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Low-level laser therapy as a treatment for androgenetic alopecia: LLLT AS A TREATMENT FOR AGA
Abstract
Background and objectives:
Androgenetic alopecia (AGA) affects 50% of males by age 50 and 50% of females by age 80. Recently, the use of low-level laser therapy (LLLT) has been proposed as a treatment for hair loss and to stimulate hair regrowth in AGA. This paper aims to review the existing research studies to determine whether LLLT is an effective therapy for AGA based on objective measurements and patient satisfaction.
Study design:
A systematic literature review was done to identify articles on Medline, Google Scholar, and Embase that were published between January 1960 and November 2015. All search hits were screened by two reviewers and examined for relevant abstracts and titles. Articles were divided based on study design and assessed for risk of bias.
Results:
Eleven studies were evaluated, which investigated a total of 680 patients, consisting of 444 males and 236 females. Nine out of 11 studies assessing hair count/hair density found statistically significant improvements in both males and females following LLLT treatment. Additionally, hair thickness and tensile strength significantly improved in two out of four studies. Patient satisfaction was investigated in five studies, and was overall positive, though not as profound as the objective outcomes.
Conclusion:
The majority of studies covered in this review found an overall improvement in hair regrowth, thickness, and patient satisfaction following LLLT therapy. Although we should be cautious when interpreting these findings, LLLT therapy seems to be a promising monotherapy for AGA and may serve as an effective alternative for individuals unwilling to use medical therapy or undergo surgical options. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.
... In women, the most common cause of DCD or Female Pattern Hair Loss (FPHL) is Female Pattern Androgenic Alopecia (FPAA), which is characterized by an increase in the frequency and duration of the kenogenic phase [2]. This condition, which affects approximately 40 % -50 % of women throughout their lives, increasing its incidence with age, begins with a loss of hair at the level of the frontal and interparietal midline, and it is believed to be caused by an excess activity of the enzyme 5α-reductase, which converts testosterone to dihydrotestosterone [3]. ...
... LLLT technology uses the non-thermal effect of red and infrared light to produce photostimulation. Although its mechanism of action has not yet been identified, it is believed that LLLT stimulates the reentry of telogen hair follicles into anagen and prolongs the duration of this phase, which would translate into an increase in the density and diameter of the hair [3]. Although knowledge about the efficacy of fractional laser technology is still limited, it has been proposed that it is capable of causing heat-induced microscopic lesions whose healing would stimulate hair growth [9]. ...
... In general, laser therapies do not present severe adverse effects, so there is consensus on their potential applicability to the treatment of CDC and on their safety when used correctly. However, the current paucity of double-blind, conflict-of-interest-free clinical studies does not yet allow a reliable determination of the true efficacy of this type of hair loss therapy [3,7]. ...
Objective: Capacitive-Resistive Electrothermal Therapies (CRET) have proven effective in
tissue regeneration. This study analyzesthe response to 448-kHz CRET treatment in 20 patients
with Female Pattern Hair Loss (FPHL) and in woman’s Dermal Papilla Cells (DPC).
Methods: Patients received ten 20-minute CRET sessions over an 8-week interval. Three
months after the last session, the effects of the treatment were trichoscopically analysed. DPC
were CRET stimulated intermittently for 12, 24 or 48 h and the effects on cell proliferation and
expression of several proteins involved in cell proliferation were analysed.
Results: Trichoscopic data revealed generalized, statistically significant hair redensification
(10 - 15 % over pre-treatment values) in all the treated scalp areas. In-vitro electrostimulation
significantly increased DPC proliferation and expression of the proteins involved in cell
proliferation. Since dysregulation of DPC proliferation is the main factor underlying abnormal
hair loss, it is likely that electrically-induced DPC proliferation is involved in the redensifying
effects obtained in the trichological study.
... [11] Since then, although the mechanism of action has not been clearly identified, several studies have provided strong evidence that LLLT stimulates hair growth. [12][13][14][15][16] However, the effectiveness and safety of helmet-type LLLT home devices for alopecia remain controversial. A new helmettype LLLT model (HAIRUP; Y & J Bio, Seoul, Korea) that combines laser diodes (LDs) and light-emitting diodes (LEDs) at a wave length of 655 nm has been developed. ...
... several studies-ranging from experimental animal studies to clinical studies-were conducted to show the effectiveness of LLLT for promoting hair growth, and LLLT was approved for hair loss treatment by the U.S. Food and Drug Administration in 2007. [12][13][14][15][16] Although the exact mechanisms have not yet been identified, some cellular and molecular mechanisms have been identified in recent studies. LLLT is assumed to release nitric oxide from cytochrome c oxidase, a chromophore responsible for the absorption of red/infrared light, driving the electron transport chain to generate adenosine triphosphate and reactive oxygen species, as well as inducing transcription factors. ...
... In previous studies, the wavelength of 655 nm was proven to be most efficient for hair growth. [12][13][14][15] Our helmet-type LLLT device contained a combination of 655-nm LDs and LEDs, and each used a continuous wave form with a maximum power of 5 mW, corresponding to about 2.36 mW/cm 2 . In order to maximize the accessibility of the treatment, we used a protocol in which the clinical device was used for 25 minutes every other day. ...
Introduction:
Androgenetic alopecia is the most common form of hair loss in both sexes. In recent studies, low-level light therapy (LLLT) has been established as an effective treatment for alopecia. The purpose of this study was to evaluate the safety and efficacy of LLLT using a new helmet-type device for the treatment of androgenetic alopecia.
Method:
A randomized, sham device-controlled, double-blind clinical trial was conducted at 2 institutions. Sixty participants diagnosed with androgenetic alopecia aged from 19 to 65 years were recruited. LLLT was performed through a helmet-type device that emitted light with a mean output power of 2.36 mW/cm at a wavelength of 655 nm. Participants were divided into 2 groups, which respectively used the experimental device and a sham device. After tattooing at the central point of the vertex, phototrichograms at that point were obtained at 0, 8, and 16 weeks. The primary endpoint of the study was the difference in the rate of change of hair density between the test group and the control group.
Results:
Comparing the results at baseline and week 16, the experimental group showed an increase in hair density of 41.90 hairs/cm and an increase in hair thickness of 7.50 μm, whereas the control group showed an increase of 0.72 hairs/cm and a decrease of 15.03 μm, respectively (P < .001). No adverse events or side effects occurred.
Conclusion:
LLLT showed a significant effect on increasing hair density in patients with androgenetic alopecia. LLLT could be a safe and effective treatment for androgenetic alopecia in both sexes.
... Red or near-infrared laser light has been reported to promote tissue repair and regeneration and, more recently, low-intensity light laser (LLL) therapy has been demonstrated to stimulate hair growth, probably by increasing the mitotic rate of the hair follicle stem cells or follicular keratinocytes (141). Additionally, LLL may modulate inflammation by increasing TGF-b1 and IL-10 while reducing proinflammatory cytokines and prostaglandin E 2 (141). ...
... Red or near-infrared laser light has been reported to promote tissue repair and regeneration and, more recently, low-intensity light laser (LLL) therapy has been demonstrated to stimulate hair growth, probably by increasing the mitotic rate of the hair follicle stem cells or follicular keratinocytes (141). Additionally, LLL may modulate inflammation by increasing TGF-b1 and IL-10 while reducing proinflammatory cytokines and prostaglandin E 2 (141). Usually wavelengths between 600 and 1550 nm (in red/infrared spectrum), emitted by heliumneon and fractional erbium glass lasers, are used. ...
... Several studies have shown that LLL may improve FPHL (141-144) but the effect is generally modest and, in a male study, although hair count increased, no differences with global photographs were observed (145). Adverse effects are few but may include headache, erythema, pruritus, burning, pain, and mild paresthesia (141). ...
Objective
To determine the current state of knowledge and provide evidence-based recommendations that could be valid for all specialists taking care of female pattern hair loss (FPHL), a common form of hair loss in women that is characterized by the reduction of hair density in the central area of the scalp, while the frontal hairline is generally well conserved.
Participants
An expert task force appointed by Androgen Excess and PPCOS society, which included specialists from dermatology, endocrinology, and reproductive endocrinology,
Evidence
Levels of evidence were assessed and graded from A to D
Process
Peer reviewed studies evaluating FPHL published through December 2017 were reviewed. Criteria for inclusion/exclusion of the published papers were agreed upon by at least two reviewers in each area and arbitrated by a third when necessary.
Recommendations
1. The term Female Pattern Hair Loss should be used avoiding the previous terms of alopecia or androgenetic alopecia. 2.The two typical patterns of hair loss in FPHL are centrifugal expansion in mid scalp or a frontal accentuation or Christmas tree pattern. 3. Isolated FPHL should not be considered a sign of hyperandrogenism when androgen levels are normal 4. The assessment of patients with FPHL is primarily clinical. 5. In all patients with FPHL, assessment of a possible androgen excess is mandatory. Measurement of vitamin D, iron studies, zinc, thyroid hormones and prolactin are optional but recommended. 6. Treatment of FPHL should start with minoxidil (5%) adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism.
... The epidermal stem cells found in the follicular ridge are stimulated by the laser, thus causing the follicular to change from the anagen phase to the telogen phase. In addition, it increases the duration of anagen and causes vasodilation and increased blood flow [16]. The used methods in the treatment of alopecia must be available, cost-effective, and have the least adverse effects. ...
... The same positive results are reported by Afifi et. al., in their systematic review of the LLLT effect on AGA [16]. In the second place after LLLT, erbium glass laser, when used as AGA treatment, also has a significant positive effect in increasing hair count and diameter. ...
Background and Aims
In recent years, the application of various light and laser devices in the treatment of different types of alopecia has been established. This systematic review aims to assess the efficacy and safety of laser therapy and phototherapy in cicatricial and non‐cicatricial alopecia.
Methods
A comprehensive search was conducted on PubMed, Scopus, Science Direct, and Google Scholar. Articles were evaluated across four subgroups: alopecia areata, androgenic alopecia, telogen effluvium, and cicatricial alopecia. Included studies were published in English or Persian between January 2010 and September 2023, focusing on interventional, cohort, or case series research that achieved a minimum score of 75% on the EBL checklist. Exclusion criteria encompassed animal and in vitro studies, review articles, case reports, duplicated or irrelevant research, as well as studies that did not meet the designated EBL score. Editorial letters and case studies were also excluded.
Results
Initially, 965 records were collected, resulting in the inclusion of 58 studies in the final review: 26 on alopecia areata, 26 on androgenic alopecia, five on cicatricial alopecia, and one on telogen effluvium. Narrow‐band ultraviolet B, 308‐nm excimer laser, and psoralen ultraviolet A therapy showed varying effectiveness; specifically, the excimer laser was notably effective for patients with shorter disease duration. In androgenic alopecia, erbium‐glass and thulium lasers effectively increased hair density but showed a gradual decline posttreatment. Low‐level light/laser therapy also increased hair density and diameter and exhibited potential benefits when used alongside minoxidil, but did not significantly enhance outcomes in telogen effluvium treatment.
Conclusion
Light/laser therapy can serve as an additive treatment for cicatricial alopecia, particularly lichen planopilaris, but has limited efficacy in treating telogen effluvium. Overall, light/laser therapies exhibit a significant positive effect on increasing hair density and diameter across various alopecia types.
... Most clinical studies have shown that LLLT is a safe and effective way to treat AGA in both women and men, as it increases hair density and strength. In some patients, the LLLT technology can even produce similar results to oral finasteride or topical minoxidil [48,49]. The exact parameters of the therapy that would allow the patients to achieve the best possible results are still the subject of research, but Forum Dermatologicum 2023, Vol. 9, No. 3 most used devices produce the following light parameters: wavelength in the range of 635-650 nm, energy density accounting for 4 J/cm² with the power of 5 mW. ...
... However, in the randomized trial of 90 patients, it has been proven that the combined therapy with the red light of 665 nm and infrared light of 808 nm produces better results than the monotherapy with light of 665 nm [50]. A single session of treatment, depending on a particular device and the used method, usually lasts from 6 to 20 minutes and most commonly should be performed three times a week [48][49][50][51]. ...
... Drug Administration as a safe and effective treatment on hair loss. [1] The non-ablative 1550 nm fractional laser also appears to be useful for increasing hair density in patients with androgenetic alopecia. [2] Moreover, our previous study found that ablative CO 2 fractional laser therapy in combination with hair growth factors proves more effective for the treatment of patients with androgenetic alopecia than topical hair growth factors alone. ...
... In 2007, low-level laser therapy was approved by the United States Food and Drug Administration as a safe and effective treatment on hair loss. [1] The non-ablative 1550 nm fractional laser also appears to be useful for increasing hair density in patients with androgenetic alopecia. [2] Moreover, our previous study found that ablative CO 2 fractional laser therapy in combination with hair growth factors proves more effective for the treatment of patients with androgenetic alopecia than topical hair growth factors alone. ...
Supplemental Digital Content is available in the text
... LLT, Boca Raton, FL, USA) and TOPHAT 655 (Apira Science Inc., Boca Raton), are FDA-approved due to their minimal risk. [8] Microneedling, a minimally invasive method for treating AGA, involves rolling fine needles over the skin to pierce the stratum corneum and induce collagen formation, neovascularization, and growth factor production in the treated area. [9] Although the number of studies investigating this therapy for hair loss is limited, microneedling has been successfully paired with other hair growth-promoting therapies, such as minoxidil, PPR, and topical steroids, and has been shown to stimulate hair follicle (HF) growth, suggesting that microneedling facilitates the penetration of this first-line drug as a mechanism to promote hair growth. ...
Background and Objectives
Androgenetic alopecia is one of the common types of hair loss and has become a medical and social problem due to its increasingly young onset. Existing therapies, although effective, have serious side effects and therefore better treatments need to be sought. The aim of this study was to evaluate the efficacy of umbilical cord mesenchymal stem cell-derived exosomes in the treatment of androgenetic alopecia and to investigate the mechanism of exosome regulation of hair growth.
Methods
First, we randomly divided 20 C57BL/6J mice into blank group, model group, positive control group and exosomal hydrogel group, and mice were treated with hair removal on the back. The mice were injected intraperitoneally with dihydrotestosterone solution except for the blank group. At the end of the experiment, new hairs were collected and the differences in length, diameter and number of hair follicles were compared among the groups; the histopathological changes of hair follicles were observed by HE staining; the expression of androgen receptor mRNA and protein in skin tissues were compared; and the skin tissues were analyzed by real-time PCR, western blotting, immunofluorescence staining and transcriptome sequencing. Finally, the results of transcriptome sequencing experiments were verified by real-time PCR, western blotting and other techniques for the corresponding genes and proteins.
Results
Compared with the blank group, mice in the model group had shorter hair length and reduced hair diameter, and pathological observation showed that the total number of hair follicles was significantly reduced and the hair follicles were miniaturized; compared with the model group, mice in the positive control and exosome groups had longer hair length, larger hair diameter and more hair follicles; the androgen receptor mRNA content and protein expression in the skin tissue of mice in the model group were significantly higher than those in the blank group, and the protein expression in the exosome gel group was lower than that in the model group. Similarly, compared with the model group, the expression of stemness-related proteins K15 and CD200 in the skin tissues of mice in the exosome group increased, and the expression of PCNA, a protein related to cell proliferation, increased. The KEGG data showed that the differential genes were mainly enriched in the RAS/ERK pathway.
Conclusions
In this study, we demonstrated the therapeutic effect of umbilical cord MSC-derived exosomes on androgenetic alopecia and verified that exosomes regulate hair follicle stem cell stemness through the RAS/ERK pathway to promote hair proliferation and thus hair growth in mice with androgenetic alopecia, providing a potential therapeutic strategy for androgenetic alopecia.
... Mean increase of terminal hair density was 40%, as well as the rest of the variables (23% to 30%), except for vellus hair density, which decreased by 1.7%. Some studies had investigated a variety of light sources and treatment parameters for the management of alopecia, such as LLLT, [16][17][18][19][20][21] various wavelengths of LED light 14,15,22,23 and several techniques combined, such as LED-LLLT 9,12,14,15,19,24 . The device used in this study is a technological innovation that combines, in a synergistic way, Nano Pulsed Cold Laser (NPCL) laser emitters, infrared diodes and RGB diodes in a magnetic tunnel. ...
... [5][6][7] Low-level laser light therapy (LLLT) is an alternative treatment that stimulates hair growth and also requires costly equipment; hair transplantation or grafting of hair follicle stem cells is another option for patients but is even more expensive than other therapies; platelet-rich plasma (PRP) is also novel treatment, yet its applicability may be restricted to individuals with a history of bleeding disorders, autoimmune disease, or ongoing anticoagulant use. [8][9][10] Recently, stem cell-derived conditioned medium (CM) has been demonstrated to be effective at treating hair loss in multiple studies. 11,12 The study of stem cells originated in the 1960s 12 Because of its technical feasibility, promising curative effects, and low cost, stem cell-derived CM has become a promising choice for surgeons in treating alopecia. ...
... However, challenges exist in standardizing treatment parameters, study designs, and assessing long-term outcomes in LLLT studies. 50,51 Hair transplantation. Hair follicle transplantation is a surgical procedure that involves removing and transplanting hair follicles from non-androgen sensitive areas to areas affected by AGA. ...
Androgenetic alopecia (AGA) is the most common nonscarring alopecia and is characterised by distinct gradual patterned hair loss. AGA is mediated by genetic predisposition and excessive follicular sensitivity to androgens, mainly in males, leading to the progressive conversion of scalp terminal hair into vellus hair. Although highly prevalent, it is not fatal but may have a severe psychosocial impact, especially on females and younger males. Significant advances have been made in understanding AGA's epidemiology and pathophysiology, but only 2 drugs remain approved by the FDA - finasteride and minoxidil. Prolonged use of these drugs, is a prerequisite for enhanced treatment response. However, this leads to poor medication adherence and adverse effects from extended use eg, the “postfinasteride syndrome” which persists beyond stopping the drug. Hence, there is a need for research on more effective alternative treatments for AGA, with fewer side effects.
This paper reviewed recent advances in AGA pathophysiology and its treatment options. The recently characterized structure of type 2, 5-alpha reductase holds significance in comprehending present and prospective treatments of AGA.
... In 2 out of 4 studies, improvements in hair strength and hair thickness were observed. 74 A more recent meta-analysis by Liu et al found that in 11 randomized double blinded controlled trials patients treated with LLLT demonstrated a statistically significant improvement in hair density compared to placebo device. 73 Additionally, increased hair growth was observed in males and females as well as in both short-and long-term follow-up. ...
Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Traditionally, topical minoxidil and oral finasteride have been the standard of care yielding mixed results. New treatments such as Low-Level Laser Therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others have been extensively studied in the literature, and the purpose of this review is to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating AGA. Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients. In this review, we present data from recent studies on the clinical efficacy of these treatments. Furthermore, as new treatments have emerged, clinicians have tested combination therapies to assess whether there may be a synergistic relationship between multiple modalities. While there has been a great increase in the treatments available for AGA, the quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments. While PRP and LLLT have demonstrated encouraging results, standardized treatment protocols are needed to adequately inform clinicians on how to use such therapies. Given the abundance of new therapeutic options, clinicians and patients must weigh the benefits and risks of each treatment option for AGA.
... The drug must be continued indefinitely or hair regrowth will subside. In 2007, low-level laser therapy has been approved by the US Food and Drug Administration and appeared to be safe and effective in treatment of maleand female-pattern hair loss (8) . ...
... Low-level red light therapy (LLRLT) is a newly emerging laser therapy which has been utilized in various diseases [3][4][5]. LLRLT utilized the 650-nm red light, which could provide sufficient energy to stimulate the tissue without causing damage to the surrounding tissues [6]. LLRLT may improve hypoxia and inhibit inflammation [7]. ...
Introduction:
To investigate the changes in the retina and choroid of children after 650 nm low-level red light therapy (LLRLT).
Methods:
In this prospective study, 25 subjects in the Shanghai Eye and ENT Hospital of Fudan University were included from August 2021 to September 2021. One eye was randomly selected to receive LLRLT for 3 minutes. Swept-source optical coherence tomography (OCT) and OCT angiography (OCTA) were used to measure retinal fovea perfusion density (RFPD), retinal fovea thickness (RFT), choroidal fovea blood flow (CFBF), and choroidal fovea thickness (CFT) before LLRLT, 5 minutes and 1 hour after LLRLT. Baseline characteristics between LLRLT and non-LLRLT eyes were compared. Changes in the retinal and choroidal parameters were analyzed by ANCOVA models. SAS software was used for data analysis. The difference was considered statistically significant if p < 0.05.
Results:
There was no difference in baseline characteristics between LLRLT eyes and non-LLRLT eyes. The RFPD in LLRLT eyes significantly increased 5 minutes after LLRLT and the increment was 1.70±0.83 % (p = 0.0389). The RFPD significantly decreased from 5 minutes to 1 hour after LLRLT with a mean of -2.62±0.86 % decrement (p = 0.0031). The RFPD levels returned to baseline at 1 hour after LLRLT (p = 0.8646). However, compared with insignificant RFPD changes in non-LLRLT eyes, there was no significant difference in RFPD changes at any sampling point. No significant changes in RFT, CFBF, and CFT were found in LLRLT eyes at each sampling point.
Conclusion:
Although LLRLT has no effect on the choroid, it may cause a short-term transient increase in RFPD. It will provide theoretical support for the role of LLRLT in myopia control.
... Precedently, LED phototherapy was described as a good and safe procedure for the treatment of acne [26], vaginal atrophy [27], facial aging [28,29], and in HL disorders [30]. Different low-level laser and light sources for the management of alopecia, such as LLLT, [31][32][33][34][35][36], various wavelengths of LED light [11,37], and several other techniques combined, such as LED-LLLT [38], have been analyzed by many investigators, with the aim to establish the related treatment parameters and the outcomes. ...
A procedure based on Microneedling (MND) with Low-Level Led Therapy (LLLT) and Growth Factors (GFs) could be a booster for hair re-growth (HRG) in patients assuming Finasteride®. The study examined the clinical outcomes of a multicentric, observational, retrospective, case-series investigation in which MND with LLLT and GFs was applied to patients suffering from androgenic alopecia (AGA) who were prescribed Finasteride®. Twenty-one patients were initially enrolled, of which seventeen males were classified in stage II–VI by the Norwood–Hamilton scale, and four females were classified in stage II–III by the Ludwig scale. One male patient was excluded after screening (exclusion and inclusion criteria evaluation). Twenty patients were analyzed, of which ten patients’ hair growth has stalled after taking Finasteride®, and ten patients did not achieve good results from Finasteride®. HRG assessment was evaluated with photography, physician’s, and patient’s global assessment scale, in addition to standardized phototrichograms during a short follow-up: T0—baseline, T1—20 weeks (wks). A statistically significant improvement in HRG (p = 0.0822) and an increase in hair density of 19 ± 2 hairs/cm2 at T1 after 20 wks (20 wks vs. 0 wks) in the targeted area over baseline (74 ± 2 hairs/cm2 at T1 versus 55 ± 2 hairs/cm2 at baseline) were reported and described as encouraging results. The effectiveness of MND with LLLT and GFs use was demonstrated in patients whose hair growth stalled after taking Finasteride® and in patients who did not achieve good results from Finasteride®.
... Currently, the common treatment options for AGA include hair transplantation, oral finasteride, topical minoxidil. In addition, there are some additional treatments, such as injection of plateletrich plasma (PRP) and low-level laser therapy (LLLT) [7][8][9]. ...
Low-level laser therapy (LLLT) has been a treatment modality by many androgenetic alopecia (AGA) patients in recent years. It remained unclear as to how long the treatment regime should be maintained, and which characteristics of patients should this be recommended. A real-world study was carried out with an FDA-cleared low-level laser helmet for 1383 patients. Ordinal logistic regression analysis with propensity score matching (PSM) was used to investigate the factors related to efficacy assessment. More than 80% of users were between 18 and 40 years old. The median use times were 133 for mild AGA patients and 142 for moderate-to-severe AGA patients, which equated to 38 weeks and 40 weeks, respectively. The overall clinical effectiveness was nearly 80%. PSM analysis revealed that gender (P = 0.002), use period (P = 0.068), scalp conditions with dandruff, rash, and itchy symptoms were associated with the grading of efficacy assessment. Male users (ordinal OR: 1.35, CI: (1.01, 1.79)); use for more than 180 times or use period for 1 year (ordinal OR: 1.40, CI: (1.11, 1.96)); and those with scalp dandruff (ordinal OR: 1.34, CI: (1.01, 1.87)), rash (ordinal OR: 1.47, CI: (1.04, 2.07)), and itchy symptoms (ordinal OR: 1.51, CI: (1.12, 2.03)) had better efficacy assessments. The recommended treatment regime with low-level laser helmet was more than 1 year or 180 use times. Male patients with dandruff, rash, and itchy symptoms in scalps tended to have a better efficacy assessment.
... Some studies have shown that LLLT (low-level laser therapy) stimulated hair growth in males and females. The wavelengths experimented ranged mainly from orange (635-650 nm) to near-infrared (800-900 nm), but other studies are necessary to determine the most effective wavelength [5][6][7]. To our knowledge, blue light therapy (BLT) has never been proposed for AGA treatment. ...
Different studies highlight photo-receptors’ presence on the hair follicle that seems to be capable of eliciting hair growth. This study aims to demonstrate blue light’s effectiveness on hair growth in patients affected by androgenetic alopecia. Twenty patients enrolled at Magna Graecia University Unit of Dermatology, affected by androgenetic alopecia, were treated with a blue LED light device at 417 ± 10 nm, fluence of 120 J/cm2, and power intensity of 60 mW/cm2 ± 20%. The treatments were performed twice a week for ten consecutive weeks. Patients were evaluated before and 1 month after the end of therapy clinically using standardized global photographs and dermoscopically estimating hair density and hair shaft width. An increase in hair density and hair shaft width was recorded in 90% of patients after 10 weeks. Photographic improvement was noted in 80% of the patients. No serious adverse events have been reported. The only side effect consisted in a darkening of the hair, perhaps due to melanic stimulation due to blue light in 2 patients. Blue light therapy is a promising therapy for patients affected by androgenetic alopecia and other diseases characterized by hair loss. Further studies will be necessary to confirm the findings of this preliminary study.
... 31 Afifi et al, conducted a systematic review of the data from 1960 to 2015, with risk of bias assessment; they concluded that LLLT is a cautiously promising monotherapy for AAI. 32 Other systematic reviews corroborated the conclusion. 33,34 ...
... Patients used the device 30 minutes, three times per week and after 24 weeks the group treated with photobiomodulation therapy showed a significant improvement in hair coverage in the analysis of standardized photos, phototrichogram assessment, and the investigator's global assessment in relation to placebo (P < 0.001) [13]. Considering these studies, a systematic review published in 2017 concluded that photobiomodulation may serve as an effective alternative for individuals unwilling to use medical therapy or undergo surgical options [14]. ...
Background
Androgenetic alopecia (AGA) is a hair loss disorder that frequently affects the male population. Conventional treatment modalities are limited to minoxidil, 5α reductase inhibitors, and hair transplantation procedures. The efficacy of low-level laser therapy (LLLT), also known as photobiomodulation, in the treatment of AGA has been reported, yet little is known about the outcomes of combining photobiomodulation with other conventional therapies.
Objective
To evaluate hair growth improvement in males with AGA, during the administration of minoxidil with and without photobiomodulation, using a half-head model.
Study Design/Materials and Methods
Twenty-one men with AGA agreed to undergo 12 minutes of low-level laser irradiation (using a modified Capellux®), followed by topical minoxidil application (1 ml of 5% solution), to the affected scalp two times per day for 6 months. The photobiomodulation devices were modified such that the left half emitted light, and the right half did not. Efficacy was assessed by blinded analyses of clinical photos and automated phototrichograms (Trichoscan®) taken before treatment and after 3 and 6 months of therapy.
Results
None of the study participants experienced any adverse events. All patients showed improvements in hair coverage on both sides of the scalp at 3 and 6 months. On the side with combined treatments, the number of total hairs was significantly increased after 3 (P < 0.001) and 6 months (P = 0.001). A similar increase was also observed on the minoxidil-only side, at both 3 (P < 0.001) and 6 months (P < 0.001). No statistically significant differences were detected between sides (P > 0.05).
Conclusion
Additional improvement was not observed with the association of photobiomodulation to topical minoxidil in male AGA. Differences from previous studies that might have influenced our result include non-collimated light source, higher dosimetry, and a cohort with darker skin phototype and more severe alopecia. Lasers Surg. Med. 2021. © 2021 Wiley Periodicals LLC
... Lately, several documents have been reported, which aim to investigate the therapeutic role of low-level laser device in AGA. [6][7][8] Low-level laser therapy (LLLT) utilizes non-thermal effect of red or near-infrared laser light in a low intensity, which promote tissue repair and stimulate cellular activities. It is also termed as photobiomodulation or photobiostimulation. ...
... In a review by the US authors Afifi et al. 4 published in 2017, the effectiveness of LLLT in AGA was evaluated based on objective outcome measures and patient satisfaction. The wavelengths used ranged from 630 to 780░nm; the duration of the sessions varied by study between 8 and 25 minutes and the treatment duration was between 24 weeks and 24 months. ...
... En la revisión de Afifi et al. 4 realizada en 2017 en Estados Unidos se examina si LLLT es efectiva en AGA basada en mediciones objetivas y en la satisfacción del paciente. La potencia energética utilizada se situó entre 630 y 780 nm; la duración de la sesión varió de unos estudios a otros entre 8 y 25 min y la duración del tratamiento entre 24 semanas y 24 meses. ...
... 1,2 There is a 50% risk of development of MPHL in men over 50, and approximately 40% of women develop FPHL by the age of 50. 3,4 As the most common cause of hair loss in men and women, MPHL and FPHL impact the individual's self-esteem, self-image, and quality of life. 5 The fundamental pathophysiological hallmark of MPHL and FPHL is non-scarring alopecia (hair loss), stemming from a variation in the hair cycle and hair follicle miniaturization, resulting in the subsequent reduction of hair of the scalp. ...
Male and female pattern hair loss (MPHL and FPHL, respectively), is the most common cause of hair loss affecting nearly 80 million people in the US, yet treatment options remain limited and lacking. As the need for more effective therapeutics remains unmet, this perspective offers a unique angle by directing attention to the inflammatory aspect of MPHL and FPHL. Evidence and implications of inflammation as a characteristic feature of MPHL and FPHL are highlighted through evaluation of clinical and quantitative data. Comparable results suggest the presence of significant perifollicular inflammatory infiltrates, such as lymphocytes and histiocytes, as well as the involvement of inflammatory genes, such as CASP7 and TNF, in the presentation of MPHL and FPHL. Resurfacing of the inflammatory aspect in MPHL and FPHL pathogenesis will advance future developments in MPHL and FPHL therapeutic options.
... The current standard of treatment for AGA includes minoxidil solution or foam in females and oral finasteride and topical minoxidil solution or foam in males (4). Additional modalities of treatment including dutasteride, prostaglandin analogs, ketoconazole, hormonal therapy, low-level laser therapy and surgical options have also been used in treating AGA (5)(6)(7)(8). ...
In spite of several modalities for androgenic alopecia therapy used such as topical minoxidil solution or oral finasteride; it still has a great challenge. This study evaluated the effect of platelet-rich plasma in androgenic alopecia treatment regarding improvement percentage as well as the rate of adverse. Fifty patients complaining of androgenic alopecia were evaluated by Micro Viewer dermoscopy, analyzed by Compare view software and treated four times at one month interval with platelet-rich plasma injection. At every visit patient evaluation and satisfaction was completed, their age ranges from 18-40 years with a mean ± SD of 25.96 ± 5.99 years, the duration of hair loss ranges from 1-15 years with a mean ± SD of 4.58 ± 3.38 years. The mean Compare view software parameters showed a statistically significant increased from 261.47 ± 39.79 to 312.03 ± 48.61 for hair density, 0.64 ± 0.13 to 0.76 ± 0.16 for hair width and 2.25 ± 1.38 to 3.56 ± 2.71 for terminal/Vellus ratio (p < 0.05), additionally a high overall patient satisfaction in the absence of adverse effects. The present study indicates that APRP is a good tool for androgenic alopecia treatment in the absence of adverse effects.
... A remarkably wide range of optical parameters has been applied to both in vitro and ex vivo model systems (variable across 2 orders of magnitude), where negative, positive and neutral outcomes are reported for visible and near-infrared (NIR) light despite very similar optical settings 3,8,9,11 . For example, exposure of human epidermal keratinocytes to similar doses of short wavelength visible light (i.e., 420 and 450 nm) were reported to alternately induce and reduce expression of differentiation markers 20, 22 . ...
Here we interrogate the appropriateness of a range
of previously-reported treatment parameters, including light wavelength, irradiance and radiant exposure, as well as cell culture conditions (e.g., serum concentration, cell confluency, medium refreshment, direct/indirect treatment, oxygen concentration, etc.), in primary cultures of normal human dermal fibroblasts exposed to visible and near infra-red (NIR) light.
... Laser therapy has minimal risks; studies have shown that it induces hair growth and thickness. 37,38 Fractional radiofrequency not only reduces hair loss, but also increase hair counts and hair shaft thickness. 39 A more invasive procedure is microneedling, in which tiny needles are rolled over areas of hair loss to puncture the skin. ...
Female pattern hair loss is a common form of hair loss in women that increases in incidence with age. The etiology is unknown with numerous factors identified that influence its onset. Female pattern hair loss may be viewed as a marker for an increased risk of cardiovascular and metabolic disease. New treatments include microneedling, low‐level laser therapy, and autologous fat transfer. This article focuses on the pathophysiology, diagnosis, systemic associations, and current treatments for female pattern hair loss, which is the most common cause of alopecia in women.
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... It was proposed that the laser therapy activates the reentry of anagen in hair follicles present in telogen phase, lengthen their time interval, escalate hair growth rate in anagen phase, and avert the catagen phase entry. Adverse effects of LLLT include acne, headache, pruritus, scalp tenderness, warm sensation, dry skin, and redness at the laser therapy site [37]. ...
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.
... However, over the course of time, we have been witnessing the results of technological advances reflected by a steady growth of home-use devices (HUDs) offering options to treat or alleviate a number of cosmetic and health conditions. A non-exhaustive list of the latter includes signs of skin ageing; excessive or/and undesired body hair growth; hair thinning and loss; oily, dry and polluted skin; acne; seasonal affective disorder, psoriasis vulgaris and chronic back pain [1][2][3][4]. ...
Demand for long-term hair reduction treatments has increased dramatically around the world in recent years, due to traditional factors, fashion, sport, wellbeing and health requirements. Some of the most popular options include laser and intense pulsed light (IPL) treatments, which are often administered by aesthetic practitioners. This article will discuss the hair growth cycle, as well as treatment options, parameters and outcomes.
... The authors proposed LLLT 15 days after each treatment to stimulate hair regrowth during the HF-MSCs and PRP treatment, and every three weeks after the last treatment for a period of six months. Regarding this field, 11 papers were reviewed by Afifi et al. [92], where nine papers assessing hair count/hair density found noteworthy improvements in the men and women following LLLT treatment. Hair thickness and rigidity were found to be improved in two papers. ...
The use of stem cells has been reported to improve hair regrowth in several therapeutic strategies, including reversing the pathological mechanisms, that contribute to hair loss, regeneration of hair follicles, or creating hair using the tissue-engineering approach. Although various promising stem cell approaches are progressing via pre-clinical models to clinical trials, intraoperative stem cell treatments with a one-step procedure offer a quicker result by incorporating an autologous cell source without manipulation, which may be injected by surgeons through a well-established clinical practice. Many authors have concentrated on adipose-derived stromal vascular cells due to their ability to separate into numerous cell genealogies, platelet-rich plasma for its ability to enhance cell multiplication and neo-angiogenesis, as well as human follicle mesenchymal stem cells. In this paper, the significant improvements in intraoperative stem cell approaches, from in vivo models to clinical investigations, are reviewed. The potential regenerative instruments and functions of various cell populaces in the hair regrowth process are discussed. The addition of Wnt signaling in dermal papilla cells is considered a key factor in stimulating hair growth. Mesenchymal stem cell-derived signaling and growth factors obtained by platelets influence hair growth through cellular proliferation to prolong the anagen phase (FGF-7), induce cell growth (ERK activation), stimulate hair follicle development (β-catenin), and suppress apoptotic cues (Bcl-2 release and Akt activation).
... LLLT was proposed by the authors 15 days after each treatment to stimulate hair regrowth during the HF-MSCs and PRP treatment and every 3 weeks after the treatment until 6 months post-treatment. Eleven studies were reviewed by Afifi et al. [47]. 9 studies assessing hair count/hair density found statistically significant improvements in both males and females following LLLT treatment. ...
Platelet rich plasma (PRP) and Micrografts containing human follicle mesenchymal stem cells (HF-MSCs) were tried as a potential treatment for androgenetic alopecia (AGA). However, little to no work has yet to be seen wherein the bio-molecular pathway of HF-MSCs or PRP treatments were analyzed. The aims of this work are to report the clinical effectiveness of HF-MSCs and platelet-rich plasma evaluating and reviewing the most updated information related to the bio-molecular pathway. Twenty-one patients were treated with HF-MSCs injections and 57 patients were treated with A-PRP. The Wnt pathway and Platelet derived-growth factors effects were analyzed. 23 weeks after the last treatment with mean hair thickness increments (29 ± 5.0%) over baseline values for the targeted area. 12 weeks after the last injection with A-PRP mean hair count and hair density (31 ± 2%) increases significantly over baseline values. The increment of Wnt signaling in Dermal Papilla Cells evidently is one of the principal factors that enhances hair growth. Signaling from mesenchymal stem cells and platelet derived growth factors positively influences hair growth through cellular proliferation to prolong the anagen phase (FGF-7), inducing cell growth (ERK activation), stimulating hair follicle development (β-catenin), and suppressing apoptotic cues (Bcl-2 release and Akt activation).
... Female pattern hair loss (FPHL) has emerged as the preferred term for androgenetic alopecia (AGA) in women, due to the uncertain relationship between androgens and this condition. [1,2] FPHL is a common cause of alopecia in women. It affects 29% to 38% of women, as well as >55% of women over 70 years. ...
The female hair loss pattern was originally described as a synonym for androgenetic alopecia. It has been defined as progressive miniaturizations of the hair follicles, with a great impact on the quality of life of affected patients, causing significant psychosocial limitations. It was recently proven that photobiomodulation is a safe and effective way to treat the different types of hair loss. It was also known that microneedling is a minimally invasive dermatological procedure that is applied to a wide range of dermatological conditions, including androgenic alopecia, telogen effluvium, as well as other facial and bodily conditions.
Goal:
The aim of this study is to verify if there is an increase in the capillary density of strands of hair, when combining 660 nm red laser photobiomodulation and microneedling in addressing female pattern hair loss (FPHL).
Methods:
There will be 66 patients divided into 3 treatment groups. G1: microneedling and 660 nm red laser photobiomodulation sham; G2: 660 nm red laser photobiomodulation and microneedling sham; G3: microneedling and 660 nm red laser photobiomodulation. The treatment will consist in 36 sessions, 3 times a week for 3 consecutive months, with an insertion of microneedling every 30 days. The patients and the researchers will be blinded. The patients will be evaluated before, during, and after the treatments, by digital photography and the trichoscopy method (dermoscopic imaging of the scalp and hair).
Expected results:
It is expected that differences will be found in the growth rates of a strand of hair in mm/d, in the density of a strand of hair in n/cm, in the diameter of a strand of hair, as well as in the anagen/telogen ratio.
Ethics and dissemination:
This protocol was approved by the Research Ethics Committee of the Nove de Julho University, São Paulo, Brazil, on the date of November 28, 2018 (CAAE: 01381718.0.0000.5511 - Acceptance Number: 3044061). This trial has been registered with the Brazilian Registry of Clinical Trials (REBEC TRIAL RBR-76VCCV). This study is not yet recruiting. Issue date: February 20, 2019.
Photobiomodulation as a therapy for hair loss is one of the more recent additions to our therapeutic armamentarium, although light based therapy in some forms dates back to ancient times. This chapter reviews the evolution of light based therapy and devices and gives the reader a perspective on its role in treating hair loss. The evolution from large, expensive office-based devices to the current wide selection of wearable and hand held devices for home use demonstrates the increased acceptance of this form of treatment which has followed published research demonstrating efficacy.
Objectives:
Hair loss, including alopecia, is a common dermatological issue worldwide. At present, the application of fractional carbon dioxide (CO2 ) laser in the treatment of alopecia has been documented; however, the results vary between reports. These varying results may be due to the limited knowledge of cellular action in laser-irradiated skin. The objective of this study was to investigate the molecular and cellular mechanisms of laser treatment under effective conditions for hair cycle initiation.
Methods:
A fractional CO2 laser was applied and optimized to initiate the hair cycle in a mouse model of alopecia. Several cellular markers were analyzed in the irradiated skin using immunofluorescence staining. Cellular populations and their comprehensive gene expression were analyzed using single-cell RNA sequencing and bioinformatics.
Results:
The effective irradiation condition for initiating the hair cycle was found to be 15 mJ energy/spot, which generates approximately 500 μm depth columns, but does not penetrate the dermis, only reaching approximately 1 spot/mm2 . The proportion of macrophage clusters significantly increased upon irradiation, whereas the proportion of fibroblast clusters decreased. The macrophages strongly expressed C-C chemokine receptor type 2 (Ccr2), which is known to be a key signal for injury-induced hair growth.
Conclusions:
We found that fractional CO2 laser irradiation recruited Ccr2 positive macrophages, and induced hair regrowth in a mouse alopecia model. These findings may contribute to the development of stable and effective fractional laser irradiation conditions for human alopecia treatment.
BACKGROUND: Non-scarring alopecia areata (AA) is a disease that is mediated through autoimmunity. Recently, autologous platelet-rich plasma (PRP) and photobiomodulation (PBM), commonly known as low-level laser (or) light therapy (LLLT) have been suggested to provide a valuable role in stimulating the growth of hair follicles (HF) AIM: Compare between the significance and well-being of PRP and LLLT in the management of AA. PATIENTS AND METHODOLOGY: Thirty patients, each having three patches of AA participated in the study. Patches were assigned randomly to have one of the two treatments: PRP or LLLT. The third patch served as a control and received placebo treatment. PRP was done once weekly, whereas LLLT was done three sessions per week for a maximum of 6 weeks. The patients were followed up (FU) at 1 month and 3 months. The thickness and density of hair were evaluated by the folliscope. RESULTS: A noteworthy higher improvement was detected in the thickness and the density of hair in the PRP treated patches as evaluated by the folliscope and patients satisfaction. The obtained outcomes were sustained during the 12 weeks FU period in most of the patients. CONCLUSION: PRP and LLLT could be considered as efficacious alternatives for the treatments of AA with the least morbidity in addition to a little cost profit ratio. © 2022 Abeer Attia Tawfik, Iman Mostafa, Mona Soliman, Mohamed Soliman, Noha Abdallah.
A new biotechnology based on micro-needling (MND) with low-level light/laser therapy (LLLT) that is used for hair re-growth (HR-G) needs to be standardized. The study aims to report the clinical outcomes resulting from a multicentric, retrospective, observational, case-series study in which MND with LLLT was used on patients affected by androgenic alopecia (AGA). Twenty-six patients were initially enrolled of which 15 males were classified as stages I–III of vertex by the Norwood–Hamilton scale, and 11 females was classified in stages I–II by the Ludwig scale. Twenty patients (10 females and 10 males) were analyzed after their screening (the exclusion and inclusion criteria evaluation). The HR-G assessment was evaluated with photography, as well as the physician’s and patient’s global assessment scales, in addition to standardized phototrichograms, during a short follow-up at T0-baseline, T1-16 weeks. Encouraging results represented by a hair density increase of 12 ± 2 hairs/cm2 at T1 after 16 weeks (16 weeks vs. 0 weeks) in the targeted area, compared with the baseline results (59 ± 2 hairs/cm2 at T1 versus 47 ± 2 hairs/cm2 at baseline), were observed using computerized trichograms with a statistically significant difference in hair re-growth (p = 0.0238). The effectiveness of MND with LLLT use has been demonstrated in mild to moderate AGA patients.
The approach to hyperandrogenism in women varies depending on the woman's age and severity of symptoms. Once tumorous hyperandrogenism is excluded, the most common cause is PCOS. Hirsutism is the most common presenting symptom. The woman's concern about her symptoms plays an important role in the management of disease. Although measurement of testosterone is useful in identifying an underlying cause, care must be taken when interpreting the less accurate assays that are available commercially. Surgical resection is curative in tumorous etiologies, whereas medical management is the mainstay for non-tumorous causes.
Background:
Up to 70% of the adult population worldwide is affected by androgenetic alopecia (AGA) hair loss. Laser therapy offers an addition or alternative to pharmaceutical and surgical treatment of hair regrowth, with non-ablative lasers being preferred over ablative lasers in terms of safety and downtime. Combining laser therapy with different topical agents may result in better hair regrowth.
Objective:
The aim was to evaluate the effectiveness and safety of non-ablative Er:YAG laser used in clinical practice, alone or in combination with other treatment modalities, in patients with both early and advanced stages of AGA.
Methods and patients:
Sixteen patients (7 male and 9 female) with active AGA in different stages were treated with the non-ablative Er:YAG laser (SMOOTHTM mode, 7 mm spot size, 7.00 J/cm2 pulse fluence, 3.3 Hz frequency) as a monotherapy or in combination with injections of platelet-rich plasma (PRP) to the scalp, topical minoxidil, and oral supplements for the promotion and support of hair growth. Efficacy was assessed with clinical assessment of AGA grade (Ludwig scale for female / Norwood-Hamilton scale for male) and with blind evaluation of hair quality in global photographs before and after treatment. Patients subjectively rated their satisfaction with the laser treatment on a scale from 0-3 and pain on a VAS scale from 0-10.
Results:
AGA grade after treatment was lower compared to baseline (p = 0.015 and p = 0.125 in female and male patients, respectively). Blind evaluation indicated an improvement in hair quality in 93% of patients, either being described as much better (14%) or as better (79%), which was not correlated with age or AGA grade. The median satisfaction score was 3, and the median VAS score for pain was 2. The positive effect of the treatment on the hair quality is ongoing. No adverse reactions were reported.
Conclusions:
The treatment was effective in treating AGA, confirmed by a decrease in AGA grade and by blinded evaluation of global photographs. Although the possible additive or complementary effect of topical minoxidil or nutraceuticals cannot be excluded, our results suggest that the non-ablative Er:YAG laser SMOOTH™ mode as a monotherapy, or in combination with PRP, is an efficient and safe treatment for AGA-with a high satisfaction rate among patients regardless of patient age, AGA duration, or AGA stage.
Hair loss affects millions of people worldwide and can have devastating effects on an individual's psychoemotional well-being. Today hair restoration technologies through hair transplantation have advanced with the use of robots and follicular unit extraction and grafting that it is possible to offer to patient's excellent clinical results. Adjuvant modalities such as platelet-rich plasma injections, lasers, and stem cells can further enhance the durability, health, and appearance of hair transplants.
The field of hair disorders is constantly growing. The most important hair diseases are divided in non‐ cicatricial and cicatricial ones. Non‐cicatricial alopecia are more frequent than cicatricial alopecia.
The first step is to obtain a good history and physical examination. Laboratory testing is often unnecessary, while trichoscopy is fundamental for all hair diseases. Scalp biopsy is strongly suggested in cicatricial alopecia and in doubtful cases. Androgenetic alopecia, alopecia areata, telogen effluvium, trichotillomania are common causes of non‐ cicatricial alopecia. Frontal fibrosing alopecia, discoid lupus erythematosus, lichen planopilaris, follicullitis decalvans are some of the most common forms of cicatricial hair loss. Many treatments are available, and a prompt diagnosis is very important for the prognosis.
Introduction
Mini-invasive therapies based on autologous non-activated Platelet-Rich Plasma (ANA-PRP), Low-Level Laser Therapy (LLL-T), and Micro-Needling Technique (MN-T) used in combining for hair re-growth need to be standardized.
Objectives
The work aims to show in vivo outcomes resulted from retrospective case-series study in which ANA-PRP + MN-T + LLL-T were used in combined in patients affected by Androgenic alopecia.
Methods
23 patients were treated, of which 13 males were classified in stage I - V by the Norwood–Hamilton scale, and 10 females were classified in stage I - III by the Ludwig scale. Assessment of hair re-growth was evaluated with photography, physician’s and patient’s global assessment scale, and standardized phototrichograms during a follow-up: T0 - baseline, T1 - 12 weeks, T2 - 23 weeks, T3 - 44 weeks, T4 - 58 weeks.
Results
Interesting outcomes represented by a hair density increase of 81 ± 5 hairs/cm² and 57 ± 7 hairs/cm² respectively at T1 and T2 compared with baseline (173 ± 5 hairs/cm² at T1 and 149 ± 9 hairs/cm² at T2 versus 92 ± 2 hairs/cm² at baseline) were observed using computerized trichograms.
Conclusions
The effect of the combined use of MN-T, LLL-T, and ANA-PRP has been demonstrated.
Background
Androgenetic alopecia (AGA) is the most common type of baldness affecting both men and women. Studies investigating combination therapies for AGA reported greater efficacy than monotherapy but without rigorous examination. The authors performed a meta‐analysis and systemic review to further verify the evidence.
Objective
To evaluate the effectiveness of three common combination therapies of minoxidil with finasteride, low‐level laser light therapy (LLLT) or microneedling versus minoxidil monotherapy.
Materials and Methods
We conducted a systematic review of randomized controlled trials (RCTs) of combination therapies consisting of topical minoxidil for AGA through April 2020. Quality assessment and data analysis were performed by Review Manager 5.3.
Results
Fifteen studies met the inclusion criteria involving a total of 1172 AGA patients. We conducted meta‐analysis for 3 groups of combined treatment separately, and all were superior to monotherapy in terms of global photographic assessment (p<0.05). Combination of LLLT or microneedling with minoxidil also showed significant increase in hair count (p<0.05) compared to monotherapy.
Conclusion
The present study suggests that combination therapy could be an effective, safe and promising option for the treatment of AGA. However, more RCTs are needed to further investigate and confirm the efficacy of combined treatment.
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Female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women. The onset may be at any age following puberty and the frequency increases with age. Clinically, it shows a diffuse hair thinning over the central scalp, while the frontal hairline is usually retained. FAGA can have a significant psychological impact, leading to anxiety and depression. For this reason, early diagnosis is very important to stop the progression of the disease. The sex hormonal milieu is the main pathogenetic mechanism studied in FAGA. The role of androgens is not clearly defined and only one-third of women with FAGA show abnormal androgen levels. Endocrinological diseases with hyperandrogenism associated with FAGA comprise polycystic ovarian syndrome (PCOS), hyperprolactinemia, adrenal hyperplasia and, rarely, ovarian and adrenal tumours. Usually the diagnosis of FAGA is made clinically. A complete clinical examination and a blood examination can reveal other signs of hyperandrogenism. Trichoscopy shows the typical hair miniaturization. A scalp biopsy can be useful when the clinical evaluation does not provide a definitive diagnosis or when cicatricial alopecias with hair loss in the distribution of FAGA or alopecia areata are suspected. FAGA is a slowly progressive disease. The goal of therapy is to stop the progression and to induce a cosmetically acceptable hair regrowth. The most important drugs are topical minoxidil and oral anti-androgens. The purpose of this review is to provide an update on FAGA and to create a guideline on diagnosis and management of this frequent hair disease, not always easily recognizable from cicatricial alopecias with a similar distribution.
Objectives:
Androgenetic alopecia (AGA) is a well-known cause of hair loss in adults but is an under-recognized cause of hair loss in children and adolescents. We reviewed the existing literature regarding androgenetic alopecia in the pediatric/adolescent population.
Methods:
PubMed searches were performed to identify all articles discussing AGA in a pediatric/adolescent population published up to December 2018.
Results:
We identified 7 articles discussing androgenetic alopecia in patients aged younger than 18. One of these articles was a review containing data from 3 conference abstracts, which were also included in the analysis. A total of 655 cases of androgenetic alopecia were found.
Limitations:
Data are limited to retrospective reviews and case reports/series.
Conclusion:
AGA in the pediatric population is not uncommon, but its incidence and prevalence are unknown. It is associated with a strong family history of AGA and can typically be diagnosed clinically by physical examination and trichoscopy. Topical minoxidil, although not approved, has been used with success. Other treatment modalities are poorly studied in children.
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.
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.
Background:
Female pattern hair loss (FPHL), or androgenic alopecia, is the most common type of hair loss affecting women. It is characterised by progressive shortening of the duration of the growth phase of the hair with successive hair cycles, and progressive follicular miniaturisation with conversion of terminal to vellus hair follicles (terminal hairs are thicker and longer, while vellus hairs are soft, fine, and short). The frontal hair line may or may not be preserved. Hair loss can have a serious psychological impact on women.
Objectives:
To determine the efficacy and safety of the available options for the treatment of female pattern hair loss in women.
Search methods:
We updated our searches of the following databases to July 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (2015, Issue 6), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1872), AMED (from 1985), LILACS (from 1982), PubMed (from 1947), and Web of Science (from 1945). We also searched five trial registries and checked the reference lists of included and excluded studies.
Selection criteria:
We included randomised controlled trials that assessed the efficacy of interventions for FPHL in women.
Data collection and analysis:
Two review authors independently assessed trial quality, extracted data and carried out analyses.
Main results:
We included 47 trials, with 5290 participants, of which 25 trials were new to this update. Only five trials were at 'low risk of bias', 26 were at 'unclear risk', and 16 were at 'high risk of bias'.The included trials evaluated a wide range of interventions, and 17 studies evaluated minoxidil. Pooled data from six studies indicated that a greater proportion of participants (157/593) treated with minoxidil (2% and one study with 1%) reported a moderate to marked increase in their hair regrowth when compared with placebo (77/555) (risk ratio (RR) = 1.93, 95% confidence interval (CI) 1.51 to 2.47; moderate quality evidence). These results were confirmed by the investigator-rated assessments in seven studies with 1181 participants (RR 2.35, 95% CI 1.68 to 3.28; moderate quality evidence). Only one study reported on quality of life (QoL) (260 participants), albeit inadequately (low quality evidence). There was an important increase of 13.18 in total hair count per cm² in the minoxidil group compared to the placebo group (95% CI 10.92 to 15.44; low quality evidence) in eight studies (1242 participants). There were 40/407 adverse events in the twice daily minoxidil 2% group versus 28/320 in the placebo group (RR 1.24, 95% CI 0.82 to 1.87; low quality evidence). There was also no statistically significant difference in adverse events between any of the individual concentrations against placebo.Four studies (1006 participants) evaluated minoxidil 2% versus 5%. In one study, 25/57 participants in the minoxidil 2% group experienced moderate to greatly increased hair regrowth versus 22/56 in the 5% group (RR 1.12, 95% CI 0.72 to 1.73). In another study, 209 participants experienced no difference based on a visual analogue scale (P = 0.062; low quality evidence). The assessments of the investigators based on three studies (586 participants) were in agreement with these findings (moderate quality evidence). One study assessed QoL (209 participants) and reported limited data (low quality evidence). Four trials (1006 participants) did not show a difference in number of adverse events between the two concentrations (RR 1.02, 95% CI 0.91 to 1.20; low quality evidence). Both concentrations did not show a difference in increase in total hair count at end of study in three trials with 631 participants (mean difference (MD) -2.12, 95% CI -5.47 to 1.23; low quality evidence).Three studies investigated finasteride 1 mg compared to placebo. In the finasteride group 30/67 participants experienced improvement compared to 33/70 in the placebo group (RR 0.95, 95% CI 0.66 to 1.37; low quality evidence). This was consistent with the investigators' assessments (RR 0.77, 95% CI 0.31 to 1.90; low quality evidence). QoL was not assessed. Only one study addressed adverse events (137 participants) (RR 1.03, 95% CI 0.45 to 2.34; low quality evidence). In two studies (219 participants) there was no clinically meaningful difference in change of hair count, whilst one study (12 participants) favoured finasteride (low quality evidence).Two studies (141 participants) evaluated low-level laser comb therapy compared to a sham device. According to the participants, the low-level laser comb was not more effective than the sham device (RR 1.54, 95% CI 0.96 to 2.49; and RR 1.18, 95% CI 0.74 to 1.89; moderate quality evidence). However, there was a difference in favour of low-level laser comb for change from baseline in hair count (MD 17.40, 95% CI 9.74 to 25.06; and MD 17.60, 95% CI 11.97 to 23.23; low quality evidence). These studies did not assess QoL and did not report adverse events per treatment arm and only in a generic way (low quality evidence). Low-level laser therapy against sham comparisons in two separate studies also showed an increase in total hair count but with limited further data.Single studies addressed the other comparisons and provided limited evidence of either the efficacy or safety of these interventions, or were unlikely to be examined in future trials.
Authors' conclusions:
Although there was a predominance of included studies at unclear to high risk of bias, there was evidence to support the efficacy and safety of topical minoxidil in the treatment of FPHL (mainly moderate to low quality evidence). Furthermore, there was no difference in effect between the minoxidil 2% and 5% with the quality of evidence rated moderate to low for most outcomes. Finasteride was no more effective than placebo (low quality evidence). There were inconsistent results in the studies that evaluated laser devices (moderate to low quality evidence), but there was an improvement in total hair count measured from baseline.Further randomised controlled trials of other widely-used treatments, such as spironolactone, finasteride (different dosages), dutasteride, cyproterone acetate, and laser-based therapy are needed.
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.
Various trials have been conducted on the management and treatment of androgenic alopecia (AGA) or male pattern hair loss using a variety of laser and light sources.
For this feasibility study, the population was composed of males between the ages of 20 and 60 years who have been experiencing active hair loss within the last 12 months and the diagnosis of AGA. They also had a Norwood-Hamilton classification of 3, 3A, 3 V, 4, 4A, or 5 for the hair thinning patterns and skin type I, II, III, or IV on the Fitzpatrick skin type scale. This two-arm randomized, parallel group study design employed stratifying randomization to balance treatment assignment within three investigational centers with at least 2 subjects enrolled in each Fitzpatrick skin type.
A statistically significant positive trend in hair growth was observed from this pilot study, to evaluate the efficacy of the novel cold X5 hairlaser device for treating male androgenic alopecia. From the repeated measures analysis of variance, difference in mean hair counts over time was statistically significant (F = 7.70; p-value < 0.0001). Subsequent, linear regression of mean hair counts at each time point was performed, and post-hoc analysis found an increasing trend of hair growth over time that was statistically significant (p-value < 0.0001) with the estimated slope of 1.406. Increased hair counts from the baseline to the end of the 26-week period were found to be strongly significant (p-value = 0.0003).
Albeit, sham device failure and resultant missing data from the control group, the positive trend hair growth, was observed due to the chronic use of X5hairlaser device. This positive benefit while in full agreement with other low laser hair devices requires intensive further investigation.Trial registration: NCT02067260.
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.
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.
Alopecia is a common disorder affecting more than half of the population worldwide. Androgenetic alopecia, the most common type, affects 50% of males over the age of 40 and 75% of females over 65. Only two drugs have been approved so far (minoxidil and finasteride) and hair transplant is the other treatment alternative. This review surveys the evidence for low-level laser therapy (LLLT) applied to the scalp as a treatment for hair loss and discusses possible mechanisms of actions.
Searches of PubMed and Google Scholar were carried out using keywords alopecia, hair loss, LLLT, photobiomodulation.
Studies have shown that LLLT stimulated hair growth in mice subjected to chemotherapy-induced alopecia and also in alopecia areata. Controlled clinical trials demonstrated that LLLT stimulated hair growth in both men and women. Among various mechanisms, the main mechanism is hypothesized to be stimulation of epidermal stem cells in the hair follicle bulge and shifting the follicles into anagen phase.
LLLT for hair growth in both men and women appears to be both safe and effective. The optimum wavelength, coherence and dosimetric parameters remain to be determined. Lasers Surg. Med. 9999:1-8, 2013. © 2013 Wiley Periodicals, Inc.
Female pattern hair loss (FPHL) or androgenic alopecia is the most common type of hair loss affecting women with reduced hair density and can have a serious psychological impact. It is characterized by progressive replacement of slow cycling terminal hair follicles by miniaturized, rapidly cycling vellus hair follicles. The frontal hair line may or may not be preserved. The aim of this review was to assess the evidence for the effectiveness and safety of the treatments available for FPHL. Searches included: Cochrane Skin Group Specialised Register, Cochrane Central Register of Controlled Clinical Trials in The Cochrane Library, MEDLINE, EMBASE, AMED, PsycINFO, LILACS and several ongoing trials registries (October 2011). Randomized controlled trials in women with FPHL were identified. Twenty-two trials, comprising 2349 participants, were included. A range of interventions was evaluated, with 10 studies examining varying concentrations of minoxidil. Pooled data from four studies indicated that a greater proportion of participants treated with minoxidil reported a moderate increase in their hair regrowth compared with placebo (relative risk 1·86, 95% confidence interval 1·42-2·43). There was no difference between the number of adverse events experienced in the twice daily minoxidil and the placebo intervention groups, except for a reported increase with minoxidil 5% twice daily. Single studies accounted for most of the other comparisons, which were assessed as either having high risk of bias and/or they did not address the prespecified outcomes for this review and provided limited evidence of either the effectiveness or safety of these interventions. Further well-designed, adequately powered randomized controlled trials investigating other treatment options are still required.
Female pattern hair loss, or androgenic alopecia, is the most common type of hair loss affecting women. It is characterised by progressive shortening of the duration of the growth phase of the hair with successive hair cycles, and progressive follicular miniaturisation with conversion of terminal to vellus hair follicles (terminal hairs are thicker and longer, while vellus hairs are soft, fine, and short). The frontal hair line may or may not be preserved. Hair loss can have a serious psychological impact on people.
To determine the effectiveness and safety of the available options for the treatment of female pattern hair loss in women.
We searched the following databases up to October 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2011, Issue 4), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), AMED (from 1985), LILACS (from 1982), PubMed (from 1947), Web of Science (from 1945), and reference lists of articles. We also searched several online trials registries for ongoing trials.
Randomised controlled trials that assessed the effectiveness of interventions for female pattern hair loss in women.
Two review authors independently assessed trial quality and extracted data.
Twenty two trials, comprising 2349 participants, were included. A wide range of interventions were evaluated, with 10 studies investigating the different concentrations of minoxidil. Pooled data from 4 studies indicated that a greater proportion of participants (121/488) treated with minoxidil reported a moderate increase in their hair regrowth when compared with placebo (64/476) (risk ratio (RR) = 1.86, 95% confidence interval (CI) 1.42 to 2.43). In 7 studies, there was an important increase of 13.28 in total hair count per cm(2) in the minoxidil group compared to the placebo group (95% CI 10.89 to 15.68). There was no difference in the number of adverse events in the twice daily minoxidil and placebo intervention groups, with the exception of a reported increase of adverse events (additional hair growth on areas other than the scalp) with minoxidil (5%) twice daily. Most of the other comparisons consisted of single studies. These were assessed as high risk of bias: They did not address our prespecified outcomes and provided limited evidence of either the efficacy or safety of these interventions.
Although more than half of the included studies were assessed as being at high risk of bias, and the rest at unclear, there was evidence to support the effectiveness and safety of topical minoxidil in the treatment of female pattern hair loss. Further direct comparison studies of minoxidil 5% applied once a day, which could improve adherence when compared to minoxidil 2% twice daily, are still required. Consideration should also be given to conducting additional well-designed, adequately-powered randomised controlled trials investigating several of the other treatment options.
Soon after the discovery of lasers in the 1960s it was realized that laser therapy had the potential to improve wound healing and reduce pain, inflammation and swelling. In recent years the field sometimes known as photobiomodulation has broadened to include light-emitting diodes and other light sources, and the range of wavelengths used now includes many in the red and near infrared. The term "low level laser therapy" or LLLT has become widely recognized and implies the existence of the biphasic dose response or the Arndt-Schulz curve. This review will cover the mechanisms of action of LLLT at a cellular and at a tissular level and will summarize the various light sources and principles of dosimetry that are employed in clinical practice. The range of diseases, injuries, and conditions that can be benefited by LLLT will be summarized with an emphasis on those that have reported randomized controlled clinical trials. Serious life-threatening diseases such as stroke, heart attack, spinal cord injury, and traumatic brain injury may soon be amenable to LLLT therapy.
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.
Currently, light therapies are widely used in both human and veterinarian medicine. The application of light to clinical therapeutics includes: photodynamic therapy, used to kill cancer cells; UVA therapies, used to treat a variety of skin diseases; and photobiomodulation, used to promote cell growth and recovery from injury. Photobiomodu-lation uses light emitting diodes (LEDs) or low energy lasers, which emit light in the visible red to near infrared range. Light in this range penetrates tissue reasonably well, lacks the carcinogenic/mutagenic properties of UV light, and acts on an endogenous photoreceptor which likely acts to initiate light-altered signaling pathways. Although early studies identified mitochondrial cytochrome c oxidase as an endogenous photoreceptor for photobiomodulation, the cellular and molecular mechanisms underlying photobiomodulation have not been clear. Three recent findings provide important new insight. First, nitric oxide has been implicated. Second, cytochrome c oxidase, an enzyme known to reduce oxygen to water at the end of the mitochondrial respiratory chain, has been shown to have a new enzymatic activity--the reduction of nitrite to nitric oxide. This nitrite reductase activity is elevated under hypoxic conditions but also occurs under normoxia. And third, low intensity light enhances nitric oxide synthesis by cytochrome c oxidase without altering its ability to reduce oxygen. From these findings, we propose that cytochrome c oxidase functions in photobiomodulation by producing nitric oxide, a signaling molecule which can then function in both intra- and extracellular signaling pathways. We also propose that the effectiveness of photobiomodulation is under the control of tissue oxygen and nitrite levels.
Androgenetic alopecia affects up to 80% of males by the age of 80. The synonym 'male-pattern hair loss' highlights the fact that hair loss occurs in a defined and reproducible pattern. Hair loss results in reduced self esteem, loss of confidence and anxiety in affected men. An effective treatment for hair baldness would be desirable.
In androgenetic alopecia, hair follicles undergo progressive miniaturization. Genetic factors and androgens play a major role in the pathogenesis of the disease. Polymorphism of the androgen receptor gene was first identified in association with androgenetic alopecia. Identification of new susceptibility genes on chromosomes 3q26 and 20p11 suggest that non-androgen-dependent pathways also are involved.
Topical monoxidil and oral finasteride are commonly in use and have FDA approval for the treatment of male androgenetic alopecia; dutasteride, a type I and II 5-alpha-reductase inhibitor, is on hold in Phase III trials. A combination of medical treatment and hair transplant surgery has shown superior efficacy.
Androgenetic alopecia is a progressive condition and although the current available treatments are effective in arresting the progression of the disease, they allow only partial regrowth of hair at its best. Early treatment achieves the best desirable outcome.
Nitric oxide is an important messenger in numerous biological processes, such as angiogenesis, hypoxic vasodilation, and cardioprotection. Although nitric oxide synthases (NOS) produce the bulk of NO, there is increasing interest in NOS independent generation of NO in vivo, particularly during hypoxia or anoxia, where low oxygen tensions limit NOS activity. Interventions that can increase NO bioavailability have significant therapeutic potential. The use of far red and near infrared light (R/NIR) can reduce infarct size, protect neurons from methanol toxicity, and stimulate angiogenesis. How R/NIR modulates these processes in vivo and in vitro is unknown, but it has been suggested that increases in NO levels are involved. In this study we examined if R/NIR light could facilitate the release of NO from nitrosyl heme proteins. In addition, we examined if R/NIR light could enhance the protective effects of nitrite on ischemia and reperfusion injury in the rabbit heart. We show both in purified systems and in myocardium that R/NIR light can decay nitrosyl hemes and release NO, and that this released NO may enhance the cardioprotective effects of nitrite. Thus, the photodissociation to NO and its synergistic effect with sodium nitrite may represent a noninvasive and site-specific means for increasing NO bioavailability.
Hair has many useful biologic functions, including protection from the elements and dispersion of sweat-gland products (e.g., pheromones). It also has psychosocial importance in our society, and patients with hair loss (alopecia) (Table 1) or excessive hair growth often suffer tremendously. Not surprisingly, the demand for drugs that alter hair growth and appearance has led to a multibillion-dollar industry, yet few drugs that are effective for these purposes are available. However, recent progress in our understanding of the biology and pathology of hair follicles should lead to more effective therapies for disorders of hair growth. Structure and Function of Hair . . .
To pical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in men with androgenetic alopecia and women with female pattern hair loss. Results can be variable, and historic experience suggests that higher concentrations of topical minoxidil may enhance efficacy.
The purpose of this 48-week, double-blind, placebo-controlled, randomized, multicenter trial was to compare the efficacy and safety of 5% topical minoxidil with 2% topical minoxidil and placebo in the treatment of female pattern hair loss.
A total of 381 women (18-49 years old) with female pattern hair loss applied 5% topical minoxidil solution (n = 153), 2% topical minoxidil solution (n = 154), or placebo (vehicle for 5% solution; n = 74) twice daily. Primary efficacy variables were change in nonvellus hair count at week 48, and patient and investigator assessments of change in hair growth/scalp coverage at week 48.
After 48 weeks of therapy, 5% topical minoxidil was superior to placebo for each of the 3 primary efficacy measures. The 2% topical minoxidil group demonstrated superiority over placebo for hair count and investigator assessment of hair growth/scalp coverage at week 48; differences in patient assessment of hair growth at week 48 were not significantly different from placebo. The 5% topical minoxidil group demonstrated statistical superiority over the 2% topical minoxidil group in the patient assessment of treatment benefit at week 48. Both 5% and 2% topical minoxidil helped improve psychosocial perceptions of hair loss in women with female pattern hair loss. An increased occurrence of pruritus, local irritation, and hypertrichosis was observed with 5% topical minoxidil versus 2% topical minoxidil and placebo.
In this 48-week study of 381 women with female pattern hair loss, 5% topical minoxidil was superior to placebo on each of the 3 primary efficacy end points: promoting hair growth as measured by change in nonvellus hair count and patient/investigator assessments of hair growth and scalp coverage. Application of 2% topical minoxidil was superior to placebo for assessments of nonvellus hair counts and investigator assessment of hair growth/scalp coverage at week 48; differences in patient assessment of hair growth at week 48 were not significantly different from placebo. At week 48, the 5% topical minoxidil group demonstrated statistical superiority over the 2% topical minoxidil group in the patient assessment of treatment benefit. Both concentrations of topical minoxidil were well tolerated by the women in this trial without evidence of systemic adverse effects. With the introduction of numerous herbal remedies for hair loss, of which most have not been tested in randomized, double-blind, placebo-controlled trials, it is important to describe well-controlled trials that demonstrate the efficacy and safety of topical drugs.
Photobiomodulation by light in the red to near infrared range (630-1000 nm) using low energy lasers or light-emitting diode (LED) arrays has been shown to accelerate wound healing, improve recovery from ischemic injury in the heart and attenuate degeneration in the injured optic nerve. Recent evidence indicates that the therapeutic effects of red to near infrared light result, in part, from intracellular signaling mechanisms triggered by the interaction of NIR light with the mitochondrial photoacceptor molecule cytochrome c oxidase. We have demonstrated that NIR-LED photo-irradiation increases the production of cytochrome oxidase in cultured primary neurons and reverses the reduction of cytochrome oxidase activity produced by metabolic inhibitors. We have also shown that NIR-LED treatment prevents the development of oral mucositis in pediatric bone marrow transplant patients. Photobiomodulation improves wound healing in genetically diabetic mice by upregulating genes important in the promotion of wound healing. More recent studies have provided evidence for the therapeutic benefit of NIR-LED treatment in the survival and functional recovery of the retina and optic nerve in vivo after acute injury by the mitochondrial toxin, formic acid generated in the course of methanol intoxication. Gene discovery studies conducted using microarray technology documented a significant upregulation of gene expression in pathways involved in mitochondrial energy production and antioxidant cellular protection. These findings provide a link between the actions of red to near infrared light on mitochondrial oxidative metabolism in vitro and cell injury in vivo. Based on these findings and the strong evidence that mitochondrial dysfunction is involved in the pathogenesis of numerous diseases processes, we propose that NIR-LED photobiomodulation represents an innovative and non-invasive therapeutic approach for the treatment of tissue injury and disease processes in which mitochondrial dysfunction is postulated to play a role including diabetic retinopathy, age-related macular degeneration, Leber's hereditary optic neuropathy and Parkinson's disease.
The aim of the present work is to analyze available action spectra for various biological responses of HeLa cells irradiated with monochromatic light of 580-860 nm.
Phototherapy (low-level laser therapy or photobiomodulation) is characterized by its ability to induce photobiological processes in cells. Exact action spectra are needed for determination of photoacceptors as well as for further investigations into cellular mechanisms of phototherapy.
Seven action spectra for the stimulation of DNA and RNA synthesis rate and cell adhesion to glass matrix are analyzed by curve fitting, followed by deconvolusion with Lorentzian fitting. Exact parameters of peak positions and bandwidths are presented.
The peak positions are between 613.5 and 623.5 nm (in one spectrum, at 606 nm), in the red maximum. The far-red maximum has exact peak positions between 667.5 and 683.7 nm in different spectra. Two near infrared maxima have peak positions in the range 750.7-772.3 nm and 812.5-846.0 nm, respectively.
In the wavelength range important for phototherapy (600-860 nm), there are four "active" regions, but peak positions are not exactly the same for all spectra.
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.
Background:
Androgenetic alopecia (AGA) is one of the most common chronic problems seen by dermatologists worldwide. It is characterized by progressive hair loss, especially of scalp hair, and has distinctive patterns of loss in women versus men, but in both genders the central scalp is most severely affected. It often begins around puberty and is known to effect self-esteem and the individual's quality of life. In contrast to the high prevalence of AGA, approved therapeutic options are limited. In addition to the scarce pharmacologic treatments, there are numerous nonprescription products claimed to be effective in restoring hair in androgenetic alopecia.
Objectives:
The purpose of this paper is to review published medical and non-medical treatments for male and female AGA using the American College of Physicians evidence assessment methods. MEDLINE, EMBASE and Cochrane Library were searched for systematic reviews, randomized controlled trials, open studies, case reports and relevant studies of the treatment of male and female AGA. The relevant articles were classified according to grade and level of evidence.
Results:
The medical treatments with the best level of evidence classification for efficacy and safety for male AGA are oral finasteride and topical minoxidil solution. For female AGA, topical minoxidil solution appears to be the most effective and safe treatment. The medical treatments corresponding to the next level of evidence quality are some commonly used therapeutic non-FDA-approved options including oral and topical anti-hormonal treatments. Surgical treatment of follicular unit hair transplantation is an option in cases that have failed medical treatment although there is high variation in outcomes.
Limitations:
Some articles, especially those concerning traditional herbs claimed to promote hair regrowth, were published in non-English, local journals.
Conclusions:
An assessment of the evidence quality of current publications indicates that oral finasteride (for men only) and topical minoxidil (for men and women) are the best treatments of AGA.
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.
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.
Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80 % Caucasian men and 42 % of women.
Patients diagnosed with androgenetic alopecia may undergo significant impairment of quality of life. Despite the high prevalence and the variety of therapeutic options available, there have been no national or international evidence-based guidelines for the treatment of androgenetic alopecia in men and women so far. Therefore, the European Dermatology Forum (EDF) initiated a project to develop an evidence-based S3 guideline for the treatment of andro-genetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference.
The purpose of the guideline is to provide dermatologists as well as general practitioners with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.
Finasteride is an important drug for the management of androgenetic alopecia. However, there are concerns about the possible side effects of the drug such as impotence. Recently stray reports have appeared about the occurrence of male breast carcinoma in patients who received the drug. These have been looked in to by Medicines and Health care products Regulatory Agency (MHRA). This article summarizes the MHRA report.
Androgenetic alopecia is the most common form of alopecia in men.
To determine the efficacy and safety of finasteride therapy for patients with androgenetic alopecia.
MEDLINE, EMBASE, CINAHL, Cochrane Registers, and LILACS were searched for randomized controlled trials reported in any language that evaluated the efficacy and safety of finasteride therapy in comparison to treatment with placebo in adults with androgenetic alopecia.
Two reviewers independently evaluated eligibility and collected the data, including assessment of methodological quality (Jadad score). Outcome measures included patient self-assessment, hair count, investigator clinical assessment, global photographic assessment, and adverse effects at short term (≤12 months) and long term (≥24 months). Heterogeneity was explored by testing a priori hypotheses.
Twelve studies fulfilled the eligibility criteria (3927 male patients), 10 of which demonstrated a Jadad score of 3 or more. The proportion of patients reporting an improvement in scalp hair was greater with finasteride therapy than with placebo treatment in the short term (relative risk [RR], 1.81 [95% confidence interval (CI), 1.42-2.32]; I², 64%) and in the long term (RR, 1.71 [95% CI, 1.15-2.53]; I², 16%); both results were considered to have moderate-quality evidence. The number needed to treat for 1 patient to perceive himself as improved was 5.6 (95% CI, 4.6-7.0) in the short term and 3.4 (95% CI, 2.6-5.1) in the long term. Moderate-quality evidence suggested that finasteride therapy increased the mean hair count from baseline in comparison to placebo treatment, expressed as a percentage of the initial count in each individual, at short term (mean difference [MD], 9.42% [95% CI, 7.95%-10.90%]; I², 50%) and at long term (MD, 24.3% [95% CI, 17.92%-30.60%]; I², 0%). Also, the proportion of patients reported as improved by investigator assessment was greater in the short term (RR, 1.80 [95% CI, 1.43-2.26]; number needed to treat, 3.7 [95% CI, 3.2-4.3]; I², 82%) (moderate-quality evidence). Moderate-quality evidence suggested an increase in erectile dysfunction (RR, 2.22 [95% CI, 1.03-4.78]; I², 1%; number needed to harm, 82.1 [95% CI, 56-231]) and a possible increase in the risk of any sexual disturbances (RR, 1.39 [95% CI, 0.99-1.95]; I², 0%). The risk of discontinuing treatment because of sexual adverse effects was similar to that of placebo (RR, 0.88 [95% CI, 0.51-1.49]; I², 5%) (moderate-quality evidence).
Moderate-quality evidence suggests that daily use of oral finasteride increases hair count and improves patient and investigator assessment of hair appearance, while increasing the risk of sexual dysfunction.
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.
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
Androgen significantly stimulates the proliferation of outer root sheath cells that are cocultured with beard dermal papilla cells without cell contact. The expression of insulin-like growth factor I (IGF-I) mRNA in beard dermal papilla cells was stimulated by androgen and antagonized by cyproterone acetate. Outer root sheath cells did not express mRNA for IGF-I either in the presence or absence of androgen. Both of these two types of cells expressed mRNA for IGF-I receptor and the expression was not affected by androgen. Neutralizing antibody against IGF-I antagonized the stimulatory effect of androgen on the growth of outer root sheath cell cocultured with beard dermal papilla cells. These findings suggest that IGF-I is a candidate for androgen induced hair growth factors.
Despite the prevalence of androgenetic alopecia (AGA) and the acceptance of its associated psychological factors in women, few studies have directly queried women about which specific aspects of their lives are affected by hair thinning and the relative importance of such effects. Perceptions of such negative effects can influence patient satisfaction, health-related quality of life (HRQL) and the impetus to seek medical attention for hair loss. Women (n = 120) aged 22-66 years with at least mild (Ludwig I) AGA were recruited from two dermatology clinics and from a large worksite and asked to complete a questionnaire. The questionnaire solicited information about specific aspects of their lives potentially affected by AGA and the relative importance of those aspects. Inability to style their hair, dissatisfaction with their appearance, concern about hair loss continuing, and concern about others noticing their hair loss were most important to women. Emotional aspects also ranked high, including self-consciousness, jealousy, embarrassment, and feeling powerless to stop their hair loss. In summary, women with AGA report numerous ways in which their hair thinning affects their lives. Knowledge of these effects may be beneficial in counseling such patients and in designing clinical trials or epidemiological studies to evaluate hair loss in women.
The timing regulation of the hair growth phases is quite complex. We name teloptosis the termination of the telogen phase with hair shedding. The initiation of the next anagen I phase is independent from teloptosis. Both events are triggered by distinct factors. Indeed, teloptosis is the result of the loss of adhesion between cells of the club hair and those of its epithelial envelope. Teloptosis synchronization is perceived as telogen effluvium, related or not to shortening of the anagen phase. Subtle changes leading to early or delayed teloptosis affect hair density. It is possible to distinguish two types of telogen hairs on a trichogram. Those with an epithelial sheath indicate strong binding, suggesting early telogen, whereas the absence of an epithelial sheath indicates loose binding, conveying teloptosis.
Topical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in individuals with androgenetic alopecia (AGA). Results can be variable, and historical experience suggests that higher concentrations of topical minoxidil may enhance efficacy.
The purpose of this 48-week, double-blind, placebo-controlled, randomized, multicenter trial was to compare 5% topical minoxidil with 2% topical minoxidil and placebo in the treatment of men with AGA.
A total of 393 men (18-49 years old) with AGA applied 5% topical minoxidil solution (n = 157), 2% topical minoxidil solution (n = 158), or placebo (vehicle for 5% solution; n = 78) twice daily. Efficacy was evaluated by scalp target area hair counts and patient and investigator assessments of change in scalp coverage and benefit of treatment.
After 48 weeks of therapy, 5% topical minoxidil was significantly superior to 2% topical minoxidil and placebo in terms of change from baseline in nonvellus hair count, patient rating of scalp coverage and treatment benefit, and investigator rating of scalp coverage. Hair count data indicate that response to treatment occurred earlier with 5% compared with 2% topical minoxidil. Additionally, data from a patient questionnaire on quality of life, global benefit, hair growth, and hair styling demonstrated that 5% topical minoxidil helped improve patients' psychosocial perceptions of hair loss. An increased occurrence of pruritus and local irritation was observed with 5% topical minoxidil compared with 2% topical minoxidil.
In men with AGA, 5% topical minoxidil was clearly superior to 2% topical minoxidil and placebo in increasing hair regrowth, and the magnitude of its effect was marked (45% more hair regrowth than 2% topical minoxidil at week 48). Men who used 5% topical minoxidil also had an earlier response to treatment than those who used 2% topical minoxidil. Psychosocial perceptions of hair loss in men with AGA were also improved. Topical minoxidil (5% and 2%) was well tolerated by the men in this trial without evidence of systemic effects.
In this paper we report 19 patients (14 males, 5 females; mean age 28.16 years +/- 7.68 SD) out of a series of 23 (17 males, 5 females) who developed a mood disturbance (moderate to severe depression) during treatment with finasteride, 1 mg/day orally, for androgenetic alopecia (Hamilton subtypes III-V; Ludwig subtypes I-II). Depression, which significatively impaired sociofamilial relations, sleep and eating behaviour, was associated to marked anxiety in some cases, developed after 9-19 weeks of treatment with finasteride, and promptly resolved after suspension of the drug. Two patients accepted reintroduction of the drug, and depression relapsed within 2 weeks. Depression as an adverse effect of finasteride has been reported only once. Further studies are needed to confirm our circumstantial observations, which are based on a retrospective series of patients.
In this paper, the cDNA microarray technique was used to investigate the gene expression profiles of human fibroblasts irradiated by low-intensity red light. Proliferation assays showed that the fibroblast HS27 cells responded with a curve effect to different doses of low-intensity red light irradiation at a wavelength of 628 nm. An optimal dose of 0.88 J per cm2 was chosen for subsequent cDNA microarray experiments. The gene expression profiles revealed that 111 genes were regulated by the red light irradiation and can be grouped into 10 functional categories. Most of these genes directly or indirectly play roles in the enhancement of cell proliferation and the suppression of apoptosis. Two signaling pathways, the p38 mitogen-activated protein kinase signaling pathway and the platelet-derived growth factor signaling pathway, were found to be involved in cell growth induced by irradiation of low-intensity red light. Several genes related to antioxidation and mitochondria energy metabolism were also found to express differentially upon irradiation. This study provides insight into the molecular mechanisms associated with the beneficial effects of red light irradiation in accelerating wound healing.
Finasteride is a specific inhibitor of type II 5alpha-reductase, the enzyme that converts testosterone (T) to the more potent androgen receptor agonist dihydrotestosterone (DHT). In utero exposure to androgen receptor antagonists and T biosynthesis inhibitors have induced permanent effects on androgen-sensitive end points such as anogenital distance (AGD), nipple retention, and malformations of the male rat reproductive tract. The objectives of this study were to (1) characterize the dose response of finasteride-mediated alterations in androgen-dependent developmental end points, (2) determine whether prenatal exposure to finasteride permanently decreases AGD or results in nipple retention, and (3) evaluate whether AGD or nipple retention is predictive of adverse alterations in the male reproductive tract. Pregnant Crl:CD(SD)BR rats (n=5-6/group) were gavaged with either vehicle or finasteride at 0.01, 0.1, 1.0, 10, or 100 mg/kg/day on gestation days 12 to 21. All male offspring were monitored individually until necropsy on postnatal day (PND) 90. The present study design has been used previously for other antiandrogens and is sensitive to perturbations of the male rat reproductive tract. Decreases in AGD on PND 1 and increases in areolae-nipple retention on PND 13 were significantly different from controls in all finasteride-exposed male rats. Finasteride-induced changes in AGD and nipple retention were permanent in male rats exposed to finasteride at and above 0.1 mg/kg/day. On PND 90, dorsolateral and ventral prostate lobes were absent in 21 to 24% of rats exposed to 100 mg/kg/day finasteride and weighed significantly less at and above 10 mg/kg/day. In the highest dose group, 73% of animals had ectopic testes, much higher than previously reported. The most sensitive malformation other than decreased AGD and nipple retention was the dose-dependent increase in hypospadias. The lowest observed adverse effect level (LOAEL) for finasteride-induced permanent effects in this study was 0.1 mg/kg/day based on permanent changes in AGD and nipple retention. Finasteride-induced changes in AGD and retention of nipples were highly predictive of hypospadias, ectopic testes, and prostate malformations even though some animals with retained nipples or decreased AGD may not have had other reproductive tract malformations. In summary, prenatal exposure to finasteride specifically inhibited DHT-mediated development with little to no change in T-mediated development.
We attempted to establish a coculture model of human dermal papilla cells (DPCs) from androgenetic alopecia (AGA) and keratinocytes (KCs) to study the pathomechanism of AGA. Since expression of mRNA for the androgen receptor (AR) decreased during subcultivation of DPCs in vitro, we transiently transfected the AR expression vector into the DPCs and cocultured them with KCs. In this coculture, androgen inhibited the growth of KCs by 50%, indicating that the DPCs produce diffusible growth suppressive factors into the medium in an androgen-dependent manner. Since recently increasing evidence has shown the importance of transforming growth factor-beta1 (TGF-beta1) in hair growth, we further examined the concentration of TGF-beta1 in this coculture medium after androgen treatment by ELISA assays. The results showed that androgen treatment increased the secretion of TGF-beta1 into the conditioned medium. Moreover, neutralizing anti-TGF-beta1 antibody reversed the inhibition of KC proliferation. Thus, we suggest that androgen-inducible TGF-beta1 derived from DPCs mediates hair growth suppression in AGA.