Low level laser for Lichen Planopilaris: Early Data

Does low level laser therapy (LLLT) help LPP?

Lasers are popular nowadays, especially as patents search for drug free alternatives. For patients with scarring alopecia, a variety of lasers are known to help. For patients with lichen planopilaris, treatment with the excimer laser has shown promising results in early studies.   In a new study, Fonda-Pascual and colleagues from Spain set out to examine the benefits of LLLT in patients with lichen planopilaris. 

The study itself was designed as a 6 month prospective interventional study and the goal was to follow the activity of the disease before and after treatment using the so called lichen planopilaris activity index (LPPAI).  Videodermoscopy was used to follow 5 specific areas for perifollcular redness and perifollicular scale and to follow hair thickness. 

The study was small with 8 patients (3 males 5 females). Patient had LPP for an average of 3-4 years (mean 44.25 months). A laser helmet based device with 246 LEDs was used (each with a wavelength of 630 nm and fluency of 4 J/cm2).

Interestingly, all patients had a reduction in symptoms, redness and scaling and there was a decrease in the LPPAI after 6 months. An increase in hair thickness was also measured. 

CONCLUSION

This is an interesting preliminary study. More studies are needed on the potential benefits of LLLT. The inflammation in LPP is generally quite high up in the skin and these laser devices only penetrate a short distance into the skin making them potentially effective agents to target the inflammation in these scarring alopecias. This research study is primarily and details about other treatments used by these 8 patients were not given.  Nevertheless, it has prompted interest in further investigations in this important area.

REFERENCE

Fonda-Pascual P, et al. Effectiveness Of Low-Level Laser Therapy In Lichen Planopilaris. J Am Acad Dermatol. 2017.

Is Low Level Laser Therapy (LLLT) Helpful For Treating Hair Loss?

Is LLLT Helpful For Treating Hair Loss?

Is low level laser therapy (LLLT) helpful for treating hair loss? To date there has been a number of studies that suggest LLLT is helpful including 5 randomized double blind studies - 2 studies with so called "laser brush/comb" devices and 3 studies with helmet/cap devices.

The photo here shows a LaserCap. This LLLT device consists of 224 ‘pure’ laser diodes (no LEDs) of 650nm/5mW each. The device is worn every second day for 30 minutes. Several hemet/cap devices now exist and are marketed as FDA cleared LLLT devices.
 

What's special about red light in promoting hair growth?

This perfect rainbow reminds us all that light is made up of many different wavelengths ranging from 400 nm to 700. Wavelengths around 650 nm produce red light.

Like many things in medicine, the use red light for hair growth came by chance. In the late 1960s, Dr Endre Mester, a Hungarian physician was studying whether a 694 nm ruby laser would cause cancer in mice. To his surprise, the laser did not cause cancer but rather dramatically stimulated hair growth!

It remains unclear exactly how red light stimulates hair growth. It appears that red light stimulates tiny organelles inside cells called mitochondria. A specific molecule known as cytochrome C oxidase (which is part of the mitochondria's cellular respiratory chain) has been proposed to be a key receptor molecule to absorb the red light and start the entire process.

To date, there have been 5 randomized double blind controlled trials studying the use of red light low level laser treatment (at 655 nm) for individuals with androgenetic alopecia. These include 2 studies with a laser "comb" device and 3 with a laser "helmet/cap" device. All studies showed improvement by 16-26 weeks compared to a placebo (sham) device.

There are many unanswered questions about using low level laser therapy. Which device is best? Is 655 nm really the best wavelength? Is the current 3 times per week really the best? Are laser combs better than laser helmets or are helmets better than combs? These are all unknown at present.