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Role of LLLT in Androgenetic Alopecia

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As more breakthroughs in the understanding of photomedicine and low level laser therapy occur, it is increasingly important for physicians to understand the role of low level laser therapy in the management of androgenetic alopecia (male and female pattern hair loss). This brief overview from the 19th Annual World Congress of Anti-Aging and Aesthetic medicine (A4M) in Orlando April 2011 followed Harvard/MIT professor, Dr. Michael Hamblin's detailed talk on the mechanisms of low level laser therapy.

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Role of LLLT in Androgenetic Alopecia

  1. 1.  The Role of Low Level Laser Therapy ! in the Medical Management of ! Androgenetic Alopecia! Alan J. Bauman, M.D. Diplomate, American Board of Hair Restoration Surgery 19th Annual World Congress American Academy of Anti-Aging and Aesthetic Medicine Orlando, FL - April 8th, 2011
  2. 2. Disclosures  !   The  following  conflicts  of  interest  are  germane  to  my  presentation:    NONE  !   FDA:    510(k)-­‐cleared  and  cosmetic  devices,  off-­‐label*  medication  !   Anecdotal  Case  Presentations   ‘LaserSpa’  at  Bauman  Medical  Group  
  3. 3. Alan  J.  Bauman,  M.D.  !   Bauman  Medical  Group  –  Boca  Raton,  FL  (1997)  !   New  York  Medical  College  !   Beth  Israel  Medical  Center  –  NY  !   Mt.  Sinai  Medical  Center  –  NY    !   Hair  Transplantation  –  NY  !   American  Bd  of  Hair  Restoration  Surgery  !   American  Hair  Loss  Association  !   Low  Level  Laser  Therapy    (1999)  
  4. 4. Overview   !   Androgenetic  Alopecia   !   Mechanisms  of  Laser  Therapy  (LLLT)   !   Role  of  LLLT  in  Hair  Restoration   !   Laser  Therapy  Dosing  Protocol   !   Our  Experience  w/  Laser  Therapy   !   Practical  Concerns  
  5. 5. Androgenetic  Alopecia  !   Hereditary  :       HAIR  LOSS  CAUSES  !   Androgen  Receptors   4%  !   Progressive   AGA  !   Patterned  hair  follicle  miniaturization   Other  !   Shorter/Finer/Thinner/Less  Pigmented     96%    
  6. 6. Androgenetic  Alopecia   Multi-­‐Therapy  Medical  Management  ! Eliminate/Reduce  ‘Triggers’   •  Medical  conditions,  meds,  social  habits,  nutrition,   stress,  etc.  ! DHT  production  and/or  Androgen  Effects   •  Finasteride,  Dutasteride*,  Spironolactone*  ! Stimulate  Hair  Follicles   •  2%,  5%,  6%*  Minoxidil,  0.03%  Bimatoprost*,     •  Laser  Therapy,  Phototherapy,  PRP  ! Redistribute  (Transplant)  Permanent  Follicles   •  NeoGraft  /  FUE  –  no  linear  scar  ! Surgically  Reduce/Remove  Bald  Areas   •  Scalp  Reduction/Flaps   *off-­‐label  
  7. 7. Phototherapy/LLLT  Concepts  Mechanism:   !   Cytochrome–C–Oxidase   !   ATP  production   !   Non-­‐ionizing   !   Non-­‐thermal   !   No  side-­‐effects   Tuner  J/Hode  L,  Laser  Therapy,  (2004)  Prima  Books  
  8. 8. growth  factor  produc4on extracellular  matrix  deposi4on   near  infrared  light cell  prolifera4on  &  mo4lity   an4-­‐apoptosis  and  pro-­‐survival Gene    signaling transcrip4on -­‐  M.  Hamblin  
  9. 9. FDA  510(k)  Clearances   #K060305,  Jan.  18th  2007  650nm    male  AGA   HairMax  LaserComb  9  x  5mW      at-­‐home   Lexington  Int l,  LLC        !   ...indicated   to   promote   hair   growth   in   males   with   androgenetic   alopecia   who  have  NW  Class  IIa-­‐V…and  does  not  present  any  safety  issues    !   A  Multi-­‐Center,  Randomized,  Placebo-­‐Controlled  Study…”  !   treatment  group  had  significantly  greater  increases  in  terminal  hair   density  than…  placebo. #K091496,  Nov.  13th  2009  650nm    female    AGA   MEP90      82  x  5mW  in-­‐office   Midwest  RF        prescription      
  10. 10. FDA  510(k)  Clearances       (con’t) FDA  510(k):    #K091496,  Nov  13,  2009   Device:    MEP90  Hair  Growth  Stimulation  System     Manufacturer:    Midwest  RF         !   Medically   prescribed   for   the   treatment   of   androgenetic  alopecia  in  females.   !   After  20  treatments,  92%  of  subjects  had  increased   hair  count  ≥10%  with  57%  demonstrating  an  increase   of  ≥30%   !   After  36th  treatment,  97%  of  the  subject  population   demonstrated  increased  hair  count  of  ≥20%,  89%   increased  hair  count  ≥30%,  with  57%  demonstrating   increase  of  ≥50%   !   87%  of  subjects  indicated  it  helped  their  condition,   60%  reporting  slowing  of  hair  loss  by  10  weeks,  65%   reported  their  area  of  hair  loss  had  gotten  smaller. !   In-Office / 650nm / 5mW x 82 diodes  
  11. 11. LLLT  Dosing  Strategy  !   Wavelength   Biphasic  Dose  Response   !   635-­‐670nm  !   Total  Power   !   #  diodes  x  output  (mW)  !   Treatment  Area  !   Duration  (min)   Tuner  J,  Hode    L,    Laser  Therapy  Handbook  (2004)  Prima  Books.  !   Interval  –  too  short  v.  too  long  !   Protocol:  Device  Dependent    
  12. 12. LLLT  &  Hair  
  13. 13. Cosmetic  Devices   !   650  nm   !   5mW  X  224  Diodes   !   80%  Duty  Cycle   !   30  Minutes   !   Hands-­‐Free   !   Rechargeable/Cordless   !   Significant  coverage   !   High  compliance   LaserCap™  
  14. 14. Results  Tracking   !   Patient  History  /  Intake  Questionnaire   !   Physical  Exam  of  Scalp  &  Hair   !   Standardized  Global  Photography   !   Video  Microscopy   !   Combined  Cross-­‐sectional  Hair  Bundle   Trichometry     !   What’s  your  “HAIR  NUMBER?”  
  15. 15. Densitometry  –  Canfield  Scientific  
  16. 16. LaserCap  Results:    
  17. 17. Laser  Therapy  in  Females   25  y/o  female   In-­‐office  Laser  Hood   2  /  week  x  6  months  
  18. 18. LLLT  x  8  months   63  y/o  female   Laser  Therapy  regimen:   3x/wk  x  3  mo   1-­‐2x/wk  since   Photos  after  12mo.  
  19. 19. 6  Months:  At-­‐Home  LLLT  
  20. 20. 24  y/o  Female:  3  mos.  of  LLLT  
  21. 21. Male  Patient  :    LLLT  x  6  mos  
  22. 22. Male  Patient:    LLLT  x  12  mos  
  23. 23. References  !  National  Institutes  of  Health:  National  Institute  of  Arthritis  and  Musculoskeletal  and  Skin  Diseases  (NIAMS):   Q&A  Alopecia  Areata  !  Al-­‐Mutairi  N.  (2007):  308-­‐nm  Excimer  laser  for  the  treatment  of  alopecia  areata.  Dermatologic  Surgery  33(12):1483-­‐1487.  ! Avram  M.R.,  Leonard  R.T.Jr.,  Epstein  E.S.,  Williams  J.L.,  Bauman  A.J.  (2007):   The  current  role  of  laser/light  sources  in  the  treatment  of  male  and  female  pattern  hair  loss.  Journal  of  Cosmetic  and  Laser   Therapy  9(1):27-­‐28.  !  Bernstein  E.F.  (2005):  Hair  growth  induced  by  diode  laser  treatment.  Dermatologic  Surgery  31(5):584-­‐586.  !  Chung  P.S.,  Kim  Y.C.,  Chung  M.S.,  Jung  S.O.,  Ree  C.K.  (2005):   The  effect  of  low-­‐power  laser  on  the  murine  hair  growth.  Journal  of  the  Korean  Society  of  Plastic  &  Reconstructive   Surgeons.  ! Satino  J.L.,  Markou  M.  (2003):   Hair  regrowth  and  increased  hair  tensile  strength  using  the  HairMax  LaserComb  for  low-­‐level  laser  therapy.  International   Journal  of  Cosmetic  Surgery  and  Aesthetic  Dermatology  5(2):113-­‐117.  !  Vlachos  S.P.,  Kontoes  P.P.  (2002):   Development  of  terminal  hair  following  skin  lesion  treatments  with  an  intense  pulsed  light  source.  Aesthetic  Plastic   Surgery  26(4):303-­‐307.  ! Waiz  M.,  Saleh  A.S.,  Hayani  R.,  Jubory  S.O.  (2006):   Use  of  the  pulsed  infrared  diode  laser  (904  nm)  in  the  treatment  of  alopecia  areata.  Journal  of  Cosmetic  and  Laser  Therapy   8(1):27-­‐30.  ! Pontinen,  PJ;  et.al.    Comparative  effects  of  exposure  to  different  light  sources  (He-­‐Ne  laser,  InGaAl  Diode  laser,  non-­‐coherent   LED)  on  skin  blood  flow  of  the  head,  Int  J  Acupuncture  &  Electro-­‐therapeutics  Research  1996  21(105-­‐118).  670nm  !  Weiss  R.,  McDaniel  D.H.,  Geronemus  R.G.,  Weiss  M.,  LED  Photomodulation  induced  hair  growth  stimulations,  presented  at   ASLMS  Annual  Meeting  –  Orlando  FL  (April  2005),  www.interscience.wiley,.com  DOI.1002/lsm.20164.      
  24. 24. References  (con’t)  
  25. 25. Bauman  Medical  Group  THANK  YOU!   doctorb@baumanmedical.com   www.twitter.com/DrAlanBauman   www.linkedin/in/alanjbauman