Letters to Editor
Low‑level Laser Therapy for Androgenic Alopecia
Sir, We would like to discuss on the report on “low‑level laser therapy for androgenic alopecia.[1]” Munck et al. have reported that “low‑level laser therapy (LLLT) represents a potentially effective treatment for both male and female androgenetic alopecia, either as monotherapy or concomitant therapy.[1]” In fact, it is no doubt that LLLT is useful alopecia treatment. Nevertheless, there are issued to further study. Avci et al. noted that “the optimum wavelength, coherence and dosimetric parameters remain to be determined.[2]” In addition, as noted by Gupta and Daigle,[3] it is still requires for further good trial to conclude for the exact non bias result of LLLT. In available studies, including to the present report by Munck et al.,[1] “power, confounding and analysis issues” are the common weak points. According to the above commentary, the primary authors’ responds in each topic will be further detailed. Regarding dosimetry, it is impossible to utilize pharmacokinetic information with topical agents to arrive at the exact clinical dosage of an “active.” Therefore, it has become generally accepted, based on references in the scientific literature that Lower Level Laser Treatment with wavelengths between 630 and 670 nm, is “thought to induce proliferative activity in hair follicles resulting in terminalitzation of vellus hair follicles”.[4] That is why 655 nm which is in between the above mentioned recognized wavelengths, has become the “gold standard” used in clinical studies to test for efficacy, based primarily on the objective measurement of hair density, and secondarily on global outcomes as judged by experts in the field. Regarding efficacy, this quote was contained in the already mentioned sentence, “in addition as noticed by Gupta and Daigle,[3] it is still requires for further good trial to conclude for the exact non‑bias result of LLLT” Unfortunately the article by Gupta and Daigle[3] was written and submitted before publication occurred describing the comprehensive and definitive clinical study by Jimenez et al.[5] Therefore, it is understandable why they reached their conclusion. [3] The mentioned article of Jimenez et al.[5] is the most comprehensive one published to date in a peer‑review journal and validates the use of 655 nm to achieve significant efficacy. This is
International Journal of Trichology / Oct-Dec 2014 / Vol-6 / Issue-4
the conclusion that Jimenez et al. reached, “we observed a statistically significant difference in the increase in terminal hair density between lasercomb and sham treated subjects¼ our results suggest that low‑level laser treatment may be an effective option to treat pattern hair loss in both men and women.[5]” The present study by Munck et al.[1] at least involved global evaluation which is also a key measurement of the visible changes in hair density and the results closely paralleled the results found in the 4 objective studies.
Sim Sai Tin, Viroj Wiwanitkit1 Medical Center, Shantou, 1Hainan Medical University, Haikou, China Address for correspondence: Prof. Sim Sai Tin, Medical Center, Shantou, China. E‑mail: [email protected] REFERENCES 1. Munck A, Gavazzoni MF, Trüeb RM. Use of low‑level laser therapy as monotherapy or concomitant therapy for male and female androgenetic alopecia. Int J Trichology 2014;6:45‑9. 2. 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;46:144‑51. 3. Gupta AK, Daigle D. The use of low‑level light therapy in the treatment of androgenetic alopecia and female pattern hair loss. J Dermatolog Treat 2014;25:162‑3. 4. Bernstein EF. Hair growth induced by diode laser treatment. Dermatol Surg 2005;31:584‑6. 5. Jimenez JJ, Wikramanayake TC, Bergfeld W, Hordinsky M, Hickman JG, Hamblin MR, et al. 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;15:115‑27. Access this article online Quick Response Code www.ijtrichology.com
DOI: 10.4103/0974-7753.142892
189
Copyright of International Journal of Trichology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Low‑level Laser Therapy for Androgenic Alopecia
Sir, We would like to discuss on the report on “low‑level laser therapy for androgenic alopecia.[1]” Munck et al. have reported that “low‑level laser therapy (LLLT) represents a potentially effective treatment for both male and female androgenetic alopecia, either as monotherapy or concomitant therapy.[1]” In fact, it is no doubt that LLLT is useful alopecia treatment. Nevertheless, there are issued to further study. Avci et al. noted that “the optimum wavelength, coherence and dosimetric parameters remain to be determined.[2]” In addition, as noted by Gupta and Daigle,[3] it is still requires for further good trial to conclude for the exact non bias result of LLLT. In available studies, including to the present report by Munck et al.,[1] “power, confounding and analysis issues” are the common weak points. According to the above commentary, the primary authors’ responds in each topic will be further detailed. Regarding dosimetry, it is impossible to utilize pharmacokinetic information with topical agents to arrive at the exact clinical dosage of an “active.” Therefore, it has become generally accepted, based on references in the scientific literature that Lower Level Laser Treatment with wavelengths between 630 and 670 nm, is “thought to induce proliferative activity in hair follicles resulting in terminalitzation of vellus hair follicles”.[4] That is why 655 nm which is in between the above mentioned recognized wavelengths, has become the “gold standard” used in clinical studies to test for efficacy, based primarily on the objective measurement of hair density, and secondarily on global outcomes as judged by experts in the field. Regarding efficacy, this quote was contained in the already mentioned sentence, “in addition as noticed by Gupta and Daigle,[3] it is still requires for further good trial to conclude for the exact non‑bias result of LLLT” Unfortunately the article by Gupta and Daigle[3] was written and submitted before publication occurred describing the comprehensive and definitive clinical study by Jimenez et al.[5] Therefore, it is understandable why they reached their conclusion. [3] The mentioned article of Jimenez et al.[5] is the most comprehensive one published to date in a peer‑review journal and validates the use of 655 nm to achieve significant efficacy. This is
International Journal of Trichology / Oct-Dec 2014 / Vol-6 / Issue-4
the conclusion that Jimenez et al. reached, “we observed a statistically significant difference in the increase in terminal hair density between lasercomb and sham treated subjects¼ our results suggest that low‑level laser treatment may be an effective option to treat pattern hair loss in both men and women.[5]” The present study by Munck et al.[1] at least involved global evaluation which is also a key measurement of the visible changes in hair density and the results closely paralleled the results found in the 4 objective studies.
Sim Sai Tin, Viroj Wiwanitkit1 Medical Center, Shantou, 1Hainan Medical University, Haikou, China Address for correspondence: Prof. Sim Sai Tin, Medical Center, Shantou, China. E‑mail: [email protected] REFERENCES 1. Munck A, Gavazzoni MF, Trüeb RM. Use of low‑level laser therapy as monotherapy or concomitant therapy for male and female androgenetic alopecia. Int J Trichology 2014;6:45‑9. 2. 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;46:144‑51. 3. Gupta AK, Daigle D. The use of low‑level light therapy in the treatment of androgenetic alopecia and female pattern hair loss. J Dermatolog Treat 2014;25:162‑3. 4. Bernstein EF. Hair growth induced by diode laser treatment. Dermatol Surg 2005;31:584‑6. 5. Jimenez JJ, Wikramanayake TC, Bergfeld W, Hordinsky M, Hickman JG, Hamblin MR, et al. 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;15:115‑27. Access this article online Quick Response Code www.ijtrichology.com
DOI: 10.4103/0974-7753.142892
189
Copyright of International Journal of Trichology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
