Tuesday, December 9, 2014

Low-Level Laser Therapy : Looking to lasers to replace lost hair, Deciding whether to see a doctor or do it yourself and Assessing the risks and benefits

Low-Level Laser Therapy

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In This Chapter

  • Looking to lasers to replace lost hair
  • Deciding whether to see a doctor or do it yourself
  • Assessing the risks and benefits

When people hear the words “laser” and “hair” in the same sentence, they usually think of hair removal. Although

lasers work for hair removal, they may possibly also stimulate hair growth if used properly, although there haven’t been enough scientific studies to prove this beyond any doubt.

In this chapter, we look at the role of lasers in hair replacement, the pros and cons of using lasers, and the results you can reason- ably expect from laser treatment, as well as potential problems associated with lasers and the question of whether they really work for most people.

Discovering Lasers

The term laser is an acronym that stands for “light amplification by the stimulated emission of radiation.” Credit for the initial theory behind lasers goes to Albert Einstein, but many other scientists took his lead and further advanced this technology.

Lasers sound high tech and complicated, and they are, but they’re easier to understand than you may think. In the next sections,

we discuss how lasers were invented, what they can do, and the differences in high-power and low-power laser therapy.

How laser therapy works

You’ve all seen lasers used in movies to defeat the evil empire, but lasers are no longer just part of science fiction. Lasers, which are thin, intensely focused light beams which emit a very pure

light of one wavelength, have many medical applications today, and are being touted as a possible stimulus for hair growth in balding areas.

Most lasers used for cosmetic purposes target specific chromophores (components in the skin that absorb light) in the body. The major chromophores that affect your hair are

  •  Melanin (in hair follicles and sun spots)
  •  Hemoglobin (in blood vessels)
  •  Water (throughout the epidermis and dermis — layers of your skin)

Medical lasers can be either high or low powered. There’s no question that high powered lasers are very effective in treating a number of medical conditions.

High-powered lasers are used to destroy hair follicles and remove unwanted hair, target abnormal blood vessels (such as varicose veins), and erase fine lines and wrinkles. High powered lasers can cut through tissue, burn tissue, and emit heat.

Low-level lasers, on the other hand, don’t produce heat, and are generally used to heal damaged tissue rather than to destroy tissue.

Low-level laser therapy (LLLT) may stimulate better hair growth in an area that still has hair; it’s not effective in growing new hair in a completely bald area.

Low-level laser therapy

Low-level laser therapy is a non-invasive technology that has been around for many years. Its main uses have been to stimulate wound healing, decrease inflammation, and lessen intense chronic pain.

The first low-level therapeutic laser was developed in the 1960s by Hungary’s Endre Mester. He reported an improved healing of wounds through low-level laser treatment.

When used for hair loss, the theory is that chromophores absorb the laser light, which then stimulates hair growth in balding areas, possibly by increasing blood flow and increased oxygen flow to the area, which may stimulate the hair follicle at the cellular level and cause weak or thin hair to become stronger and thicker. We say “possibly” because this theory has yet to be scientifically proven.

Some clinicians believe these effects are due to a photochemical reaction produced by the interaction of the laser light with the hair follicle. This reaction alters the cell’s internal processing and signals it to start growing rather than slowly dying.

Hairs that have already begun to miniaturize (thin in diameter) apparently respond to treatment, though completely bald areas typically do not respond. It takes typically up to 12 months to see any new hair growth, if it happens at all.

Who benefits from LLLT?

Both men and women experiencing androgenic alopecia, or genetic induced pattern baldness, appear to be the best candidates for LLLT. Some evidence suggests that LLLT works better when used in conjunction with minoxidil (topical over the counter medication for hair growth) and/or finasteride (prescription pill). (See Chapter 9 for more on both medications.)

Because LLLT isn’t particularly effective on bald areas, it may be a more effective treatment in women, whose hair loss is typically diffuse (spread throughout the scalp) and more miniaturized, than in men, who typically have more areas of the scalp that are totally bald.

Note that laser therapy does not lead to permanent results. You must continue therapy in order for the hair to keep growing.

Looking at the clinical data

The clinical data for LLLT relating to hair loss isn’t as plentiful as it is for proven treatments such as minoxidil and finasteride (see Chapter 9 for more on these medications). Although numerous reports and studies document its effectiveness, none of these studies were conducted in a controlled manner over a long period of time (greater than six months). Many reports of success with LLLT are anecdotal from individuals.

This lack of evidence does not mean that it doesn’t work, but it does underscore the need for in-depth, long-term studies on the effectiveness of LLLT.

In 2003, a peer-reviewed medical journal published the first study looking at the effectiveness of a handheld LLLT device for the treatment of hair loss. Thirty-five patients diagnosed with androgenic alopecia participated in this study (28 male, 7 female); each got the handheld device for use at home for five to ten minutes every other day for six months.

After six months of use, hair counts in the temples increased by an average of 55 percent in females and 74 percent in males. In the vertex (crown of the scalp), the increase was 65 percent for females and 120 percent for men.

In total, for both areas, hair count increased by an average of 94 percent. In addition, the study reported an increase in hair strength.

Although these numbers sound very positive, put them in perspective. For example, one male patient had a total of 12 hairs in the counted area at baseline and then 23 hairs six months later. This change corresponded to an increase in hairs of 92 percent. In reality, though, 11 extra hairs probably didn’t make a huge difference in his physical appearance, and the data was highly suspect when analyzed by these authors.

Finding a Physician

We recommend that you contact a physician who has experience in diagnosing the cause of hair loss before beginning LLLT therapy either in the doctor’s office or at home, because other equally or more-effective treatments may be available to you; you may also be able to use these other treatments in conjunction with LLLT to enhance your results.

Combined therapy makes sense, as you may get complementary benefits from the different approaches, and one type of therapy may enhance the other.

Dermatologists are specifically trained in the diagnosis and treatment of hair loss, so consider starting with them. Check out www.aad.org for a list of dermatologists. Head to www.ishrs.org to find doctors who specialize in the surgical treatment of hair loss and who also have knowledge of LLLT treatments.

LLLT systems available in the doctor’s office involve the patient sitting under the machine, an experience similar to sitting under a hair dryer at the hair salon. The advantages of having laser done in the office include the following:

  • The lasers are stronger.
  • You get a precise amount of laser delivered each time.
  • It’s less stressful than trying to do it yourself.
  • Results are better-monitored over time by a doctor.

The disadvantages of the office-based system are

  • You have to leave home to have it done.
  • You have to make multiple trips to the office.
  • It’s much more expensive than doing it yourself.

Treatments are generally administered two or three times per week for 6 weeks and then once a week for the next 16 weeks. After observable hair growth occurs, periodic touch-ups may be needed to maintain the benefits of the treatment. Each treatment session takes approximately 20 minutes.

The doctor’s office based systems generally price the service for a three or six month course of therapy with up to three visits per week at a cost of a few thousand dollars.

As of this writing, the in-office systems have been issued an accession number by the FDA, meaning the products are classified as cosmetic products and have met the international laser standards for safety. However, they’re not yet FDA cleared for hair growth because scientific proof is lacking.

Manufacturers of the devices claim that studies with this type of machine have shown an 85 percent success rate in halting the progression of hair loss and up to a 39 percent increase in fullness, but again, scientific studies are lacking to confirm this.

Office-based treatments come in two varieties: a system with fixed diodes and a system with moving diodes.

In the fixed or static system, approximately 100 diodes (an electrical device which has two wires leading into them to produce a flow of electricity, in one side and out the other), each emitting light at a wavelength of about 650mn, are set into an apparatus that sits over the person’s head.

The moving-diode system utilizes Rotational Phototherapy (RPT), in which 30 laser diodes rotate 180 degrees around the scalp. This process supposedly increases the contact of the laser energy with the hair follicles around the entire scalp and is potentially more effective in stimulating hair growth than other types of lasers.

The “shade covering” caused by your hair may block the laser from reaching the scalp, but in the moving diode systems, a new position assures more laser penetration through the hair and into the scalp.

Doing It Yourself: Hand-held Home-use Lasers

You may be interested in trying out an LLLT device, but aren’t willing to put out the time and effort, not to mention the cash, to do LLT in a doctor’s office.

There are now handheld home use lasers that might work for you if this is a therapy you’d like to try but don’t feel like making a heavy time commitment.

Don’t count on saving much cash, though; home use handheld LLLTs cost around $300–$500, not a small chunk of change but less than the several thousand you’d spend for in office treatment.

The advantages of the hand-held system are:

  • It’s much cheaper and more convenient than driving to the doctor’s office.
  • The handheld system, which can part your hair to reach your scalp, may allow the laser to better reach your scalp if you still have quite a bit of hair.

The major disadvantages of the handheld device are

  • You may get tired of doing treatments several times a week, or forget to do it.
  • You may have a hard time judging whether the treatments are working or when to stop them.

Some handheld products emit low level laser when held over your head; theoretically using a comb may deliver the therapy more directly to the scalp. Another handheld system delivers the laser light through multiple clear plastic tips on the end of the instrument that are in direct contact with the scalp.

With this system, 15 separate points of laser light irradiate the scalp. In addition, the floating laser heads of this instrument ensure that the laser light channels conform to the shape of

the scalp and head. This direct contact is the main differentiating feature between this machine and the laser comb.

Two of the more popular handheld laser combs are the HairMax LaserComb, which was FDA-cleared (see chapter 18 for information on the difference between FDA clearance and FDA approval) to promote hair growth in men with certain types of male pattern

balding, and the X-5 hair laser, which conforms to the scalp arch and delivers energy directly at the scalp level after the hair is separated by the prongs.

Although the manufacturers recommend use of the handheld home devices three times a week, it’s not clear what frequency of use is effective, since no evidence has been presented to show the value of either the frequency or the duration of the laser application.

Most of the home use lasers emit a beep to let you know when it’s time to move the device to another part of your hair, so you don’t laser one area for too long.

In the one reported study of the handheld LaserComb, 93 percent of the participants (ages 30 to 60) had an increase in the number of terminal (thick) hairs. In the treatment group, the average number of terminal hairs per square centimeter increased by 19 hairs per square centimeter over a six-month period.

For the same period, the number of hairs in the control (placebo) group decreased by an average of 10.6 hairs per square centimeter, so the relative increase with the laser comb was actually 29.4 hairs per square centimeter.

The base hair counts in both groups were 125 hairs per square centimeter. (As a reference, the average non-balding person has approximately 220 hairs per square centimeter.) During the study, patients reported no serious adverse reactions.

Understanding the Potential Risks of LLLT

We consider handheld lasers to be safe devices that can be used for hair application. There appear to be no safety issues concerning their use and, although the current scientific studies are lack- ing, they may be beneficial for some people.

One caveat, however, may be that the long term use of LLLT devices for hair loss hasn’t been adequately studied, and that long term side effects could show up in the future.

Because some LLLT devices for hair loss have been cleared by the FDA, many people feel that they must be safe and effective.

However, FDA clearance and FDA approval are different things (see chapter 18 for more discussion on the FDA’s involvement with hair care products).

Obtaining FDA approval is a far more stringent process, with clinical trials required to prove that the drug or device is both safe and effective.

Backing up medical claims

Devices intended for cosmetic use don’t generally require FDA clearance or approval. However, one device, called the LaserComb did require FDA clearance because it made a medical claim, that it would promote hair growth in males with certain types of balding.

To obtain FDA clearance, the company had to submit both safety and effectiveness data. The effectiveness data was obtained from a multicenter, randomized, placebo- controlled trial conducted at four sites in the U.S. FDA approval requires a much more rigorous process.

In this study, participants used the laser comb or a “sham” (placebo type) device three times a week for six months. In fact, a major limitation of this study is that the treatment period was only six months with relatively infrequent use, so that the long- term results and safety issues are unknown.

Another problem was that the studies don’t appear to have been double blinded (in a double blinded study, the doctors and patients involved don’t know who’s getting the sham treatment and who’s getting the laser treatment) and it’s not clear whether the participants may have agreed not to use other treatment modalities, so there’s the additional problem of potential biases in the measurement of mean terminal hair density; in other words, the doctor’s doing the assessing may have found more hair in the patients who got the actual treatment because they expected to.