in vitro activation using various biological forms of cell-secreted, recombinant, and serum latent TGF-beta using the p3TP reporter and enzyme-linked immunosorbent assays. We demonstrate here that low-power lasers are capable of activating latent TGF-beta1 and -beta3 in vitro and, further, that it is capable of "priming" these complexes, making them more amenable to physiological activation present in the healing milieu. Using an in vivo oral tooth extraction-healing model, we observed an increased TGF-beta1, but not beta3, expression by immunohistochemistry immediately following laser irradiation while TGF-beta3 expression was increased after 14 days, concomitant with an increased inflammatory infiltrate. All comparisons were performed between laser-irradiated wounds and nonirradiated wounds in each subject essentially using them as their own control (paired T-test p<0.05). Low-power laser irradiation is capable of activating the latent TGF-beta1 complex in vitro and its expression pattern in vivo suggests that TGF-beta play a central role in mediating the accelerated healing response.