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Could Low Level Laser Light Help Lichen Planopilaris or Frontal Fibrosing Alopecia?

Tuesday, 17 July 2018

About four years ago whilst at a research meeting in Miami I heard about an American dermatologist treating patients with scarring hair loss and inflammatory scalp conditions with low level laser light (LLLT). These are home use or salon based devices that are predominantly used for male and female pattern age related thinning. They have been around for more than a decade now and whilst the evidence isn’t as strong as minoxidil and finasteride, they do seem to help pattern hair loss for the majority of patients. But what about scarring and inflammatory conditions? Well up until now it had just be this anecdotal experience but in May’s Journal of the American Academy of Dermatology we have the first case series of this technology in Lichen Planopilaris (LPP) Low level laser light in Lichen Planopilaris

This is a very small study with 8 patients with LPP. They used the validated activity score LPPAI and 5 fixed points to take measurements of the hair and record inflammation and markers of the condition. In this study they used a red laser light device 630nm with 246 lights every day for 15 minutes. After 6 months of use all patients had responded with an average decrease from 3.35 to 0.86. This is very encouraging as LLLT is seen as very safe, avoids taking any drugs with potential side effects and also has the benefit of thickening normal hair which can help disguise areas of loss. I have lots of patients who struggle with medications, or have limited benefit with them and I am sure this will be of interest.

It is very early days. It is a small study with no control group and the study time is relatively short. The actual device the study used is not available in the UK. Devices with 240 diodes are usually very expensive in the £2-3000. An alternative option is to use something like the Hairmax82 

I questioned the practicality of this style of device when it came out as most of the competitors were developing cap or helmet shaped devices. However, when I’ve discussed devices with manufacturers many stand by their more expensive devices (with 200-300 diodes) as being the most effective and offer a cheaper one (60-80 diodes) to have an offering at a lower price point. By simply moving the band type Hairmax82 back in 3 positions you can achieve the same effect for 1/3 of the price or if you just have Frontal Fibrosing Alopecia, you could use on the frontal band of hair loss where the condition is active.

In recent years, I’ve also got a number of patients to trial minoxidil whilst treating their FFA to thicken existing hair and help camouflage the loss. In theory, this device would do both. What we don’t know is how best to use this device in LPP. Is it daily and does it need longer than the 90 secs in each area that is recommended with the Hairmax82? I expect daily use for a slightly prolonged period may be necessary.

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