role of lllt in androgenetic alopecia
DESCRIPTION
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.TRANSCRIPT
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
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
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)
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
Androgenetic Alopecia
96%
4%
HAIR LOSS CAUSES
AGA Other
! Hereditary : ♀♂
! Androgen Receptors
! Progressive
! Patterned hair follicle miniaturization
! Shorter/Finer/Thinner/Less Pigmented
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
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
near infrared light extracellular matrix deposi4on growth factor produc4on
cell prolifera4on & mo4lity an4-‐apoptosis and pro-‐survival
Gene transcrip4on signaling
-‐ M. Hamblin
FDA 510(k) Clearances
! “...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.”
#K060305, Jan. 18th 2007 650nm male AGA HairMax LaserComb 9 x 5mW at-‐home Lexington Int’l, LLC
#K091496, Nov. 13th 2009 650nm female AGA MEP90 82 x 5mW in-‐office Midwest RF prescription
FDA 510(k) Clearances (con’t)
! “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
FDA 510(k): #K091496, Nov 13, 2009 Device: MEP90 Hair Growth Stimulation System Manufacturer: Midwest RF
LLLT Dosing Strategy ! Wavelength
! 635-‐670nm
! Total Power ! # diodes x output (mW)
! Treatment Area
! Duration (min)
! Interval – too short v. too long
! Protocol: Device Dependent
Tuner J, Hode L, Laser Therapy Handbook (2004) Prima Books.
Biphasic Dose Response
LLLT & Hair
Cosmetic Devices ! 650 nm
! 5mW X 224 Diodes
! 80% Duty Cycle
! 30 Minutes
! Hands-‐Free
! Rechargeable/Cordless
! Significant coverage
! High compliance LaserCap™
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?”
Densitometry – Canfield Scientific
LaserCap Results:
Laser Therapy in Females 25 y/o female
In-‐office Laser Hood
2 / week x 6 months
LLLT x 8 months
63 y/o female
Laser Therapy regimen: 3x/wk x 3 mo
1-‐2x/wk since
Photos after 12mo.
6 Months: At-‐Home LLLT
24 y/o Female: 3 mos. of LLLT
Male Patient : LLLT x 6 mos
Male Patient: LLLT x 12 mos
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.
References (con’t)
Bauman Medical Group
THANK YOU! [email protected]
www.twitter.com/DrAlanBauman www.linkedin/in/alanjbauman