Received: 21 October 2020 Revised: 18 February 2021 Accepted: 22 February 2021

DOI: 10.1111/dth.14940

ORIGINAL ARTICLE

Results of low-level laser therapy in the treatment of hair

growth: An Egyptian experience

Mohamed Amer | Amany Nassar | Heba Attallah | Amin Amer

Dermatology, Venereology and Andrology

Department, Zagazig University, Zagazig,
Egypt
Correspondence
Amin Amer, Dermatology, Venereology and
Andrology Department, Zagazig University,
Zagazig, Egypt.
Email: aminamer74@gmail.com
Abstract
Recently, low level laser therapy was evaluated as an effective stimulating hair
growth. Hair loss is the most common complaint in dermatology (specially females). It
causes a significant psychosocial distress and decreased quality of life in affected
patients and exists in different types, but the most common types are androgenetic
alopecia and telogen effluvium (TE). Although there are many treatments with
highest levels of medical evidence, but patients who exhibit intolerance or poor
response to these treatments need additional treatment modalities. To evaluate the
efficacy and safety low level laser therapy for female pattern hair loss (FPHL) and
TE. A prospective interventional study included 20 female patients, 13 were diag-
nosed as FPHL, and 7 were diagnosed TE. Patients received two sessions per week
with Hair Growth System (TOPHAT655) a bicycle-helmet type device. Treatment
session of 20 minutes for 16 successive weeks (total of 32 treatments) with follow-
up. Patients were evaluated by software-analyzed trichoscopic images, as the primary
endpoint was the percent increase in hair counts from baseline to post-treatment.
Global photography and patient satisfaction were determined as a secondary end
point. Twenty patients completed the study (13 FPHL, 7 TE). FPHL patients baseline
hair counts were 222.3 ± 33.5 (N = 13), in TE patients baseline hair counts were
271.2 ± 39.0 (N = 7). Post-treatment hair counts were 255.3 ± 30.4 (N = 13) In FPHL
patients (P = .007), and 294.2 ± 38.1 (N = 7) in TE patients (P = .143). Low level laser
therapy of the scalp at 655 nm significantly improved hair counts in FPHL, and there
is no significance difference in TE patients with no serious adverse events. Additional
studies should be considered to determine the long-term effects of low-level laser
therapy treatment on hair growth and maintenance, and to optimize laser modality.

KEYWORDS
alopecia, hair regrowth, low-level laser therapy, photobiomodulation

1 | I N T RO DU CT I O N such disorders may include infectious, nutritional, congenital, autoim-

Hair loss is the most common complaint in dermatology, and it can
cause significant psychosocial distress decreased quality of life in
1
affected patients.
Hair loss can affect both sexes at any age and can be temporary
or long lasting (cicatricial or non-cicatricial). The pathophysiology of
mune, or environmental causes. The most common forms of non-
scarring alopecia are androgenetic alopecia, telogen effluvium
(TE) and alopecia areata (AA).2
The current therapies are not very effective for all patients. Medi-
cal therapies require indefinite use and are limited by patient adher-
ence.3 Recently, the use of low-level laser therapy has been proposed

Dermatologic Therapy. 2021;e14940. wileyonlinelibrary.com/journal/dth © 2021 Wiley Periodicals LLC. 1 of 8

https://doi.org/10.1111/dth.14940
2 of 8
as an alternative treatment for hair loss and stimulate hair regrowth,
with possibly better outcomes and minimal risk.4
The biological effects of low-level laser therapy include anti-
inflammation, pain reduction, wound healing, anti-edema, antibiosis,
immunity, local blood circulation improvement, and recently to
enhance hair regrowth which are based on the principles of low-level
5
laser therapy or biostimulation effect (Figure 1).
Low level laser therapy provides treatment options for a myriad
of dermatological conditions involving acne, scars, aging and pigmen-
tation. The most commercially successful use of low-level laser ther-
6
apy is for managing alopecia in both men and women (Figure 2).
2 | P A T I E NT S A N D M E TH O D S
The study was conducted from October 2016 to December 2018,
evaluated and approved by the authors' Institutional Review Boards
(IRBs). Patients were randomly selected from outpatient clinic of Der-
matology, Venereology and Andrology Department, Medical School,
Zagazig University Hospital. This study included 20 female patients
FIGURE 1 Show female pattern hair loss (FPHL) patient no. 1 (A) at baseline week 0. (B) Post-treatment week 16. (C) After follow-up at
week 28
FIGURE 2 Trichoscopic images of frontal area of patient no. 1 (A) at baseline week 0. (B) Post-treatment week 16. (C) After follow-up at
week 28
AMER ET AL.
with hair loss who were diagnosed clinically and trichoscopic as
female pattern hair loss (FPHL) and TE, divided into two groups.
Group of FPHL included 13 patients and group of TE included seven
patients.
1. Inclusion criteria: Female patients with FPHL and TE, at age 20 to
50 years old.
2. Exclusion criteria: Patients with active infection on the scalp,
chronic dermatologic conditions (eg, eczema, psoriasis, inflection,
etc), dysplastic or malignant lesions in the scalp other than pattern
hair loss.
Patients with history of chronic disease as hepatic, renal, malig-
nancy, or thyroid. Pregnant or lactating were excluded as well from
the study. Patients used drugs inducing hair loss or growth within
6 months prior to study. All patients received two sessions per week
of the iGrowR (TOPHAT655) helmet type device, each treatment ses-
sion of 20 minutes for 16 successive weeks. The treatment was evalu-
ated by software-analyzed trichoscopic images at baseline and post-
treatment. Assessment by measuring the total hair count (total hair
AMER ET AL. 3 of 8

count/high power field) in trichoscopic images at 16 weeks from T A B L E 1 Total hair count/high power field in FPHL group, at
baseline was used as the primary endpoint of the treatment. Global baseline (week 0), after end of treatment (week 16) and on follow-up
(week 28)
photography and patient satisfaction were used as a secondary
endpoint. Total hair count FPHL group (N = 13)
Baseline
Min. – Max. 174–292
2.1 | Statistical analysis Mean ± SD 222.3 ± 33.5
Post-treatment
The data were analyzed using Two-sided unequal variance t-test program. Min. – Max. 194–315
Comparisons between measures (mean ± SD) were done using paired
Mean ± SD 255.3 ± 30.4
t test. The test results were considered significant when P value <.05.
Follow-up
Min. – Max. 190–333
Mean ± SD 252.8 ± 41.6
3 | RESULTS
P-value

3.1 | Demographic data Com. bet. Periods P1 = .007a, P2 = .025b, P3 = .432c

Note: Com. bet. Periods: comparison between periods using two-sided

3.1.1 | FPHL group unequal variance t-test.
a
P1: P value for comparing between baseline and post-treatment.
Statistically significant at P ≤ .05.
All patients were females (100%). Their ages ranged from 20 to b
P2: P value for comparing between baseline and follow-up. Statistically
44 years with mean ± SD = 32.0 ± 6.3. Nine patients were skin type significant at P ≤ .05.
c
III (69.2%) and 4 patients had skin type IV (30.7%). Family history was P3: P value for comparing between post-treatment and follow-up.
positive in 9 patients (69.2%). Duration of hair loss ranged between Statistically significant at P ≤ .05.

1 and 15 years with a mean ± SD = 5.5 ± 4.2. Onset of hair loss was
early in 7 patients (53.8%) and late in 6 patients (46.1%). Pull test was
positive in 4 patients (30.7%) and negative in 9 patients (69.2%). His-
tory of stress was detected in 12 patients (92.3%).
3.1.2 | TE group
All patients were females (100%). Their ages ranged from 24 to
37 years and a mean ± SD = 30 ± 4.5. All patients were skin type III
(100%). Onset of hair loss was acute in 3 patients (42.8%) and chronic
in 4 patients (57.1%). Duration of hair loss ranged between 3 and
9 months with a mean ± SD = 5.4 ± 2.5. Pull test was positive in
3 patients (42.8%). Stress was the most important risk factor in this
group, as it was positive in all patients (100%).
TE group
Total hair count at baseline was ranged from 205 to 316 with mean
± SD = 271.2 ± 39.0, at post-treatment was ranged from 227 to
347 with mean ± SD = 294.2 ± 38.1, and at follow-up was ranged
from 207 to 327 with mean ± SD = 286.4 ± 42.2. With P-value
P1 = .143, P2 = .249, P3 = .360 (Table 2).
3.2.2 | Percent of increase total hair count
The primary end point for evaluation was the percent increase in total
hair count from baseline to the end of 16 weeks of treatment
(Table 3). The percent increase from baseline is to be obtained by the
following formula:

3.2 | Primary analysis X = 100 × End count – Baseline count=Baseline count

3.2.1 | Total hair count

Total hair count was analyzed for each patient at baseline (week 0),
end of treatment (week 16), and follow up (week 28) in four examined
areas (frontal, mid-frontal, vertex, and mid-occipital).
FPHL group
Total hair count at baseline was ranged from 174-292 with mean
± SD = 222.3 ± 33.5, at post-treatment was ranged from 194 to
315 with mean ± SD = 255.3 ± 30.4, and at follow-up was ranged
from 190 to 333 with mean ± SD = 252.8 ± 41.6. With P-value
P1 = .007*, P2 = .025*, P3 = .432 (Table 1).
FPHL group
The Difference of total hair count from baseline to post-treatment
was ranged from 6 to 77 with mean ± SD = 32.0 ± 20.9. And a per-
centage of increase was ranged from 2.4% to 44.2% with mean
± SD = 15.7 ± 12.0.
TE group
The Difference of total hair count from baseline to post-treatment
was ranged from 9 to 36 with mean ± SD = 23.7 ± 9.8. And a percent-
age of increase was ranged from 2.8% to 13.8% with mean
± SD = 8.7 ± 4.1.
4 of 8 AMER ET AL.

T A B L E 2 Total hair count/high power field in TE group, at 2. At follow-up (week 28) after stopping treatment: three patients
baseline (week 0), after end of treatment. (week 16) and on follow-up showed significant improvement (23.0%), eight patients showed
(week 28)
minimal improvement (61.5%), and two patients showed no
Total hair count TE group (N = 7) improvement (15.3%) (Figures 3 and 4).
Baseline
Min. – Max. 205–316
Mean ± SD 271.2 ± 39.0 3.3.2 | Patient satisfaction
Post-treatment
All treated patients reported overall improvement of hair falling condi-
Min. – Max. 227–347
tion, thickness and fullness of hair as a self-assessment after end of
Mean ± SD 294.2 ± 38.1
treatment (week 16).
Follow-up
Min. – Max. 207–327
FPHL group
Mean ± SD 286.4 ± 42.2
1. Hair falling: Eight patients reported significant improvement of hair
P-value falling (61.5%). Five patients reported no change of hair falling con-
Com. bet. Periods P1 = .143a, P2 = .249b, P3 = .360c dition (38.4%).
Note: Com. bet. Periods: comparison between periods using two-sided 2. Hair density: Twelve patients reported significant improvement of
unequal variance t-test. hair density (92.3%). One patient reported no change of hair den-
a
P1: P value for comparing between baseline and post-treatment. sity condition (7.6%).
b
P2: P value for comparing between baseline and follow-up.
c 3. Hair thickness: Eight patients reported improvement of hair thick-
P3: P value for comparing between post-treatment and follow-up.
ness (61.5%). Five patients reported no change of hair thick-
ness (38.4%).
T A B L E 3 Percentage of increase total hair count from baseline to
the end of 16 weeks of treatment in two groups
TE group
Variable FPHL group TE group 1. Hair falling: Four patients reported significant improvement of hair
Baseline falling (57.1%). One patient reported no change of hair falling con-

Min. – Max. 174–292 205–316 dition (14.2%). Two patients reported worse of hair falling condi-
tion (28.5%).
Mean ± SD 222.3 ± 33.5 271.2 ± 39.0
2. Hair density: Five patients reported significant improvement of
Post-treatment
hair density (71.4%). One patient reported no change of hair den-
Min. – Max. 194–315 227–347
sity (14.2%). One patient reported worse of hair density condition
Mean ± SD 255.3 ± 30.4 294.2 ± 38.1
(14.2%) (Figures 5 and 6).
Difference from baseline
Min. – Max. 6–77 9–36
Mean ± SD 32.0 ± 20.9 23.7 ± 9.8
Percent increase 4 | DI SCU SSION
Min. – Max. 2.4–44.2% 2.8-13.8%
Mean ± SD 15.7 ± 12.0 8.7 ± 4.1 Up to date there are various studies that evaluated the efficacy of pho-
tobiomodulation (PBM) in FPHL, there are studies which used different
device types, irradiation parameter, session frequency (days/week) and
treatment duration (weeks) of PBM from our present study.
3.3 | Secondary analysis Also, there are other studies used the same device, parameters,
and treatment durations AS our present study.
3.3.1 | Global photography assessment

FPHL group 4.1 | FPHL group

By comparing the patient's digital images of the fullness central hair
partline at the baseline (week 0), post-treatment (week 16), and at
follow-up after stopping treatment (week 28):
1. After end of treatment (week 16): two patients showed significant
improvement (15.3%), seven patients showed minimal improve-
ment (53.8%), and four patients showed no improvement (30.7%).
By using the ImageJ software analyzer for the high-resolution tri-
choscopic images, gives Total hair, count manually. The present study
results came in accordance with most of the previous studies regard-
ing increased hair count following PBM. It should be noted that these
variables were measured in a larger surface area of (high power field)
rather than per square centimeter.
AMER ET AL. 5 of 8

FIGURE 3 Show female pattern hair loss (FPHL) patient no. 2 (A) at baseline week 0. (B) Post-treatment week 16. (C) After follow-up at
week 28

FIGURE 4 Trichoscopic images of frontal area of patient no. 2 (A) at baseline week 0. (B) Post-treatment week 16. (C) After follow-up at
week 28

FIGURE 5 Show TE patient no. 3 (A) at baseline week 0. (B) Post-treatment week 16. (C) After follow-up at week 28

4.1.1 | Total hair count
In our study, the results showed statistically significant (P = .007) in
total hair count from baseline with mean ± SD = 222.3 ± 33.5 vs
mean ± SD = 255.3 ± 30.4 at post-treatment at week 16.
These results confirm that the use of PBM for the treatment of hair
loss assumed to stimulate anagen re-entry in telogen hair follicles, pro-
long the duration of the anagen phase, increase the rates of proliferation
in active anagen hair follicles and prevent premature catagen develop-
ment. Mechanisms for the PBM effect was observed in these cases 1.
6 of 8
FIGURE 6 Trichoscopic images of frontal area of patient no 3 (A) At baseline week 0. (B) Post-treatment week 16. (C) After follow-up at
week 28
Our results were similar to Blume et al7 results, after using a
5X hair laser device in 70 patients were three times weekly for
10 to 15 minutes each time, over a period of 26 weeks, which
showed statistically increase in Mean hair count from baseline to
post-treatment: 159 hair/cm2 at baseline vs 174.80 hair/cm2at
26 weeks.
Our results were similar to Jimenez et al1 results, after using dif-
ferent models of HairMax Laser Comb for 26 weeks in four clinical tri-
als in both males and females with different parameters and session's
time, reported that were increases in hair counts.
Rushton et al,8 results which was not significant, after using Hai-
rMax Laser Comb in two patients for 7.5 minutes. 3 d/wk with param-
eters 655 nm for treatment duration 26 weeks. Showed no
statistically significant increase in hair count. As hair count at baseline
with mean ± SD = 230 ± 3 and with mean ± SD = 243 ± 5 at
26 weeks. It may have been explained by the small sample size which
may gave statistically inaccurate results.
4.1.2 | Increased total hair count increase
percentage
In our study, results showed that the difference of total hair count
from baseline to post-treatment was ranged from 6 to 77 with mean
± SD = 32.0 ± 20.9. Percentage of increase was ranged from 2.4% to
44.2% with mean ± SD = 15.7 ± 12.0.
These results were less than Lanzafame et al,9 results after using
the same laser helmet-type device, with parameters 655 ± 5 nm and
session time was 25 minutes in 47 females for 16 weeks every other
day. Reported that hair count in LLLT-treated females vs sham-
treated controls increase with a mean = 35%. This may have explained
by the higher frequency of sessions with total 60 treatments vs
32 treatments in our study.
Similar to Kim et al,10 results after using Helmet-type device, in
Double blind, sham device-controlled trial on 40 patients, once daily
for 18 minutes. With parameters 660 nm over a period of 24-week.
Hair count was increased by 17.2 in LLLT group compared to a
decrease of 2.1 in sham-treated.
AMER ET AL.
4.1.3 | Global photography assessment
Digital images of the patients were compared according to the full-
ness of central hair part line at the baseline (week 0), post-treatment
(week 16) and at follow-up after stopping treatment (week 28). Global
photography was scored as significant improvement minimal improve-
ment and no improvement.
In our study, post-treatment results showed that there was a sig-
nificant/minimal improvement in 69.2% of patients (9/13), and no
improvement in 30.7% of patients (4/13). However, this was not sta-
tistically significant (P = .5). None of the patients experienced worsen-
ing immediately post-treatment (week 16).
These results were similar to Avram et al,11 after using a Laser
hood in seven patients were twice weekly for 20 minutes each time
with parameters 650 nm, over a period of 12 weeks, where no statis-
tically significant difference between baseline and post-treatment
(P = .44).
Less than Munck et al,12 results used HairMax Laser Comb
3 time/week for 8 minutes with parameters 655 nm over a period of
8 to 48 weeks as monotherapy in 6 patients. The result was 100% of
patients (6/6) showed significant/moderate improvement, and zero
patients no improvement (00.0%). The difference may be having been
explained due to the different type of low-level laser device, and the
treatment duration.
4.1.4 | Patient satisfaction
In our study, all 13 patients of FPHL group showed improvement of
hair falling condition, thickness, and fullness of hair as a self-assess-
ment. Patient satisfaction from the treatment effect on hair loss con-
dition was 84.6% of patients (11/13) were satisfied, and 15.3% of
patients (2/13) were not satisfied.
These results which were similar to Kim et al10 results, which
reported that 83% of patients were satisfied with PBM therapy. Also
similar to Jimenez et al,4 results, female patients with PBM therapy
reported overall improvement of hair loss condition, and increase in
fullness and thickness.
AMER ET AL.
4.2 | TE group
There was no reports or studies that examine the use of PBM in
TE. Our understanding of the pathogenesis of TE, and the mecha-
nism of action of PBM on hair growth suggest it should work in TE
patients. According to one such theory, particularly at wavelengths
in the red range was used in this investigation, affects the function-
ing of the stem cells that cause hair growth. It activates cytochrome
C oxidase and increases mitochondrial electron transport, which
leads to an increase in ATP and subsequent reversal of hair follicles
from the dormant telogen stage of growth, to the active growth or
9
anagen stage.
4.2.1 | Total hair count
In our study, the results showed no statistically significant (P = .143)
in total hair count from baseline with mean ± SD = 271.2 ± 39.0 vs
mean ± SD = 294.2 ± 38.1 at post-treatment at week 16.
4.2.2 | Percent of increase total hair count
In our study, results which showed that the difference of total hair
count from baseline to post-treatment was ranged from 9 to 36 with
mean ± SD = 23.7 ± 9.8. Percentage of increase was ranged from
2.8% to 13.8% with mean ± SD = 8.7 ± 4.1.
Although the results were statistically not significant, there is a
slight increase of total hair count but still low-grade increase up to
13.8% alternative to FPHL group as percentage of increase up to
44%. Also, the small number of patients in the study group made it
difficult to obtain sturdy statistical findings. A larger and longer study
is essential to obtain the necessary power to give more robust statisti-
cal results.
4.2.3 | Global photography assessment
In our study, post-treatment results showed that there was a signifi-
cant/minimal improvement in 42.8% of patients, and no improvement
in 57.1% of patients. However, this was not statistically significant
(P = .5) and none of the patients experienced worsening immediately
post-treatment (week 16).
4.2.4 | Patient satisfaction
In our study, all seven patients of TE group which were reported on
improvement of hair falling condition and fullness of hair as a self-
assessment. Patient satisfaction from the treatment effect on hair loss
condition was 57.1% of patients were satisfied, and 42.8% of patients
were not satisfied.
7 of 8
4.3 | Safety and adverse effects
In our study, no serious adverse events were reported in any subject
receiving the helmet-laser type. The reported adverse effects in all
20 patients included headache at session time may remain for few
hours, dryness of hair through treatment duration, heat sensation,
scalp tenderness.
No adverse events had an impact on the study device use.
These results were similar to Kim et al10 results, which
reported some adverse effects as headache, skin pain, pruritus, ery-
thema and acne. Also similar to Jimenez et al4 result, reported that
dry skin, pruritus, scalp tenderness, irritation, and warm sensation
at the site.
5 | CONC LU SION
PBM of the scalp at 655 nm improved hair counts in FPHL signifi-
cantly, with no significance difference in TE patients.
No serious adverse events were reported. Additional studies
should be considered to help determine the long-term effects of low-
level laser treatment on hair growth and maintenance, and to optimize
laser modality.
DATA AVAILABILITY STAT EMEN T
No data available.
OR CID
Amin Amer https://orcid.org/0000-0002-3146-417X
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