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

Doris Day, Madison McCarthy, Iva Talaber, Doris Day, Madison McCarthy, Iva Talaber

Abstract

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 (SMOOTHTM 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.

Keywords: androgenetic alopecia; combined therapy; hair restoration; laser therapy; platelet-rich plasma.

Conflict of interest statement

The authors declare no conflict of interest.

© 2021 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
Difference in AGA grade (mean ±SD) before and after the treatment in (A) female patients (n = 9) and (B) male patients (n = 7). The numbers above the charts represent p‐values for Wilcoxon matched pairs test
FIGURE 2
FIGURE 2
Representative before and after photographs of three patients. (A) Patient 6, treated with laser monotherapy. AGA stage improved from N‐H stage 6 to 5 (North‐Hamilton stage), and hair quality was assessed as better by blind evaluation after treatment; (B) patient 9, treated with laser combined with PRPb. AGA stage improved from grade 2 to 1 (Ludwig scale), and hair quality was assessed as better by blind evaluation after treatment; (C) patient 15, treated with laser combined with PRPa. AGA stage improved from N‐H stage 3 to 2, and hair quality was assessed as much better by blind evaluation after treatment [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Hair quality after treatment as assessed by the blind evaluation of global photographs
FIGURE 4
FIGURE 4
Patient satisfaction [Color figure can be viewed at wileyonlinelibrary.com]

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Source: PubMed

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