Introduction:
Around 50% of men and 30% of women will experience hair loss in their life. Testosterone converting to DHT in the scalp is a major contributor to hair loss for men, however many other underlying medical issues such as vitamin deficiencies, gut problems, stress and major illness can also lead to hair loss. For further information, read Hair Loss.
Therapies for hair loss in mainstream medical practice include finasteride in men, minoxidil in both men and women and laser light therapy followed by more invasive procedures such as PRP injections and hair transplants.
Light therapy involves using a red light device, same as is used for collagen growth, on the scalp for 20-30 minutes, three times per week. This has been associated with up to 30% improvement in hair density in averaged populations.
Summary
Studies show an increase in terminal hair density
The effect of LLLT on hair growth, when used three times per week, over 26 weeks was comparable to minoxidil and finasteride
Light therapy is recommended prior to starting minoxidil as it may reduce initial hair shedding associated with use of minoxidil
There is no research regarding the use of light therapy to grow hair on any other part of the body and such treatments are experimental; for example, beards.
Light therapy would be a lifelong treatment for the prevention of hair loss however patients will often opt to trial the light before committing to longer periods of use.
Introduction
Multiple commercial laser light devices exist for scalp hair regrowth, however beard regrowth using laser has not been extensively studied. Facial lasers for collagen remodelling are in wide use however no combination device exists for a user to have both a beard and hair laser device in one sitting. Laser therapy has an excellent safety profile and is well tolerated.
Ideally, this device has multiple colours on the facial component and has the studied parameters for hair growth on the scalp and potentially blue light for dandruff with a customised fit.
Laser/Light Therapy
Light therapy has been used in a range of medication conditions including psoriasis, wound healing, acne and collagen growth for aesthetic practitioners for several decades. Light therapy is a technique whereby visible cold laser light between 630- 670nm with low power photo stimulates targets in a tissue, leading to cellular signals stimulating enhanced activity that promote cell activity and survival.
The effect is mediated by a process of photobiomodulation which is simply how light changes cellular activity. Most devices use light 500-1100 nm wavelength and the fluencies used range from 1-10J/cm2 and the power density is around 3-90 mW/cm.
Hair grows from epithelial bulge stem cells in a repetitive cycle with defined stages called anagen, telogen and catagen with other phases noted in the growth cycle. When growth signals are interrupted or modified such as by androgens, toxicity, hormonal imbalances, inflammation then the regenerative activity of these cells decline and less hair grows. This is the cellular basis of hair loss.
The exact mechanism by which phototherapy induces hair growth is not clear however studies suggest that mitochondrial involvement and ATP, associated with changes to Nitric Oxide signaling is involved in setting a path leading to greater cellular activity. There is some overlap with how minoxidil might work in this regard (Pinar et al). Mice treated with laser therapy had less inflammatory infiltrates and inflammatory cytokines or signals in the body are implicated in hair loss diseases.
Furthermore, NAD+ infusions have been reported in a case series to lead to hair growth, perhaps underlying a similar mitochondrial energy enhancement of these two therapies.
Studies have suggested that light therapy prolongs the growth phase of a hair (called anagen) and also seems to work better at lower levels on cells under stress. In a study whereby rats were given chemotherapy to induce hair loss, rats using LLLT experienced hair regrowth 5 days earlier. Laser therapy has also been shown to cause stronger hair and a report of thicker feeling hair and shine amongst study participants.
Most studies presently focus on light therapy 635-650nm wavelength however very few infrared (810nm) have been studied; infrared can penetrate deeper than red wavelength. Commercial devices tend to be in that range and recommend three times per week for 20-30 minutes.
For scalp hair growth, a handheld or comb device has been shown to significantly increase hair counts. Current consensus suggests using the device for 30 minutes, 3 times per week.
The procedure involves remaining under a laser light helmet or device for 30-60 minutes several times a week. Most people describe the procedure as comfortable and apart from immobility and a slight feeling of heat, there are few side effects. Many patients will elect to purchase their own laser whilst others will rent or use a clinic laser for a period of time and monitor the effect before committing to buy one. It is suggested to use the laser therapy in conjunction with other forms of treatment.
There is some debate on whether a device needs to have lasers (more focused or coherent light) or LED is sufficient. There is insufficient data to support a laser predominate device and doubt has been cast on manufacturer claims that only lasers penetrate to a useful depth. Most devices contain LEDs for coverage and cost reasons and there is proof that they work at least compared with placebo.
Finally, beard growth has not been extensively studied. Beard hair is thicker, grows slower than scalp hair and has different characteristics. Minoxidil and microneedling treatments have been reported to improve beard growth and are currently widely marketed. Laser therapy has not been trialled for beard growth.
The causes of poor beard growth are not clearly established however would be different to the scalp as testosterone and DHT enhance beard growth. Interestingly, most men with poor beard growth have normal testosterone. It remains to be seen if the general growth promoting effects described for laser therapy on both male and female hair would apply to beard growth however a sufficient market exists for it, it is safe, it would not be of added inconvenience for somebody already wearing a scalp mask and a device itself would assist clinical trials.
References
Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers Surg Med. 2014;46(2):144-151. doi:10.1002/lsm.22170
Donovan et al (2017) Treatment of androgenetic alopecia in men. In M Hordinsky (Ed.), Up To Date. Retrieved February 2019 from
https://www.uptodate.com/contents/treatment-of-androgenetic-alopecia-in-men
Jimenez et al (2014) Efficacy and Safety of a Low-level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-controlled, Double-blind Study. Am J Clin Dermatol (2014) 15:115–127 DOI 10.1007/s40257-013-0060-6
Heiskanen V, Hamblin MR. Photobiomodulation: lasers vs. light emitting diodes? [published correction appears in Photochem Photobiol Sci. 2018 Oct 31;:]. Photochem Photobiol Sci. 2018;17(8):1003–1017.
Erin M. Dodd, Margo A. Winter, Maria K. Hordinsky, Neil S. Sadick & Ronda S. Farah (2018) Photobiomodulation therapy for androgenetic alopecia: A clinician’s guide to home-use devices cleared by the Federal Drug Administration, Journal of Cosmetic and Laser Therapy, 20:3, 159-167.
Gupta 2018) Gupta, A. , Mays, R. , Dotzert, M. , Versteeg, S. , Shear, N. and Piguet, V. (2018), Efficacy of non‐surgical treatments for androgenetic alopecia: a systematic review and network meta‐analysis. J Eur Acad Dermatol Venereol, 32: 2112-2125.
Miranda, B. H., Charlesworth, M. R., Tobin, D. J., Sharpe, D. T., & Randall, V. A. (2018). Androgens trigger different growth responses in genetically identical human hair follicles in organ culture that reflect their epigenetic diversity in life.
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