Laser on Hair Regrowth
João Roberto Antonio, Carlos Roberto Antonio, and
Ana Lúcia Ferreira Coutinho
Abstract
Alopecia is a common disorder affecting more
than half of the population worldwide. There is
an urgent need to investigate alternative treat-
ment options, while there are still a few thera-
peutics options for different types of alopecia
in the market. The photobiomodulation phe-
nomenon followed by hair growth was first
described in 1967 by Professor Endre Mester,
an Hungarian physician, the pioneer of laser
medicine. For decades, clinical studies have
been conducted to evaluate the efficacy, mech-
anism of action, and risks of using Low-level
laser therapy - LLLT (collimated or non-
collimated) in different forms of hair loss as a
further treatment option. This chapter will pre-
sent the clinical studies conducted with LLLT
on female pattern hair loss (FPHL), male pattern
J.R. Antonio (*)
Faculdade Estadual de Medicina, Hospital de Base de São
José do Rio Preto, São Paulo, Brazil
e-mail: dr.joao@terra.com.br; dr.joao@pelle.com.br
C.R. Antonio
Faculdade de Medicina Estadual de São José do Rio Preto –
FAMERP, São José do Rio Preto, SP, Brazil
Hospital de Base de São José do Rio Preto,
São Paulo, Brazil
e-mail: carlos@ipele.com.br
A.L. Ferreira Coutinho
Instituto de Dermatologia Professor Rubem David Azulay
do Hospital da Santa Casa da Misericórdia do Rio de
Janeiro, Rio de Janeiro, Brazil
e-mail: anacoutinho_10@hotmail.com
# Springer International Publishing AG 2018
M.C.A. Issa, B. Tamura (eds.), Lasers, Lights and Other Technologies, Clinical Approaches and Procedures in
Cosmetic Dermatology 3, https://doi.org/10.1007/978-3-319-16799-2_17
hair loss (MPHL), alopecia areata (AA), and
chemotherapy-induced alopecia (CIA) investi-
gated in several databases including PubMed,
Google Scholar, Medline, Embase, and
Cochrane. At the end of this chapter, the authors
concluded that LLLT may be a promising treat-
ment option for patients who do not respond to
conventional treatments and who do not want to
undergo hair transplantation. This technology
appears to work better for some people than
others. Factors predicting who will get the
most benefit need to be determined. Larger,
longer-term placebo-controlled studies are
needed to confirm these findings and reinforce
the efficacy of the LLLT in those patients, gen-
erating, therefore, more consistent protocols.
Keywords
Laser • Low-level laser therapy • Low-level
light therapy • Photobiomodulation • Hair
loss • Alopecia • Androgenetic alopecia •
Female pattern hair loss • Male pattern hair
loss • Alopecia areata • Chemotherapy
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Historical Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Proposed Mechanisms: LLLT on
Hair Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
LLLT in Chemotherapy-Induced Alopecia
(CIA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
LLLT in Androgenetic Alopecia (AGA) . . . . . . . . . . 237
233
234 J.R. Antonio et al.

LLLT in Alopecia Areata . . . . . . . . . . . . . . . . . . . . . . . . . . 240 MPHL, and AA. In the next paragraphs, experi-
Authors Experience: Case Studies . . . . . . . . . . . . . . . . 241 mental and clinical studies conducted with the use
of LLLT in these conditions will be discussed.
Take Home Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
Historical Data
Introduction In 1996, a team of researchers from Kuopio
University, Finland, conducted a single-blind pla-
The use of laser in dermatology was firstly cebo-controlled study to assess and compare the
assessed in the treatment of benign vascular effects produced by three different types of laser/
tumors. However, it gained ground while proving light (He-Ne, As-Ga-Al diode, noncoherent LED
clinical effectiveness and safety in the treatment light) on hair blood flow. The study involved ten
of other dermatological conditions such as healthy male individuals. Two sessions were held,
removal of pigmented lesions, tattoos, scars, and and the placebo (noncoherent LED light) was
undesirable hairs and in photoaging treatment. compared to other two laser sources (He-Ne and
Laser therapy has become popular over the last As-Ga-Al diode). Measurements were carried out
years. The first report of the use of the laser for by laser Doppler flowmetry. Results demonstrated
hair growth was carried out by Professor Endre that coherent laser sources were the only light
Mester et al. in 1967, during an experimental sources able to produce vasodilation (Pöntinen
observation. Investigators reported the hair regrowth et al. 1996).
in the epilated area exposed to low-potency ruby In 2000, a study carried out by researchers
laser, evaluated to demonstrate the potential car- from Harvard Medical University showed that
cinogenic effect on the shaved backs of guinea volunteers exposed to ruby laser (694 nm) for
pigs (Mester et al. 1968). This finding triggered hair removal and diode (800 nm), responders or
the interest not only in identifying which laser nonresponders, presented some level of hair
apparatus could give efficient clinical responses growth, thinner and without pigment, sometime
without risk but also in verifying which therapeu- after the procedure. The authors concluded that
tic mechanisms would be involved in those changes observed depend on the type of laser and
responses. individual response (Lin et al. 2000).
To understand the mechanism of action of laser Gerardo Moreno-Arias et al. (2002) reported a
in hair regrowth process, mainly in the scalp, laser phenomenon called paradoxical hypertrichosis or
medicine experts have developed different lines of terminalization or induction of terminal hair
research in low-level laser therapy (LLLT) and growth. The clinical finding was described as a
hair loss disorders with available data to date rare but significant secondary effect present in
demonstrating efficacy. patients with hirsutism who undertook intense
The LLLT could be distinguished from other pulsed light (IPL) treatment during a period
forms of laser therapy using low power and low from 3 to 6 months. As the authors argue, intense
density. Most low-level laser therapy devices pulsed light would have the property of inducing
operate at wavelength intervals between 600 and latent hair follicle in non-treated areas located
1000 nm and use much less power than the around treated areas (Moreno-Arias et al. 2002;
amount requested to warm tissue (10 mW/cm, Desai et al. 2010).
2–5 W/cm2) (Bouzari and Firooz 2006). In recent literature’s review made by Sophia
Recently, the use of low-level laser therapy Rangwala, paradoxical hypertrichosis rates range
(LLLT) has been proposed as an alternative from 0.6% to 10% after low-energy laser therapies
therapy (mono or in combination) for hair loss to with almost all types of laser: XeCL excimer
stimulate hair regrowth in alopecia: FPHL, 308 nm, helium-neon (He-Ne), and fractional
Laser on Hair Regrowth
Erbium glass fiber 1550 nm. The event is more
frequent over the face and the neck of volunteers
with darker skin color (prototypes III–IV), dark
hair, and/or with coexisting hormone imbalance
(Rangwala 2012).
The appearance of pilli bigeminy in four cases
after alexandrite or ruby laser treatments due to
suboptimal fluencies insufficiently low to induce
thermolysis, but high enough to stimulate
follicular growth. Although the face and neck
seem to be the areas which are most sensitive
to hair growth induction effect, sensitivity and
response of scalp under these conditions are not
recognized (Ye et al. 1999).
Under some researchers’ perspective, laser
phototherapy prolongs the duration of anagen
phase, stimulates the anagen reentry in telogen
hair follicles, increases the proliferation rates of
the anagen hair follicles, and prevents the pre-
mature catagen development (Chung et al.
2004). There are many theories to explain the
LLLT’s mechanism of action in hair loss, but it
has not yet been fully elucidated (Karu 1989;
Karu and Kolyakov 2005; Hawkins-Evans and
Abrahamse 2008a, b; Lubart et al. 1992;
Oliveira et al. 2008; Mognato et al. 2004; Karu
1987).
Although medical guidelines make special
reference to LLLT clinical benefits in alopecia, it
is important to reinforce the need for clinical
studies of a better quality, randomized with an
adequate number of volunteers (Kreisler et al.
2003; Kim et al. 2015; Avram and Rogers 2010;
Stillman 2010).
Proposed Mechanisms: LLLT on Hair
Growth
The LLLT has biomodulating effects on cells
and tissues. These effects activate or inhibit
physiological, biochemical, metabolic processes
through photophysical or photochemical effects
and promote morpho-differentiation, cellular pro-
liferation, tissue neoformation, revascularization,
reduction of edema, increased cellular regeneration,
microcirculation, and vascular permeability (Karu
235
1989; Karu and Kolyakov 2005; Hawkins-Evans
and Abrahamse 2008a, b).
When laser therapy is used in the visible elec-
tromagnetic spectrum, there is an initial photo-
biostimulation in mitochondria, which activates
a chain of biological events. When the irradiation
is in the infrared spectrum, there is stimulation of
the plasmatic membrane channels, resulting in
changes in membrane permeability, temperature,
and pressure gradient (Lubart et al. 1992; Oliveira
et al. 2008; Mognato et al. 2004; Karu 1987).
Both visible and infrared light can be absorbed
by different components of the cellular respiratory
chain such as chromophores in cytochrome C
oxidase or porphyrins, which results in the pro-
duction of reactive oxygen species or superoxide
radicals. It has been commented that reactive oxy-
gen species have a fundamental role in increasing
the proliferation of keratinocytes (Lubart et al.
1992; Oliveira et al. 2008; Mognato et al. 2004;
Karu 1987).
According to Mognato et al., the oxidation
reaction seems to be associated with stimulation
and proliferation, whereas the reduction reaction
seems to be associated with inhibition of cell
growth (Mognato et al. 2004).
Kreisler et al. (2003) emphasized that there is a
stimulation of photoreceptors in the mitochondrial
respiratory chain. After the laser light has been
absorbed, photophysical and photochemical
effects, isolated or combined, stimulate the
mitochondrial membrane, increasing the mem-
brane potential and, consequently, changing the
mitochondria’s properties. LLLT acts on
the mitochondria and may alter cell metabolism
through photodissociation of inhibitory nitric
oxide (NO) from cytochrome C oxidase (CCO),
resulting in an increased production of molecular
oxygen and ATP, which stimulates the activity of
DNA and RNA to synthesize regulatory proteins
of the cell cycle, and thus the speed of mitosis can
be increased (Kim et al. 2015; Avram and Rogers
2010; Stillman 2010). Moreover, NO is known
to be a potent vasodilator via its effect on
cyclic guanine monophosphate production, and
it can be speculated that LLLT may cause photo-
dissociation of NO not only from CCO but also
236 J.R. Antonio et al.

from intracellular stores such as nitrosylated LLLT in Chemotherapy-Induced

forms of both hemoglobin and myoglobin leading
to vasodilation and increased blood flow which
was reported in several studies (McElwee 2012;
Chung et al. 2012).
According to Stein et al. (2005), laser therapy
induces the phosphorylation of MAPK/ERK
protein kinases in cells, which are known to be
associated with the mechanism of cell prolifera-
tion. It is worth noting that the interaction of
laser light with tissues can lead to different
results (stimulation or inhibition) depending on
several factors, such as wavelength, dose,
power, time, number of irradiations, optical
properties of tissues, and type of irradiated cell,
besides the physiological characteristics of the
cells at the time of irradiation.
In fact, the magnitude of the cellular response
to irradiation depends on the physiological state of
the cell (the amount of nutrients available and the
age of the cell culture). Generally, cells in the
exponential phase of growth are more photosen-
sitive than those in the stationary phase of growth
(Avram and Rogers 2010; Stillman 2010;
McElwee 2012; Chung et al. 2012; Stein et al.
2005; Karu 1988) (See Fig. 1.)
Alopecia (CIA)
In 2003, a nonclinical study was conducted
focusing on assessing the use of low-level laser
therapy in guinea pigs (rodents) which presented
chemotherapy-induced alopecia (CIA), consider-
ing that there was no efficient approach to this
type of alopecia.
HairMax LaserComb#, a low-level laser
device, was used, whose application had already
been authorized by FDA for androgenetic alope-
cia treatment.
Throughout the study, traditional chemothera-
peutical agents were used, cyclophosphamide,
etoposide, or a combination of cyclophosphamide
and doxorubicin, to induce alopecia in young rats
with or without low-level laser therapy (LLLT).
As expected, after 7–10 days of chemotherapy,
all rats developed complete corporeal alopecia.
However, the rats, which had been submitted to
low-level laser therapy, recovered their natural
state, with hair growth around 5 days earlier than
those submitted only to chemotherapy without
LLLT exposure. Hair growth in rats treated with
laser was confirmed by histological study.

ATP NITRIC OXIDE DNA

PROMOTES
ENERGY Blood vessels GROWTH FACTORS
(NUCLEUS)
dilataon
INCREASED BLOOD
VESSELS
N
O REPAIRS NEURONS

INCREASES COLAGEN

DECREASES
INFLAMMATION
GENE UP
REGULATION
PROMOTES HEALING
MITOCHONDRIA
ADAPTED FROM SAJJAD KHAN 2016
ILHT.COM

Fig. 1 Schematic drawing of possible mechanisms of LLLT on hair growth

Laser on Hair Regrowth
Results showed that low-level laser treatment
accelerated significantly hair growth after CIA,
without affecting chemotherapy efficiency, con-
cerning the guinea pig model used for that study
(Wikramanayake et al. 2013).
LLLT in Androgenetic Alopecia (AGA)
Androgenetic alopecia (AGA) is one of the most
common chronic problems seen by dermatolo-
gists worldwide, characterized by progressive
hair loss, especially of scalp hair. It has distinc-
tive patterns of loss in women versus men, but in
both genders the central scalp is most severely
affected.
It often begins around puberty and is known to
effect self-esteem and the individual’s quality of
life. In contrast to the high prevalence of AGA,
approved therapeutic options are limited. In addi-
tion to the scarce pharmacologic treatments, there
are numerous nonprescription products claimed
to be effective in restoring hair in androgenetic
alopecia.
Low-intensity laser therapy or photobio-
modulation or photobiostimulation was approved
by US Food and Drug Administration (FDA) in
2007 with a safe approach to the treatment of male
and female androgenetic alopecia. From then on, a
series of devices designed for domestic use (daily
or many times a week) became available on the
market, relatively cheap if compared to medical
treatment and hair transplant surgery.
Although the mechanism of action of this
device is still not clear about androgenetic alope-
cia treatments, some controlled clinical studies
show visible hair growth.
Different types of laser have been studied dur-
ing the assessment of hair growth in androgenetic
alopecia, including XeCL excimer 308 nm,
helium-neon (He-Ne), and fractional Erbium
glass fiber 1550 nm (Blumeyer et al. 2011; Tsuboi
et al. 2012; van Zuuren et al. 2012; Zarei et al.
2016; Jimenez et al. 2014; Leavitt et al. 2009;
Wikramanayake et al. 2009; Avram et al. 2007;
Kim et al. 2011; Kobielak et al. 2013; Kandyba
and Kobielak 2013; Kandyba et al. 2013;
237
Kobielak et al. 2003, 2007; Lee et al. 2011) (see
Table 1).
The HairMax LaserComb# (Lexington Int-
ernational, Florida), a 3R class laser (safety level),
was evaluated in androgenetic alopecia in multi-
center, double-blind controlled study (against a
non-active device). The clinical trial was per-
formed in four centers and assessed 110 men
with male AGA (Norwood-Hamilton: IIa-V,
Fitzpatrick: I a IV) aged between 30 and 60 years
(Jimenez et al. 2014).
The study subjects were instructed to use the
device three times a week, during 15 min, over
26 weeks. The sites for application were marked
with a circular tattoo, 2.96 cm in diameter, which
was assessed after haircut. By means of comput-
erized countdown, the scalp was evaluated via
macroimage.
The study subjects treated with laser comb
(655 nm) showed an increase in density of around
19.8 hairs/cm2 in comparison to 7.6 hairs/cm2
presented by the control group (P < 0,0001). No
statistical improvement was observed in the inves-
tigator’s overall evaluation.
In 2014, another group of researchers published
a double-blind, randomized, controlled, multicenter
study which had been performed to assess the clin-
ical efficacy and safety of the same device in
women and men with androgenetic alopecia.
A hundred and forty-one female volunteers
(n = 141) and a hundred and twenty-eight male
volunteers (n = 128) were randomized to receive
the active device LaserComb or sham device
(control) according to the following design: #1
with beams 9 X control, #2 with beams 12 X
control, #3 with beams 7 X control, and #4 with
beams 12 X control.
The application all over the scalp was
performed three times a week throughout
26 weeks. Terminal hair density in the targeted
area was assessed at the beginning and in the 16th
and 26th weeks of the follow-up.
Both investigators and study subjects remained
blind to the type of device used during the test.
The specialist responsible for evaluating the dig-
ital pictures taken along the trial also remained
blind to each branch of the study.
238 J.R. Antonio et al.

Table 1 Literature review about different devices and protocols

Treatment Peer
Home devices Power regimes Studies Subjects Results reviewed?
CapillusTM 410 mW 30 min Double blind 44F 63.7% increase in No
82 Laser Cap 3–4/week RCT terminal hair count vs
CapillusTM 1010 mW 30 min sham
202 Laser Cap 3–4/week
CapillusTM 1360 mW 30 min
272 Pro Laser 3–4/week
Cap
HairMaxTM 205 mW 3 min Prospective 28M, Total hair count and Yes (Satino)
Laser Band 41 3/week cohort 7F hair tensile strength
increased
HairMaxTM 410 mW 90 s Double blind 110M Mean terminal hair Yes
Laser Band 82 3/week RCT density increased by (Leavitt)
~20 hairs/cm2
HairMaxTM 35 mW 15 min Case report 2M No significant change Yes
Prima7 Laser 3/week in hair count or (Rushton)
Comb thickness
HairMaxTM 45 mW 15 min Retrospective 11M, Global photos – Yes (Munk)
Ultima 9 Laser 3/week Cohort 21F majority w/moderate
Comb improvement
HairMaxTM 60 mW 8 min Double blind 128M, Terminal hair density Yes
Ultima 3/week RCT 141F increased by ~15 hairs/ (Jimenez)
12 Laser Comb cm2
iGrowTM Hair 255 mW 25 min Double blind 41M 35–37% increase in Yes
Growth System every other RCT terminal hair count (Lanzafame)
day Double blind 42F
RCT
iRestoreTM 255 mW 25 min Double blind 18M, Pending, study in N/A
Hair Growth every other RCT 18F progress
System day
LasercapTM 1120 mW 36 min Case series 7F Improvement in hair N/A
LCPRO every other Case series 1M, 2F volume and shine
day
NutraStimTM 60 mW 8 min N/A N/A N/A N/A
Laser Hair 3/week
Comb
TheradormeTM 400 mW 20 min Double blind 80M Pending, study in N/A
LH80 PRO 2/week RCT progress
Source: Data obtained by consulting suppliers/internet/sales representatives. May 2017

At the end of study, the investigators observed
an increase statistically significant in terminal hair
density for subjects treated with active device
against those treated with the sham device
(control).
No serious adverse events have been reported.
According to the authors, these results suggest
that LLLT might be an efficient option for hair
loss regarding both male and female patterns.
However, the researchers recognized that the
mechanism by which LLLT convert telogen into
anagen follicles remains unknown.
Avram and Rogers conducted the first indepen-
dent blinded study of LLLT and hair growth with
seven volunteers and found that on average, there
was a decrease in the number of vellus hairs, an
increase in the number of terminal hairs, and an
increase in shaft diameter. Nevertheless, these
data were not considered statistically significant
(Avram et al. 2007).
Laser on Hair Regrowth
The first study involving a fractional Erbium
glass fiber 1550 nm (Mosaic# Lutronic Co., Ltd.,
Seoul, South Korea) published is a non-clinic
essay carried out in 2011. The investigators eval-
uated the effect of the device on hair cycle in a
form of alopecia in rats. The radiation was applied
over the shaved skin of C3H/HeN rats using var-
ious power and density configurations in different
radiation intervals. Stimulation effects on hair were
observed due to the level of power employed,
density, and radiation interval. Histologic findings
reveal the conversion of hair in telogen phase into
anagen phase. The conversion into anagen hair and
the increase of 5a Wnt, β-catenin were regarded as
signs of therapeutic response.
Later, to assess the clinical effects of that same
sort of laser, a study was performed involving
20 males with AGA (Kim et al. 2011). In the
study involving humans, 20 male volunteers
were treated in five sessions and in 2-week inter-
vals. It was employed with 5 mJ power with a total
density of 300 spots/cm2.
According to the investigators, fractional laser
can cause thermal injury or photothermolysis for
each thermal microzone (TMZ), which induces col-
lagen regeneration and thermal shock over proteins.
Both events lead to the expression of growth fac-
tors, including vascular endothelium growth factor
(VEGF), which induces neoangiogenesis. Other
possible mechanisms are cytokine biomodulation
and growth factors such as PDGF, KGF, and IGF.
Nowadays, it is known that there is a complex
net of genes involved in the control of hair growth
cycle and connected to Wnt and BMP signaling
pathways, especially Wnt7 gene, which cause inad-
equate hair growth, if inactivated. Research data
have already proved that, if BMP signaling path-
ways are reduced and Wnt pathways are increased,
a hair growth phase is activated (Kobielak et al.
2013; Kandyba and Kobielak 2013; Kandyba et al.
2013; Kobielak et al. 2003, 2007).
During the study, incremental improvements in
hair density and hair growth rate were observed,
which suggested that fractional Erbium glass fiber
1550 nm might induce hair growth.
In that same year (2011), the investigators
evaluated fractional Erbium glass fiber 1550 nm
effect on female pattern alopecia (Lee et al. 2011).
239
Twenty-eight South Korean volunteers took part
into the study. The volunteers received laser appli-
cation with intervals of 15 min, following the
same parameters of the study conducted with
male volunteers. Phototrichograms and global
photos were taken at the beginning and at the
end of the treatment. Changes in density and in
the hair shaft diameter were analyzed. The global
photos were evaluated by three independent der-
matologists using a scale of seven points.
Volunteers involved also answered an efficacy
self-evaluation questionnaire. All adverse events
were reported during 5 months of treatment.
After 5 months of study, the results demonstrated
an increase in hair density of 157  28/cm2
(P < 0.0001) and in shaft thickness of 75 
13 μm (P < 0.001).
According to the global photos, out of the
remaining 27 volunteers, 24 (87.5%) showed an
improvement in their conditions. Two volunteers
(7.4%) reported moderate pruritus after laser appli-
cation, which was spontaneously solved 2 h later.
In 2013, a multicenter, double-blind, random-
ized, controlled study was performed to evaluate
the efficacy and safety of LLLT in volunteers with
androgenetic alopecia against a sham device, over
24 weeks, against sham device (control).
The study involved 40 volunteers with andro-
genetic alopecia. One group of volunteers was
exposed to a helmet-like apparatus, which pro-
duces radiation in wavelengths of 630, 650, and
660 nm, and the other group was exposed to sham
device (control) during 18 min per day.
A phototrichogram and overall evaluations
were carried out. After 24 weeks, the results
showed a significant increase in hair density in
group of volunteers exposed to the active appara-
tus (LLLT) against the other group (sham device).
The average diameter of hair shaft also increased
significantly in the volunteers submitted to the
intervention compared to sham device group.
According to the investigator’s evaluation, a
significant clinical improvement was observed in
the group of volunteers exposed to the active
apparatus. No adverse event was reported. In
the investigators’ opinion, LLLT was considered
effective and safe concerning AGA treatment
(Kim et al. 2013).
240
LLLT in Alopecia Areata
Alopecia areata is an autoimmune disease which
is characterized by rapid and complete hair loss in
one or many sites in the form of patches, generally
located on the scalp. Available treatments are
employed with variable success. These include
pulsed high doses of oral or intravenous steroids,
topical high-potency steroids under occlusion,
photochemotherapy, and topical immunotherapy.
Efficacy of treatments in patients with alopecia
totalis and alopecia universalis is poor, with
long-term complete regrowth in less than 20% of
patients (Tosti et al. 2006).
In 1984, Trelles and collaborators investigated
He-Ne laser action in alopecia areata (Trelles et al.
1984), and, from 2002 on, a series of studies were
undertaken to evaluate the role played by different
forms of light/laser as an alternative therapy to the
types of alopecia (particularly alopecia areata)
(Shukla et al. 2010; Touma and Rohrer 2004).
In 2003, a study assessed the effects of polar-
ized linear infrared radiation produced by a com-
mercial device denominated Super Lizer# in
volunteers with alopecia areata. Fifteen volunteers
over 18 years old diagnosed with alopecia areata
and with multiple patches were engaged in this
trial. Results showed that, out of 15 volunteers
(46.7%), 7 presented hair growth in the radiated
areas around 1.6 months earlier than those not
radiated. Regarding the adverse events, only one
patient complained about heat sensation over the
radiated area (Yamazaki et al. 2003).
The most explored laser in the treatment of alo-
pecia areata is the XeCL excimer 308 nm, better
established by a vast number of studies conducted
even in children, proposing as its mechanism of
action apoptotic effect over T cells (Gundogan
et al. 2004; Raulin et al. 2005; Al-Mutairi 2007,
2009; Ohtsuki et al. 2010, 2013; Byun et al. 2015).
In 2006, a study evaluated the efficacy of
superpulsed Ga-As, 904 nm diode laser, in the
treatment of alopecia areata. For this purpose,
16 volunteers with 34 alopecia areata patches
refractory to other forms of therapy were selected.
In each patient, there was a remaining patch with-
out treatment as control lesion. Four sessions were
held, one per week, with pulsed infrared diode laser
J.R. Antonio et al.
(904 nm), pulse rate of 40/s. Photos were taken of
each patient before and after the treatment, being
11 males (68.75%) and 5 females (31.25%).
Concerning the volunteers’ age, there was a range
between 4 and 50 years of age with an average of
26.6 +/ SD of +/ m 13.8. The disease duration
varied between 12 months and 6 years with an
average of 13.43 +/ SD of +/ 18.34.
Results showed that hair regrowth was
observed in 32 areas of alopecia (94%), whereas
only two areas of alopecia did not show any
response. On the alopecic patches, considered
control, hair regrowth was not verified. On
29 patches (90.6%), terminal hair could be veri-
fied. Less pigmented vellus have been observed
on three patches (Waiz et al. 2006).
In responders, the effect was earlier detected:
24 volunteers(75%) a week after the first session.
At the end of the study, the researchers concluded
that pulsed infrared diode laser is an efficient
therapy with a high success rate in volunteers
with alopecia areata (patches) refractory to vari-
ous modalities of treatment.
In 2009, a group of researchers from the
Department of Dermatology of Chung-Ang
University College of Medicine, Seoul, SK,
report the case of a 35-year-old man with several
large-sized alopecia areata patches on frontal
region of the scalp refractory to different
methods/drugs (minoxidil topical solution 5%,
topical steroids, and intralesional corticosteroid
injections). Non-ablative laser (fractional Erbium
glass fiber 1550 nm) applications were made once
a week, during 24 weeks. A pulse energy of
10–15 mJ, with a density of 300MTZ/cm2, was
used in each application. Two applications were
made in each session (Yoo et al. 2009).
The treatment was well tolerated, without any
side effect reported. Firstly, hair growth was
observed 1 month after the treatment was started.
After 3 months, lesions were covered with termi-
nal hair, mostly pigmented, in an average of
30–40%. Six months after the therapy began,
new hair grew over all lesions. No relapse was
reported during a 6-month clinical follow-up.
Regarding the LLLT’s mechanism of action on
AA, researchers assumed that one or more factors
among improved microvascular circulation,
Laser on Hair Regrowth 241

reduced inflammation, and increased cell energy
in the form of ATP, working together, could
explain the clinical benefits of LLLT on AA.
In conclusion, a LLLT offers a safe and effec-
tive option as monotherapy or in combination
with other conventional therapy for non-scarring
alopecia, such as male and female pattern hair
loss, chemotherapy-induced alopecia, and alope-
cia areata, with available data to date demonstrat-
ing efficacy. We must consider that, regardless of
these good results, the establishment of more
consistent protocols requires the conduction of
randomized, double-blind, sham-device-con-
trolled trial with an adequate number of volun-
teers and longer follow-up.
Authors Experience: Case Studies
Our case studies (Figs. 2, 3, and 4) involving two
patients with androgenetic alopecia using Erbium
glass laser 1550 nm, energy of 8 mJ, density of

a b

Lateral view

Vertex view

Fig. 2 Patient 1: Before (a) and 6 months after (b) 6 sessions, 1 month apart. Erbium glass laser 1550 nm; energy, 8 mJ;
density, 9%

Fig. 3 Patient 2: Before (b) a b

and 6 months after (b)
6 sessions, 1 month apart.
Erbium glass laser Frontal view
1550 nm; energy, 8 mJ;
density, 9%

Parietal view
242
Fig. 4 Patient 3: Before (a) a b
and 4 months after (b)
6 sessions, 1 month apart.
Erbium glass laser
1550 nm; energy, 8 mJ;
density, 9%
9%, and making 6 applications over the areas
affected by alopecia. One-month interval between
sessions.
Take Home Messages
1. LLL therapy offers a safe therapeutic option as
monotherapy or in combination with other
conventional therapies for non-scarring alope-
cia, taking into consideration the data available
demonstrating efficacy up to date.
2. The interaction of laser light with tissues
can lead to different results (stimulation or
inhibition) depending on several factors, wave-
length, dose, power, time, number of irradia-
tions, optical properties of tissues, and type of
irradiated cell, besides the physiological char-
acteristics of the cells at the time of irradiation.
3. There has been a rapid increase in market
availability of devices each with differing char-
acteristics making both physician and patient/
consumer navigation difficult.
4. Further investigation is needed to compare
efficacy of LLLT devices to be able to address
patient needs and expectations.
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