Fractional photothermolysis laser treatment of male pattern hair loss

Progress of clinical research on fractional laser treatment of androgenetic alopecia: A review article

BACKGROUND

Androgenetic alopecia (AGA) is a prevalent form of hair loss that affects both men and women, severely impacting patients' quality of life. Traditional treatments include oral medications, topical medications, and hair transplantation, but these methods have certain side effects and limitations. How to safely effectively and maximally promote hair growth has been a key issue in the treatment of AGA. In recent years, fractionated laser therapy, as a noninvasive method, has gradually gained attention due to its minimally invasive and highly effective nature.

AIMS

In this paper, we summarized the studies related to fractional laser treatment of AGA in the past 15 years, and discussed its therapeutic mechanism, clinical effect, future development direction, and advantages and disadvantages compared with traditional treatment methods in the treatment of AGA.

METHODS

An extensive literature search was conducted using PubMed, Google, Google Scholar, Embase, and Scopus. All available articles studying fractional laser treatment of AGA were compiled in March 2024. Titles and abstracts were then screened for relevance and thoroughly examined for patient clinical outcomes. Prospective clinical trials, retrospective chart reviews, case series, and individual case reports were included in the literature review.

CONCLUSIONS

Fractional laser treatment of AGA showed remarkable efficacy and high safety. Compared with traditional treatments, fractional laser has the advantages of minimally invasive, quick recovery, fewer side effects, and a wide range of population applicability, providing an effective treatment option for AGA patients. Further large-scale clinical studies will help optimize the laser parameters and treatment settings to improve the therapeutic effect.

Investigator-blinded, controlled, and randomized comparative study on 1565 nm non-ablative fractional laser versus 5% minoxidil for treatment of androgenetic alopecia

BACKGROUND

Characterized by progressive hair loss due to an excessive response to androgens, androgenetic alopecia (AGA) affects up to 50% of males and females. Minoxidil is one of approved medications for AGA but inadequate responses occur in many patients.

AIMS

To determine whether 1565 nm non-ablative fractional laser (NAFL) could yield better therapeutic benefits for patients with AGA as compared with 5% minoxidil.

METHODS

Thirty patients with AGA were enrolled; they were randomly assigned into the laser or minoxidil treatment groups. For the laser treatment group, patients were treated by 1565 nm NAFL at 10 mJ, 250 spots/cm2 with 2 weeks intervals for 4 sessions in total. For the minoxidil treatment group, 1-milliliter of topical 5% minoxidil solution was applied to hair loss area twice a day.

RESULTS

The primary outcomes were the changes in numerous hair growth indexes at the Week 10 as compared with the baselines. Both 1565 nm NAFL and 5% minoxidil led to significantly greater hair densities and diameters in patients at the Week 10 than the baselines (p < 0.01). As compared with 5% minoxidil, 1565 nm NAFL showed significantly greater improvements in total hair number, total hair density (hair/cm2), terminal hair number, terminal hair density (hair/cm2), number of hair follicle units, and average hair number/number of hair follicle units.

CONCLUSIONS

Our data demonstrate that 1565 nm NAFL exhibits superior clinical efficacy in some aspects of hair growth to the topical minoxidil. It is a safe and effective modality in treating AGA.

Lasers in the management of alopecia: a review of established therapies and advances in treatment

Alopecia, also known as hair loss, is a highly prevalent condition affecting millions of men and women in the United States and worldwide, making it one of the most common complaints by patients presenting to a dermatologist. The symptomology on the presentation of alopecia can be highly variable, ranging from diffuse thinning of hair, discrete and localized patches completely absent of hair, or noticing significant shedding when brushing and showering. Although alopecia does not have a direct negative health impact on patients, it is nonetheless a debilitating disease as it can profoundly impact an individual's self-image and psychosocial well-being. There are multiple treatment options available to patients with alopecia, and they are typically tailored to the patient's needs and preferences. The most common of these is the Food and Drug Administration-approved drugs for alopecia, minoxidil, and finasteride. However, both of these are known to be partially efficacious for all patients, so clinicians often use different modalities in conjunction with them, in particular laser-based therapies. This review article will provide a comprehensive assessment of lasers and other light therapies that may be used to manage the two most common types of alopecia: androgenetic alopecia and alopecia areata.

What Do We Know About Hair Growth Induced by Wounding and Its Therapeutic Applications?

BACKGROUND

Many studies have reported the role of hair follicles (HFs) in the wound healing response, and vice versa, the creation of superficial injuries may stimulate hair growth, which has encouraged new treatments for hair loss.

OBJECTIVE

To review the phenomenon of wound-induced hair growth and the usefulness of therapeutic procedures based on skin wounding in androgenetic alopecia (AGA).

METHODS

A literature search was conducted to review cases of localized hypertrichosis induced by wounds and the role of microneedling, fractional laser, and scalp threading as monotherapy for AGA.

RESULTS

Localized hypertrichosis has been extensively reported after bone fractures, burn injury, chronic venous ulcer, etc. Only 2 cases of wound-induced hair neogenesis in humans have been reported. As monotherapy for AGA, 1 of 3 studies of microneedling, 4 of 6 of fractional lasers, and 2 of 3 studies of scalp threading show good efficacy.

CONCLUSION

Certain types of wounds seem to stimulate localized hair growth in humans, but the underlying mechanism is unclear. Reports on wound-induced HF neogenesis in humans are anecdotal and questions remain as to whether this is a true phenomenon in humans. Further clinical studies are needed before recommending wound-induced hair growth procedures as therapies for AGA.

Combination therapy in female pattern hair loss

Patterned hair loss is a common type of non-scarring alopecia, characterized by miniaturization of hair follicles. The etiology of female pattern hair loss (FPHL) is not clearly linked to androgens or other hormones thereby making it a challenging condition to treat. Various treatment modalities, like minoxidil (topical or oral), spironolactone, finasteride, have been tried alone or in combination with variable results. Combination therapy is superior to the monotherapy, since these multiple treatment modalities act by targeting different pathogenetic pathways, making the treatment aggressive and more effective.

Effect of fractional laser alone or in combination on alopecia areata: A systematic review and meta-analysis

BACKGROUND

Alopecia areata (AA) is characterized by limited non-scarring patchy alopecia, which appears as round or oval patches and is prone to recurrence, causing severe psychological burdens to patients. No specific device has been approved by the FDA for the treatment of baldness, but new treatments are being investigated and treatments such as the excimer laser, He- Ne laser, and excimer lamp have been proposed. A growing number of studies have found that fractional lasers also have great potential in the treatment of AA.

METHODS

A literature search and meta-analysis using Review Manager 5.4 software to investigate the efficacy of fractional laser treatment for AA.

RESULTS

Fractional laser combined with minoxidil (RR 1.32, 95% CI 1.17-1.49, p < 0.00001) or cortisol (RR 1.39, 95% CI 1.15-1.67, p = 0.00006) was more effective than either drug alone in the treatment of AA. Of course, the fractional laser alone was also effective in the treatment of AA (RR 10.33, 95% CI 2.07-51.36, p = 0.004) and more effective than cortisol alone (RR 1.86, 95% CI 1.36-2.52, p < 0.00001), and there was no effect on the occurrence of adverse effects (p = 0.49 > 0.05). When compared to other physical treatments of a comparable kind, fractional laser therapy's effectiveness was not significantly different (p = 0.15 > 0.05).

CONCLUSION

Our results show that the use of fractional lasers can effectively treat alopecia areata.

The efficacy and safety of fractional lasers for alopecia in mono and adjunctive therapy: A systematic review and meta-analysis

BACKGROUND

Hair loss is affecting over half of the population worldwide, leading to noticeable psychotic disorders in a considerable proportion of patients. The current treatments remain unpredictable and disappointing.

OBJECTIVE

This study aimed to evaluate the efficacy and safety of fractional lasers compared with other conventional treatments as either mono or combined therapy in the treatment of alopecia.

METHODS

We have conducted a thorough literature search in PubMed, Web of Science, Embase, Cochrane library, and China national knowledge infrastructure databases (from inception to February 9, 2022). Relevant clinical trials, mainly randomized controlled trials, were included, regardless of their comparisons. The Cochrane risk of bias assessment was used for quality appraisal. Outcomes were evaluated by efficiency rate, hair density, etc. RESULTS: Thirteen controlled clinical trials, including nine randomized controlled trials, with 606 patients were retrieved. As an individual therapy, the fractional laser is superior to any other therapy in total efficiency (RR = 1.58, 95% CI: 1.16-2.14, p = 0.003). When the fractional laser was applied in combined treatments, the result showed a significant difference (RR = 1.23, 95%CI: 1.02 to 1.49, P = 0.03) compared with other treatments. Although both mono and adjunctive groups were confirmed to be efficient, there were no statistical differences between the two of them (RR = 1.24, 95% CI: 0.87-1.77, p = 0.24).

CONCLUSION

Our results showed that the fractional laser has a significant efficacy as either mono or adjuvant therapy. Further research and exploration of fractional lasers with larger sample sizes are required to confirm the efficiency and safety of this treatment.

Photobiomodulation Therapy With Different Wavebands for Hair Loss: A Systematic Review and Meta-Analysis

BACKGROUND

Photobiomodulation is a promising therapy for hair loss with negligible side effects. However, the reported effects of photobiomodulation therapy for hair loss are inconsistent.

OBJECTIVE

To assess the curative effect of photobiomodulation therapy for the treatment of hair loss.

METHODS

A systematic review of self-controlled studies and randomized controlled trials was conducted. ScienceDirect, PubMed, and Wiley Online Library were searched from the earliest date to May 30, 2021.

RESULTS

Thirty-six studies (966 patients) were included. Two to 4 meta-analyses with different indices were performed separately on 4 groups of studies to test the effectiveness of the following hair loss treatments: ultraviolet light for alopecia areata (AA), red light for androgenetic alopecia (AGA), infrared light for AA, and infrared light for AGA. All meta-analyses showed that treatments were superior to control ( p < .05).

CONCLUSION

The meta-analyses strongly suggested that photobiomodulation therapies with ultraviolet and infrared light were effective for treating AA, and photobiomodulation therapies with red light and infrared light were effective for treating AGA.

A study to assess the efficacy of fractional carbon dioxide laser with topical platelet-rich plasma in the treatment of androgenetic alopecia

Owing to the inadequate response to and limitations of the approved medications for androgenetic alopecia, novel therapies are warranted to enhance outcomes. The objective of this paper is to ascertain the effectiveness of fractional carbon dioxide laser followed by platelet-rich plasma application on hair regrowth and to compare the two laser settings. Seven participants were enrolled in this half-head pilot study based on different laser pulse energy and density values (12 mJ, 800 spots/cm² and 22 mJ, 400 spots/cm²). Ten treatment sessions were performed every 2 weeks with 12-week follow-up. The evaluation methods were based on hair density from standardized phototrichograms, global photographic assessment, and patient satisfaction. Significantly increased total and terminal hair densities were observed during treatment in both groups as compared with baselines. The mean total hair density has weekly increased significantly with high pulse energy (1.42 hair/cm²) as compared to low pulse energy (1.04 hair/cm²) throughout the study period (p = 0.023; 4.89 hair/cm²). Global photographs and patient satisfaction scores demonstrated improvement, but only the latter showed statistical significance (p = 0.029). The average pain intensity scores were not different between the groups (p = 0.760) all over the procedure. The adverse events were minor and well tolerated. This synergistic treatment remarkably leads to hair restoration and high patient satisfaction. The parameters of 22-mJ beam energy with 400 spots/cm² density are appropriate and superior to 12-mJ beam energy with 800 spots/cm². Albeit higher energy, no more pain is indicated in the high pulse energy group. Trial registration number (TRN): TCTR20180619004, Thai Clinical Trials Registry (TCTR) since 2018-05-15 13:39:48.

Non-ablative Er:YAG laser is an effective tool in the treatment arsenal of androgenetic alopecia

Background

Up to 70% of the adult population worldwide is affected by androgenetic alopecia (AGA) hair loss. Laser therapy offers an addition or alternative to pharmaceutical and surgical treatment of hair regrowth, with non‐ablative lasers being preferred over ablative lasers in terms of safety and downtime. Combining laser therapy with different topical agents may result in better hair regrowth.

Objective

The aim was to evaluate the effectiveness and safety of non‐ablative Er:YAG laser used in clinical practice, alone or in combination with other treatment modalities, in patients with both early and advanced stages of AGA.

Methods and patients

Sixteen patients (7 male and 9 female) with active AGA in different stages were treated with the non‐ablative Er:YAG laser (SMOOTH^TM mode, 7 mm spot size, 7.00 J/cm² pulse fluence, 3.3 Hz frequency) as a monotherapy or in combination with injections of platelet‐rich plasma (PRP) to the scalp, topical minoxidil, and oral supplements for the promotion and support of hair growth. Efficacy was assessed with clinical assessment of AGA grade (Ludwig scale for female / Norwood‐Hamilton scale for male) and with blind evaluation of hair quality in global photographs before and after treatment. Patients subjectively rated their satisfaction with the laser treatment on a scale from 0–3 and pain on a VAS scale from 0–10.

Results

AGA grade after treatment was lower compared to baseline (p = 0.015 and p = 0.125 in female and male patients, respectively). Blind evaluation indicated an improvement in hair quality in 93% of patients, either being described as much better (14%) or as better (79%), which was not correlated with age or AGA grade. The median satisfaction score was 3, and the median VAS score for pain was 2. The positive effect of the treatment on the hair quality is ongoing. No adverse reactions were reported.

Conclusions

The treatment was effective in treating AGA, confirmed by a decrease in AGA grade and by blinded evaluation of global photographs. Although the possible additive or complementary effect of topical minoxidil or nutraceuticals cannot be excluded, our results suggest that the non‐ablative Er:YAG laser SMOOTH^™ mode as a monotherapy, or in combination with PRP, is an efficient and safe treatment for AGA—with a high satisfaction rate among patients regardless of patient age, AGA duration, or AGA stage.

Non-thermal plasma promotes hair growth by improving the inter-follicular macroenvironment

Non-thermal plasma (NTP) is widely used in the disinfection and surface modification of biomaterials. NTP treatment can regenerate and improve skin function; however, its effectiveness on hair follicle (HF) growth and its underlying mechanisms need to be elucidated. Herein, we propose an air-based NTP treatment, which generates exogenous nitric oxide (eNO), as a therapeutic strategy for hair growth. The topical application of air-based NTP generates large amounts of eNO, which can be directly detected using a microelectrode NO sensor, in the dermis of mouse dorsal skin. Additionally, NTP-induced eNO has no cytotoxicity in normal human skin cells and promotes hair growth by increasing capillary tube formation, cellular proliferation, and hair/angiogenesis-related protein expression. Furthermore, NTP treatment promotes hair growth with adipogenesis and activation of CD34⁺CD44⁺ stem cells and improves the inter-follicular macroenvironment via increased perifollicular vascularity in the mouse hair regrowth model. Given the importance of the hair follicle (HF) cycle ratio (growth vs. regression vs. resting) in diagnosing alopecia, NTP treatment upregulates the stem cell activity of the HF to promote the anagen : catagen : telogen ratio, leading to improved hair growth. We confirmed the upregulation of increasing Wnt/β-catenin signaling and activation of perifollicular adipose tissue and angiogenesis in HF regeneration. In conclusion, these results show that the eNO from NTP enhances the cellular activities of human skin cells and endothelial cells in vitro and stem cells in vivo, thereby increasing angiogenesis, adipogenesis, and hair growth in the skin dermis. Furthermore, the results of this study suggest that NTP treatment may be a highly efficient alternative in regenerative medicine for achieving enhanced hair growth.

Non-thermal plasma (NTP) is widely used in the disinfection and surface modification of biomaterials.

A systematic summary of survival and death signalling during the life of hair follicle stem cells

Hair follicle stem cells (HFSCs) are among the most widely available resources and most frequently approved model systems used for studying adult stem cells. HFSCs are particularly useful because of their self-renewal and differentiation properties. Additionally, the cyclic growth of hair follicles is driven by HFSCs. There are high expectations for the use of HFSCs as favourable systems for studying the molecular mechanisms that contribute to HFSC identification and can be applied to hair loss therapy, such as the activation or regeneration of hair follicles, and to the generation of hair using a tissue-engineering strategy. A variety of molecules are involved in the networks that critically regulate the fate of HFSCs, such as factors in hair follicle growth and development (in the Wnt pathway, Sonic hedgehog pathway, Notch pathway, and BMP pathway), and that suppress apoptotic cues (the apoptosis pathway). Here, we review the life cycle, biomarkers and functions of HFSCs, concluding with a summary of the signalling pathways involved in HFSC fate for promoting better understanding of the pathophysiological changes in the HFSC niche. Importantly, we highlight the potential mechanisms underlying the therapeutic targets involved in pathways associated with the treatment of hair loss and other disorders of skin and hair, including alopecia, skin cancer, skin inflammation, and skin wound healing.

The Effect of Conditioned Media From Human Adipocyte-Derived Mesenchymal Stem Cells on Androgenetic Alopecia After Nonablative Fractional Laser Treatment

BACKGROUND

The conditioned media from adipocyte-derived mesenchymal stem cells-conditioned media (ADSC-CM) contains cytokines and growth factors that stimulate hair regeneration.

OBJECTIVE

We evaluated the efficacy and safety of human ADSC-CM treatment on patients who underwent nonablative fractional laser for the treatment of androgenetic alopecia (AGA).

MATERIALS AND METHODS

Thirty patients who underwent nonablative fractional laser treatment were topically administered either ADSC-CM or placebo solution. As a primary outcome, phototrichograms were taken to measure changes in hair density at each visit. In addition, global improvement scores (GISs) were compared by clinical digital photographs, which were taken at the initial and final visits, and assessed by 2 independent dermatologists. Finally, the investigator's improvement score was measured by questionnaire response during the final visit.

RESULTS

Hair density comparisons during the treatment period revealed that the ADSC-CM group had significantly higher final densities compared with the placebo group. The GIS of the ADSC-CM group was also significantly higher than the placebo group. Finally, no adverse effects associated with the application of ADSC-CM were noted during the study.

CONCLUSION

The application of ADSC-CM after nonablative fractional laser treatment accelerated increases in hair density and volume in AGA patients.

A review of the treatment of male pattern hair loss

Introduction: Androgenetic alopecia is a common hair loss disorder affecting up to 80% of males by the age of 80. It is characterized by androgen related progressive thinning of hair in a defined pattern. It results in diminished self-esteem, reduced confidence and distress in affected men, irrespective of age or stage of baldness. An effective treatment for hair baldness is needed.Areas covered: In androgenetic alopecia, hair follicles undergo progressive miniaturization. Genetic factors and androgens are key role-players in disease pathogenesis. Herein the authors review the pharmacologic treatment of androgenetic alopecia, which involves 5 alpha reductase inhibitors, minoxidil and prostaglandins. Non-pharmacologic approaches are also explored.Expert opinion: Androgenetic alopecia progresses over time and although the current available medical treatments like finasteride and minoxidil are effective in arresting the progression of the disease, they allow only partial regrowth of hair at its best. Early treatment achieves a more optimal outcome. Non-pharmacologic treatments like PRP can be considered in patients refractory to medical treatment.Abbreviations: MPHL: male pattern hair loss; AGA: androgenetic alopecia; DHT: dihydrotestosterone; 5AR: 5-alpha-reductase; VEGF: vascular endothelial growth factor; PG's: prostaglandins (PG's); PGD2R: prostaglandin D2 receptor; VPA: valproic aid; SR: Serenoa Repens; PRP: platelet-rich plasma; PDGF: platelet derived growth factor; TGF: transforming growth factor; ERK: extracellular signal-regulated kinase; PKB: protein kinase B; LLLT: low-level laser therapy; ROS: reactive oxygen species; RCT: randomized control trial; SFRP1: secreted frizzled related protein 1; DP: dermal papilla; PDE5: phosphodiesterase 5.

Laser-assisted Hair Regrowth: Fractional Laser Modalities for the Treatment of Androgenic Alopecia

Background:

A large proportion of the population is at sometime affected by androgenic alopecia. Current therapies consisting of minoxidil or finasteride are often the first choices for treatment. These regimens are limited by their efficacy, side-effect profiles, and often lengthy treatment courses. Low level laser/light has shown to be relatively effective and safe for the treatment of hair loss, and a number of products are currently available to consumers. Recently, fractional lasers have been examined as treatment options for androgenic alopecia. The mechanism of action of these minimally invasive resurfacing procedures is thought to be 2-fold. First, the microscopic injuries created by these treatments may induce a favorable wound healing environment that triggers hair growth. Alternatively, disruption of the stratum corneum allows for improved transdermal passage of well-established therapeutic drugs to the hair roots.

Methods:

A literature review was performed to evaluate the efficacy of these emerging treatments on hair regrowth.

Results:

Nine original studies examining the effect of fractional lasers on hair growth in androgenic alopecia have been reviewed.

Conclusions:

Preliminary evidence suggests that fractional laser therapies have a positive effect on hair regrowth; however, most of the literature is limited to case reports, and small prospective and retrospective series. Further studies, in the form of well-designed randomized controlled trials, are necessary to evaluate the efficacy, safety, and optimal treatment courses.

The rise of transcutaneous drug delivery for the management of alopecia: a review of existing literature and an eye towards the future

Introduction: Fractional lasers and microneedling devices are increasingly used with topical drugs to treat various conditions, including alopecia, as they grant access to dermal structures such as hair follicles and cutaneous vasculature. Objective: To perform a comprehensive review on transcutaneous drug delivery for the management of alopecia. Methods: PubMed, Embase, and Ovid Medline databases were searched using terms including: alopecia, microneedling, lasers, androgenetic alopecia (AGA), alopecia areata (AA), drug delivery. Articles were examined for inclusion criteria: diagnosis of alopecia regardless of type, use of fractional laser or microneedling devices, and subsequent administration of topical medication. Results: 8 studies, 6 prospective clinical trials and 2 case series, examining either AA or AGA were identified. For AA, five studies examined microneedling together with topical triamcinolone in three of these, while two studies used photodynamic therapy. Regarding AGA, two studies used topical minoxidil plus microneedling, and one examined topical finasteride with fractional erbium glass laser. Improvement was seen in 6 of the 8 studies. Discussion: Transcutaneous drug delivery via fractional laser and microneedling is a promising modality with preliminary evidence for increased hair regrowth over topical therapy alone. Further studies are needed to elucidate treatment parameters and appropriate device selection for drug delivery.

Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation

The aim of this study was to evaluate the efficacy and safety of fractional carbon dioxide laser for the treatment of acne scars. Thirty-one participants, 15 female and 16 male, whose mean age was 34.84 ± 10.94 years, were included in this prospective study. The study took place between 2012 and 2016. Participants were evaluated with the "ECCA Grading Scale" before the first session, 3 months (short-term evaluation) and 3 years after the last session (long-term evaluation). Participants received two or three treatment sessions at 4-week intervals, with a 10,600 nm fractional carbon dioxide laser with pulse energies ranging between 100 and 160 mJ, 120 spot type, 75-100 spot/cm² density, and 30 W power. Self-assessments by the participants were done 3 months and 3 years after the last session. The mean ECCA score was 107.90 ± 39.38 before the first session, and 82.17 ± 36.23 at the time of short-term evaluation (p = 0.000). The grade of improvement at the short-term evaluation was as follows: no improvement, mild, moderate, and significant improvement for 7 (22.6%), 11 (35.5%), 9 (29%), and 4 (12.9%) of the participants, respectively. Regarding self-assessments, 80.6 and 61.3% of the participants rated themselves as having at least mild improvement at the short-term and the long-term follow-up periods, respectively. The results of this study suggest that fractional carbon dioxide laser is an efficient treatment option for acne scars. Furthermore, self-assessment results show that more than half of the participants still experience at least mild improvement at the end of 3 years.

Efficacy of fractional lasers in treating alopecia: a literature review

Hair loss stemming from different types of alopecia, such as androgenic alopecia and alopecia areata, negatively affects over half the population and, in many circumstances, causes serious psychosocial distress. Current treatment options for alopecia, such as minoxidil, anthralin, and intralesional corticosteroids, vary efficacy and side effect profiles. It is known that low-level laser/light therapies (LLLT), or photobiomodulations, such as the US FDA-cleared HairMax Lasercomb®, He-Ne laser, and excimer laser, are relatively affordable, user-friendly, safe, and effective forms of treatment for hair loss. While less is known about the effectiveness of fractional lasers for combating hair loss, research suggests that by creating microscopic thermal injury zones, fractional lasers may cause an increase in hair growth from a wound healing process, making them potential therapeutic options for alopecia. A literature review was performed to evaluate the effectiveness of fractional lasers on hair regrowth. The specific fractional laser therapies include the 1550-nm nonablative fractional erbium-glass laser, the ablative fractional 2940-nm erbium:YAG laser, and the ablative fractional CO₂ fractional laser. Additional randomized controlled trials are necessary to further evaluate the effectiveness of the lasers, as well as to establish appropriate parameters and treatment intervals.

Androgenetic Alopecia: An Update of Treatment Options

Androgenetic alopecia (AGA) is characterized by a non-scarring progressive miniaturization of the hair follicle in predisposed men and women with a pattern distribution. Although AGA is a very prevalent condition, approved therapeutic options are limited. This article discusses the current treatment alternatives including their efficacy, safety profile, and quality of evidence. Finasteride and minoxidil for male androgenetic alopecia and minoxidil for female androgenetic alopecia still are the therapeutic options with the highest level evidence. The role of antiandrogens for female patients, the importance of adjuvant therapies, as well as new drugs and procedures are also addressed.

Fractional resurfacing in the Asian patient: Current state of the art

BACKGROUND AND OBJECTIVE

Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient.

METHODS

A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO₂ ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors.

CONCLUSION

Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment efficacy. Lasers Surg. Med. 49:45-59, 2017. © 2016 Wiley Periodicals, Inc.

A case of successfully treated recalcitrant EGFR inhibitor-induced acneiform eruption following non-ablative fractional laser

Epidermal growth factor receptor (EGFR) inhibitor, a targeted therapy in the field of oncology, is a new drugs suggested for the cause of acneiform eruptions. The unresponsiveness to conventional acne therapy is a pivotal reason of seeking alternatives to treat drug-induced acneiform eruptions. A 30-year-old female treated with cetuximab, EGFR inhibitor presented with numerous sized erythematous papules and pustules on her face. All responses of oral medications and topical application were poor. She was treated with two passes of non-ablative 1550 nm fractional erbium glass laser with topical clindamycin. After three laser sessions, the skin lesions improved dramatically without any side effects. There is currently no single effective treatment for acneiform eruption. This report shed light on the possibility that non-ablative fractional laser can be an alternative for recalcitrant drug-induced acneiform eruptions.

Hair regrowth through wound healing process after ablative fractional laser treatment in a murine model

BACKGROUND AND OBJECTIVE

Alopecia is one of the most common dermatological problems in the elderly; however, current therapies for it are limited by low efficacy and undesirable side effects. Although clinical reports on fractional laser treatment for various alopecia types are increasing, the exact mechanism remains to be clarified. The purposes of this study were to demonstrate the effect of ablative fractional laser treatment on hair follicle regrowth in vivo and investigate the molecular mechanism after laser treatment.

MATERIALS AND METHODS

Ablative CO2 fractional laser was applied to the shaved dorsal skin of 7-week-old C57BL/6 mice whose hair was in the telogen stage. After 12 mice were treated at various energy (10-40 mJ/spot) and density (100-400 spots/cm(2) ) settings to determine the proper dosage for maximal effect. Six mice were then treated at the decided dosage and skin specimens were sequentially obtained by excision biopsy from the dorsal aspect of each mouse. Tissue samples were used for the immunohistochemistry and reverse transcription polymerase chain reaction assays to examine hair follicle status and their related molecules.

RESULTS

The most effective dosage was the 10 mJ/spot and 300 spots/cm(2) setting. The anagen conversion of hair was observed in the histopathological examination, while Wnt/β-catenin expression was associated with hair regrowth in the immunohistochemistry and molecular studies.

CONCLUSIONS

Ablative fractional lasers appear to be effective for inducing hair regrowth via activation of the Wnt/β-catenin pathway in vivo. Our findings indicate that fractional laser treatment can potentially be developed as new treatment options for stimulating hair regrowth.

Drug discovery for alopecia: gone today, hair tomorrow

INTRODUCTION

Hair loss or alopecia affects the majority of the population at some time in their life, and increasingly, sufferers are demanding treatment. Three main types of alopecia (androgenic [AGA], areata [AA] and chemotherapy-induced [CIA]) are very different, and have their own laboratory models and separate drug-discovery efforts.

AREAS COVERED

In this article, the authors review the biology of hair, hair follicle (HF) cycling, stem cells and signaling pathways. AGA, due to dihydrotesterone, is treated by 5-α reductase inhibitors, androgen receptor blockers and ATP-sensitive potassium channel-openers. AA, which involves attack by CD8(+)NK group 2D-positive (NKG2D(+)) T cells, is treated with immunosuppressives, biologics and JAK inhibitors. Meanwhile, CIA is treated by apoptosis inhibitors, cytokines and topical immunotherapy.

EXPERT OPINION

The desire to treat alopecia with an easy topical preparation is expected to grow with time, particularly with an increasing aging population. The discovery of epidermal stem cells in the HF has given new life to the search for a cure for baldness. Drug discovery efforts are being increasingly centered on these stem cells, boosting the hair cycle and reversing miniaturization of HF. Better understanding of the molecular mechanisms underlying the immune attack in AA will yield new drugs. New discoveries in HF neogenesis and low-level light therapy will undoubtedly have a role to play.

Characteristics of androgenetic alopecia in asian

Androgenetic alopecia (AGA), or pattern hair loss, is a common disorder in Asian men and women, with a reported incidence of up to 73% among general population. There are several descriptions regarding the characteristics of AGA in patients of European descent. Asian patients with AGA have different types of hair loss and family histories from Europeans, which may affect treatment response. Therefore, in this review, prevalence, hair loss patterns, familial factors, androgen receptor gene polymorphisms of Asian AGA patients, and management based on algorithmic guidelines for AGA are discussed. This review may be useful for dermatologists in clinical practice for diagnosing and designing management approaches for Asian patients with AGA.