Is laser therapy effective in halting hair loss in FFA? (photos)

Question

I am a 55 year old man with a diagnosis of FFA, I have lost beard, side burns and eyebrows, though there is some slight regrowth of the eye brows. I have been told that laser treatment might be effective in dramatically reducing hair loss, by treating the inflammation of the scalp. I have seen nothing to support this and it is not a cheap treatment. Can you advise? Thank you

Jeff Donovan, MD, PhD · Answer

There is a bit of information to support this. You should know about an interesting 2017 study if you don’t already as well as some older 2006 and 2011 studies with the excimer laser.

In 2017, Fonda-Pascual and colleagues from Spain set out to examine the benefits of a laser known as “low level laser” in patients with lichen planopilaris. (FFA is thought to be somewhat related to LPP).

The study was small with 8 patients (3 males 5 females). Patient had LPP for an average of 3-4 years (mean 44.25 months). A laser helmet based device with 246 LEDs was used (each with a wavelength of 630 nm and fluency of 4 J/cm2). Interestingly, all patients had a reduction in symptoms, redness and scaling and there was a decrease in the disease activity after 6 months.
This was an interesting preliminary study. More studies are needed on the potential benefits of LLLT in LPP and especially in FFA where we really have no information. The inflammation in LPP is generally quite high up in the skin and these laser devices only penetrate a short distance into the skin making them potentially effective agents to target the inflammation in these scarring alopecias.

Now for FFA, we really have little information about low level red lasers. We don't know if low level laser would do much. Many with FFA also have LPP in the middle of the scalp so it might do something for that area. Some laser devices are expensive as you say but some are not very expensive. Some are a few hundred USD and some are a few thousand USD. Do we know that the more expensive ones work better in FFA? No, not at all.   In fact, one of my concerns in using laser in FFA is making sure the chosen device actually covers the front of the scalp. Some devices do a wonderful job targeting the middle and crown of the scalp but less effectively target the middle of the scalp.

So, the main point about low level laser in FFA is that we just do not know quite yet.

Now let’s move on to excimer lasers. In a 2006 study by Vavricka et al , 13 LPP patients were treated with an average of 10 excimer laser treatments. Only 3 responded. Two had more hair growth and 1 showed less activity. A small proportion of responders.

In 2011, Navarini et al also treated patients with LPP with twice weekly excimer laser. Some of the patients had FFA too. The authors found the treatment was successful in all 13 patients. I have not consistently found excimer to help all our patients.

Now on to the key point of all the discussion. The key point is that lasers are probably less effective than the leading treatments which include finasteride/dutasteride, isotretinoin, and steroid injections.

I suspect that low level laser therapy or excimer laser if it helps might have an important role as an add on. For now, finasteride and dutaseride and isotretinoin and steroid injections are probably first line. That does not mean they must be used for any patient but it does mean they should be discussed before moving on to other therapies.

I hope this helps.

REFERENCE
Fonda-Pascual P, et al. Effectiveness Of Low-Level Laser Therapy In Lichen Planopilaris. J Am Acad Dermatol. 2017.

Navarini A, Kolios A, Prinz-Vavricka B. Low-dose excimer 308-nm laser for treatment of lichen planopilaris. Arch Dermatol. 2011;147(11):1325–1326.

Vavricka BP, Haug S, Eliades I, Trueb R. 308-nm excimer laser treatment of lichen planopilaris of the scalp. Dermatology. 2006;213:74.

Is laser therapy effective in halting hair loss in FFA? (photos)

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Is laser therapy effective in halting hair loss in FFA? (photos)

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Everything you need to know about Hair Loss Treatment

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