Efficacy and Safety of Laser Therapy and Phototherapy in Cicatricial and NonCicatricial Alopecia: A Systematic Review Study.
Mohammad Amin Jafari,
Ghazal Bazgir,
Fatemeh Sadat Hosseini-Baharanchi,
Alireza Jafarzadeh,
Azadeh Goodarzi
Review
Health science reports
2024
14 उद्धरण
PubMed
DOI
CC-BY
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Study Design
- अध्ययन प्रकार
- systematic_review
- हस्तक्षेप
- Efficacy and Safety of Laser Therapy and Phototherapy in Cicatricial and NonCicatricial Alopecia: A Systematic Review Study. various laser/phototherapy modalities (NBUVB, 308-nm excimer, PUVA, LLLT, erbium-glass, thulium lase
- तुलनित्र
- Placebo
- प्रभाव की दिशा
- Positive
- पूर्वाग्रह का जोखिम
- Moderate
Abstract
BACKGROUND AND AIMS: In recent years, the application of various light and laser devices in the treatment of different types of alopecia has been established. This systematic review aims to assess the efficacy and safety of laser therapy and phototherapy in cicatricial and non-cicatricial alopecia. METHODS: A comprehensive search was conducted on PubMed, Scopus, Science Direct, and Google Scholar. Articles were evaluated across four subgroups: alopecia areata, androgenic alopecia, telogen effluvium, and cicatricial alopecia. Included studies were published in English or Persian between January 2010 and September 2023, focusing on interventional, cohort, or case series research that achieved a minimum score of 75% on the EBL checklist. Exclusion criteria encompassed animal and in vitro studies, review articles, case reports, duplicated or irrelevant research, as well as studies that did not meet the designated EBL score. Editorial letters and case studies were also excluded. RESULTS: Initially, 965 records were collected, resulting in the inclusion of 58 studies in the final review: 26 on alopecia areata, 26 on androgenic alopecia, five on cicatricial alopecia, and one on telogen effluvium. Narrow-band ultraviolet B, 308-nm excimer laser, and psoralen ultraviolet A therapy showed varying effectiveness; specifically, the excimer laser was notably effective for patients with shorter disease duration. In androgenic alopecia, erbium-glass and thulium lasers effectively increased hair density but showed a gradual decline posttreatment. Low-level light/laser therapy also increased hair density and diameter and exhibited potential benefits when used alongside minoxidil, but did not significantly enhance outcomes in telogen effluvium treatment. CONCLUSION: Light/laser therapy can serve as an additive treatment for cicatricial alopecia, particularly lichen planopilaris, but has limited efficacy in treating telogen effluvium. Overall, light/laser therapies exhibit a significant positive effect on increasing hair density and diameter across various alopecia types.
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Tables
Table 1
| PubMed | (“Alopecia”[Title/Abstract] OR “Baldness”[Title/Abstract] OR “Hair loss”[Title/Abstract] OR “Androgenetic Alopecia”[Title/Abstract] OR “Androgenic Alopecia”[Title/Abstract] OR “Alopecia Cicatrisata”[Title/Abstract] OR “Alopecia Areata”[Title/Abstract] OR “Telogen Effluvium”[Title/Abstract] OR “Discoid lupus erythematosus”[Title/Abstract] OR “Lichen Planopilaris”[Title/Abstract] OR “Frontal fibrosing alopecia”[Title/Abstract]) AND (“Phototherapy” “[Title/Abstract] OR “Laser Therapy” [Title/Abstract] OR “Lasers”[Title/Abstract] OR “Excimer”[Title/Abstract] OR “YAG Laser” [Title/Abstract] OR “Low‐Level Light Therapy”[Title/Abstract] OR “LLLT”[Title/Abstract] OR “Ultraviolet Therapy”[Title/Abstract] OR “Photobiomodulation”[Title/Abstract] OR “PUVA Therapy”[Title/Abstract] OR “Psoralen Ultraviolet A Therapy”[Title/Abstract] OR “narrow band UVB” [Title/Abstract] OR “UVA” [Title/Abstract] OR “UVB”[Title/Abstract] OR “UV”[Title/Abstract]) AND (2010:2023[pdat]) |
| Scopus | (TITLE‐ABS‐KEY (“Alopecia” OR “Baldness” OR “Hair loss” OR “Androgenetic Alopecia” OR “Androgenic Alopecia” OR “Alopecia Cicatrisata” OR “Alopecia Areata” OR “Telogen Effluvium” OR “Discoid lupus erythematosus” OR “Lichen Planopilaris” OR “Frontal fibrosing alopecia”)) AND TITLE‐ABS‐KEY (“Phototherapy” OR “Laser Therapy” OR “Lasers” OR “Excimer” OR “YAG Laser” OR “Low‐Level Light Therapy” OR “LLLT” OR “Ultraviolet Therapy” OR “Photobiomodulation” OR “PUVA Therapy” OR “Psoralen Ultraviolet A Therapy” OR “narrow band UVB” OR “UVA” OR “UVB” OR “UV”) AND PUBYEAR > 2009 AND PUBYEAR < 2025 |
| Web of Science | TS = (“Alopecia” OR “Baldness” OR “Hair loss” OR “Androgenetic Alopecia” OR “Androgenic Alopecia” OR “Alopecia Cicatrisata” OR “Alopecia Areata” OR “Telogen Effluvium” OR “Discoid lupus erythematosus” OR “Lichen Planopilaris” OR “Frontal fibrosing alopecia”) AND TS = (“Phototherapy” OR “Laser Therapy” OR “Lasers” OR “Excimer” OR “YAG Laser” OR “Low‐Level Light Therapy” OR “LLLT” OR “Ultraviolet Therapy” OR “Psoralen Ultraviolet A Therapy” OR “narrow band UVB” OR “UVA” OR “UVB” OR “UV”) |
Table 2
| First author, year | Study type | Light/laser type | Sample size | Sex | Intervention | Laser/light features | Judgment criteria | Results | Side effect | Risk of bias | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Sandeep Kaur (2015) [ | Clinical trial | NBUVB | 40 Patients (120 patches) | 28 M, 12 F | 6 weeks, twice a week, patch1 with intralesional triamcinolone, patch2 with NBUVB, patch3 both | initial dose of 300 mJ/cm2 with increments of 10% at every visit, till MED (minimal erythema dose) | G0 no growth, G1 < 25% regrowth (poor), G2 < 50% regrowth (fair), G3 < 75% regrowth (good), G4 complete regrowth (excellent) | P1: more than 50% response in 67.5% (with 35% G4) P2: more than 50% response in 17.5% (with 12.5% G4) P3: more than 50% response in 62.5% (with 32.5% G4) | Transient itching or redness in the treated area | 3 |
| 2 | Moustafa A. El Taieb (2019) [ | Clinical trial | NBUVB | 60 Patients | 28 M,32 F | 3 months, twice a week, group1 topical calcipotriol, group2 NBUVB, group3 both, group4 placebo |
311 nm by eight narrowband UVB lamps (TL01) of Waldman‐type F 85/100W‐01. initial dose of 0.25 J/cm2 with increments of 10%–20% at every visit, with a maximum dose of 740 mJ/cm2 according to MED | SALT score and vitD3 levels | Group2: Salt score: before (3.97 ± 0.7), after (2.33 ± 0.7), | Not reported | 4 |
| 3 | DilekBayramgürler (2011) [ | Cohort | NBUVB | 25 Patients | 9 M, 16 F | 30–113 sessions, thrice a week, then after terminal hair regrowth, then once per week |
A Cosmedico cabinet, the initial dose of 0.2 or 0.3 J/cm2 with increments of 20% at every visit to max. 1.8 J/cm2 | SALT score | Before: S3: 9, S4: 6, S5: 3, S5B: 7 after: S1: 12, S2: 4, S3: 3, S4: 6, | Not reported | 5 |
| 4 | Kübra ESEN SALMAN (2019) [ | Cohort | NBUVB | 34 Patients | 21 M, 13 F | 23.76 ± 13.60 (2–54) sessions, twice to thrice a week, | A Daavlin–Levia device, Initial dose at 50% of MED with increments of usually 20% every session | No response (0%–25%), mild response (25%–50%), moderate response (51%–75%), significant response (76%–90%), and complete response ( > 90%) | No response 9, mild 10, moderate 4, significant 0, complete 9, n = 32 An excellent response was obtained in 52.9% of Patients with alopecia areata. | Mild to severe erythema | 7 |
| 5 | Ji Won Byun (2015) [ | Clinical trial | 308‐nm excimer laser therapy | 8 Patients | 3 M,5 F | 12 weeks, twice a week, alopecic patch divided into control and treated side | XTRAC®, Initial at a dose of 50 mJ lower than the MED with increments of 50 mJ every week | Hair diameter and hair count (vellus and terminal) | Hair diameter: before (treated 0.0435 ± 0.014) and (control 0.0429 ± 0.022 mm), after (treated 0.0681 ± 0.018) and (control 0.043 ± 0.009 mm), | Mild pain, erythema | 4 |
| 6 | Zo Nun Sanga (2015) [ | Clinical trial | 308 nm excimer light | 30 Patients | 23 M, 7 F | 8 Weeks or till total growth, twice a week, alopecic patch divided in control and treated side | A Xenon chloride lamp, the initial dose of 300 mJ/cm2, with increments of 100 mJ/cm2 at every sitting until MED | < 25% hair regrowth (poor response – Grade 1), 25–49% (fair response – Grade 2), 50–74% hair regrowth (good response – Grade 3), and 75%–100% hair regrowth (excellent response – Grade 4) | G1: [treated 18 (60%), control 29 (96.67%)], G2: [treated 11 (36.67%), control 1 (3.33%)], G3: [treated 1 (3.33%), control 0], G4: [0, 0] | Persistent symptomatic erythema | 3 |
| 7 | Anqi Li (2019) [ | Clinical trial | 308‐nm excimer lamp with minoxidil | 34 Patients | 21 M,13 F | 12 Weeks, twice a week, alopecic patch divided in control and treated side + topical minoxidil into both sides | Initial at a dose of 50 mJ lower than the MED, then adjusted according to the skin reaction | Hair diameter, hair count and G0 no growth, G1 < 25% regrowth (poor), G2 < 50% regrowth (fair), G3 < 75% regrowth (good), G4 complete regrowth (excellent) | G0: [treated 2 (5.8%), control 4 (11.7%)], G1: [treated 3 (8.8%), control 8 (23.5%)], G2: [treated 14 (41.1%), control 14 (41.1%)], G3: [treated 8 (23.5%), control 6 (17.6%)], G4: [treated 7 (20.5%), control 2 (5.8%)] Hair diameter: treated [before 41.38 ± 13.03 in µm, after 74.53 ± 13.87], control [before 42.09 ± 12.30 in µm, after 62.35 ± 15.71], | Hyperpigmentation and erythema, itching, desquamation, and pain | 5 |
| 8 | Yukiyasu ARAKAWA (2016) [ | Cohort | 308‐nm excimer light | 11 Patients | 1 M, 10 F | At least 8 months, every 2 weeks, irradiating along the midline of the scalp, then temporal regions of the head after sufficient terminal hair regrowth was seen along the midline | Initial dose of 200 mJ/cm2, with increments of 50 mJ/cm2 in each step | SALT score | From 96.8 ± 10.6 to 31.8 ± 40 (%) no patient with complete remission, the first occurrence of terminal hair growth after a mean of 15.5 ( ± 4.89) sessions | Not reported | 6 |
| 9 | Tzu‐Chien Hsu (2014) [ | Cohort | A 308‐nm excimer lamp | 17 Patients | 6 M, 11 F | At least 8 weeks, two to three times each week, | VTRAC™ Excimer Lamp, initial dose of 50 or 100 mJ/cm2, with increments of 50 mJ/cm2 every week | Response rate is defined as the percentage of patients with regrowth of hair to any extent, a “satisfactory response rate” is defined as the percentage of patients with hair regrowth of more than 50% of the hair loss areas | The overall response rate was 41.1%, and the satisfactory response rate was 29.4%. | Painful erythema, desquamation, pruritus | 5 |
| 10 | Medhat El‐Mofty (2019) [ | Clinical trial | PUVA | 40 Patients | 32 M, 8 F | 3 Months, twice a week, group A PUVA, group B intralesional corticosteroid (ILC) | Initial dose of 6 or 3 J/cm2, with increments of 2 J/cm2 every session | SALT score, patient satisfaction | Patient satisfaction 5point scale: 2.7 ± 1.45 (95% CI: 2.02–3.38) SALT score: before (41.47 ± 23.62), after (24.4 ± 20.95 (14.6:34.2)) | Pain, hyperpigmentation, blistering, itching, erythema | 4 |
| 11 | Mostafa Mokhtar Kamel (2011) [ | Clinical trial | PUVA | 35 Patients | 27 M, 8 F | Every 3 months, max. 1 year | Initial dose of 6 J/cm2, with increments of 1 J/cm2 every session | SALT score | Before median 2, IR(1–3), after median 1, IR(0–2), | Erythema, burning sensation, and hyperpigmentation | 3 |
| 12 | Kui Young Park (2013) [ | Cohort | PUVA | 32 Patients | 19 M, 13 F | 16 Weeks, twice a week, concomitant oral cyclosporine | Initial dose of 1 J/cm2, with increments of 0.5 J/cm2 | Excellent response, more than a 50% extent of hair regrowth; good response, hair regrowth of 25%–50%; fair response, hair regrowth of 10%–25%; and poor response, hair regrowth of 0%–10% | 3 (9.4%) of excellent responses; 5 (15.6%) of good responses; 11 (34.4%) of fair responses, 13 (40.6%) poor response | Gastrointestinal disturbance, hypertrichosis, headache, and hypertension | 5 |
| 13 | GürolAçıkgöz (2013) [ | Clinical trial | Topical 8‐MOP plus targeted UVA | 7 Patients | 7 M | 15–24 Sessions, 3 times a week | Daavlin T500x targeted phototherapy device, the initial dose of 0.3 or 0.5 J/cm2, with increments of 20%–30% every third therapy session | Four‐point scale (0 = no hair, 1 = white vellus hair, 2 = regrowth cosmetically acceptable for the patient, 3 = complete hair growth) | Score 1: 3, score 2: 1, score 3: 3, | Slight erythema | 3 |
| 14 | Lucinda Siyun Tan (2020) [ | Clinical trial | PUVA | 10 patients | 6 M, 4 F | 21–151 sessions, twice a week | With a curve panel and a flat panel UVA unit, the initial dose of 2.88–4.88 J/cm2 | Percentage of terminal hair regrowth and percentage change in baseline severity of alopecia tool (SALT) score | All the patients who continued treatment with paint PUVA without premature termination were successful in hair regrowth to more than 75%. | Scalp tenderness | 3 |
| 15 | Maira E. Herz‐Ruelas (2017) [ | Clinical trial | UVA‐1 | 22 Patients | 9 M, 13 F | 6 Months, 3 to 5 times a week | Sellamed 3000 UVA‐1‐Part‐body Radiation System, 25 sessions of 30 J/cm2, then 60–120 J/cm2 | SALT score defined as S0‐absence of hair loss, S1‐less than 25%, S2‐hair loss between 25% and 49%, S3‐hair loss between 50% and 74%, S4‐hair loss between 75% and 99%, and S5‐100% hair loss | Mean difference in SALT absolute value: in 30 J/cm2 (−1.09 ± 4.02, | Mild xerosis, mild hyperpigmentation | 3 |
| 16 | Muhsin A. Al‐Dhalimi (2019) [ | Clinical trial |
1540 nm Fractional erbium‐ glass laser | 30 Patients (60 patches) | 18 M, 12 F | 6 Weeks, every week, patches were divided to study and control groups, both receiving topical minoxidil | Quanta System S.P.A. DNA Laser Technology, 1 Hz frequency, 7 ms pulse duration, spot size 8 mm, energy MTS (microthermal spot) as 8.1 mJ, with 300 μm estimated depth | Hair count, percentage of hair regrowth, patient satisfaction | Hair count: before: (8.4667 ± 4.63669), after: (9.3000 ± 4.67680), follow‐up: (10.9667 ± 4.83153), | Burning sensation, erythema, itching | 4 |
| 17 | Wuyuntana Wang (2019) [ | Clinical trial | 1550‐nm NAF erbium–glass laser | 8 Patients | 4 M, 4 F | 20 Weeks, every 2 weeks | GSD, 10–15 mJ of energy with a total intensity of 300 spots/cm2 | Score: 0, no effect; 1, hair regrowth involving < 50% of the lesions; 2, hair regrowth involving more than 50% of the lesions | Score 0: 2, score1: 1, score2: 5, | Mild erythema and mildly broken hair shafts | 3 |
| 18 | Ji Hae Lee (2020) [ | Clinical trial | 311‐nm Titanium: Sapphire laser (TSL) | 19 Patients | 9 M, 10 F | Once or twice weekly | Gain‐switched 311‐nm TSL, the initial dose of 300 mJ/cm2, with increments of 50 mJ each session until MED | No regrowth, 0%; mild, 1%–24%; moderate, 25%–49%; good, 50%–74%; excellent, 75%–99%; complete, 100% | 14 Patients (73.9%) excellent to complete, 1 patient marked and 2 moderate, 2 patients no response | Persistent erythema | 3 |
| 19 | BasakYalici‐Armagan (2016) [ | Clinical trial | Long‐pulsed neodymium: yttrium aluminum garnet (Nd: YAG) laser and fractional carbon dioxide laser | 32 Patients (96 patches) | 19 M, 13 F | Nd: YAG laser 2–3 sessions with 2–8‐week intervals, the fractional carbon dioxide laser 3–6 sessions with 2 or 4‐week intervals, patchANd: YAG laser, patch B CO2 laser, patch C control | LaserscopeLyrai, shortest pulse duration of 30 ms and lowest energy of 10 J/cm2, eCO2, power of 30 W, 120 mm probe diameter, pulse energy 10–45 mJ/cm2, and density 75–100 spot/cm2/pass | SALT score, hair count | SALT score: Nd‐YAG: initial median = 28, final median = 33, | Pain in the CO2 laser group | 5 |
| 20 | Rania El‐Husseiny (2020) [ | Clinical trial | Fractional CO2 laser | 20 Patients | 12 M, 8 F | 3 Months, every 2 weeks, one patch treated with FCO2 laser, the other with ILC (Triamcinolone) | Fire‐Xel Bison laser, pulse width: 1026‐1346 μ, density: 0.8, and energy: 30.7–40.3 mJ | Patient satisfaction (10 point VAS), hair count, < 25% = no or minimal improvement, 25%–49% = moderate, 50%–74% = marked, > 75%– 99 = excellent, and 100% = complete improvement | CO2: 2/20 minimal, 3/20 moderate, 3/20 marked, 7/20 excellent, Median 4 ( > 75%–99%), IQR 2.5–4.5, ILC: 11/20 minimal, 9/20 moderate, Median 1 ( < 25%), IQR 1–2, | Mild pain, transient posttreatment scaling, erythema, and edema | 4 |
| 21 | Imran Majid (2018) [ | — | Fractional CO2 laser | 8 Patients | 4 M, 4 F | Max. 8 sessions, every 3 weeks, spraying triamcinolone solution immediately after each session | 120 µm tip, fluence of 50–60 mJ/cm2, and density of 100 microthermal zones (MTZ)/cm2 | Percentage of hair regrowth | 7 Patients with more than 75% regrowth | Nothing reported | — |
| 22 | Nermeen Mohamed Abdelhalim (2014) [ | Clinical trial | LLLT | 23 Patients (52 patches) | 14 M, 9 F | 4 Weeks, 3 times a week, 23 patches as control, 29 patches treated | ENDOLASER 422 – Enraf‐Norius® with a dose of 1.5 J/cm², 905 nm wavelength, and 5000 Hz frequency with a peak power of 100 W | hair count and visual analog scale (VAS) of hair loss (0–100) | VAS: before (87.79 ± 7.64), after (40.94 ± 26.92), Follow‐up (26.1 ± 31.33), | Not reported | 3 |
| 23 | HEBA A. EID (2018) [ | Clinical trial | Polarized (Biopteron) light therapy | 30 Patients | — | 3 Months, 3 times a week, Group A treated, Group B control, both receiving topical minoxidil | B‐type lens unit at a setting of 1.26 W, with 4‐s pulses delivered at 1‐s intervals | Hair count, the 7‐point scale for global photos assessment | 7‐Point scale: treated (before: −3, after:+1, | Not reported | 4 |
| 24 | KWANG HO YOO (2010) [ | Clinical trial | Photodynamic therapy (PDT) with red light | 8 Patients | 2 M, 6 F | 3 Sessions, every 4 weeks, microneedle rolling on the right side of the scalp, red light on both sides of the scalp | Aktilite lamp, average wavelength, 630 nm; light dose, 37 J/cm2 | Hair regrowth | No hair regrowth on both sides | Mild pain and erythema | 3 |
| 25 | C. M. Giorgio (2019) [ | Clinical trial | Photodynamic therapy (PDT) | 41 Patients | 17 M, 24 F | 18 Weeks, once every 3 weeks, Group A microneedling, Group B ALA‐PDT, group C both micro‐needling and ALA‐PDT | 630 nm, 37 J/cm2 |
0, no hair regrowth; 1, < 50% hair regrowth; 2, ≥ 50% hair regrowth; and 3, complete (100%) hair regrowth | Group A: no hair regrowth, Group B: 0(4), 1(1), 2(5), 3(2), Group C: 0(1), 1(6), 2(7), 3(3) | Not reported | 3 |
| 26 | Ali Tanakol (2020) [ | Clinical trial | 2940‐nm erbium:yttrium‐aluminum‐garnet (Er:YAG) laser | 25 Patients (16 scalp AA) | 19 M, 6 F | 3 Sessions, 4–6 weeks apart, | Fotona, the spot size of 4 mm, pulse energy 1.2 J, one laser pass, frequency of 6 Hz, long‐pulsed mode | Hair regrowth, SALT score, patient satisfaction (0–5) | Mean regrowth rate of 17.4 ± 3, 5% (0–100), A total of 16 patients who were treated for patchy alopecia areata of the scalp showed 27.8 ± 31.3% regrowth. mean percent change in the SALT score: 17.4 ± 3.5%, patient satisfaction: 1.84 ± 2.21 | Transient erythema, folliculitis | 4 |
Table 3
| First author, year | Study type | Light/laser type | Sample size | Sex | Intervention | Laser/light features | Judgment criteria | Results | Side effect | Risk of bias | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Mohammed K. Alhattab (2019) [ | Clinical trial | 1540‐nm fractional erbium‐glass laser | 47 Patients | 22 M, 25 F | 5 months, every 2 weeks |
Quanta System SPA DNA Laser Technology, 7 mm tip, 6 mJ pulse energy, 1 HZ frequency | Hair diameter, hair count, patient satisfaction, global evaluation scale (−3, +3) | Global scale: 12/47 + 1, 13/47 + 2, and 2/47 + 3, 18/47 0, and 2/47 ‐1, hair diameter: Women: (before 3.12 ± 0.43), (after 3.84 ± 0.51), | Mild erosion, mild erythema, burning sensation | 4 |
| 2 | JitladaMeephansan (2018) [ | Clinical trial | 1550 nm Er: Glass fractional laser | 23 Patients | 16 M, 7 F | 24 Weeks, every 2 weeks, | MOSAIC, 2*12‐mm tip, power 6 mJ, spot density 300 spots/cm2 (static mode), two passes | Hair diameter, terminal hair count, non‐vellus hair count | Hair diameter: before (42.52 ± 9.82 μm), after (50.74 ± 10.69), | TTolerable pain, significant itching, mild erythema | 3 |
| 3 | G.‐Y. Lee (2011) [ | Clinical trial | 1550 nm Er: Glass fractional laser | 27 Patients | 27 F | 5 Months, every 2 weeks |
Mosaic, 5–10 mm tip, 6;mJ pulse energy, 800 spot ⁄ cm2 density, static mode | Hair diameter, hair count | Hair diameter: before 58 ± 12, after 75 ± 13 μm ( | Pruritus | 3 |
| 4 | PoonkiatSuchonwanit (2019) [ | Clinical trial | 1550 nm Er:Glassfractional laser | 29 Patients | 29 M | 24 weeks, every 2 weeks, one side of scalp monotherapy with topical minoxidil, the other side combined laser and minoxidil therapy | Fines can, 7 mm probe diameter; energy 6 mJ; density 300 spot/cm2; 10% overlapping treatment area | Hair diameter, hair count, 7‐point global assessment scale, as follows (−3, +3) | Hair diameter: treated: [from 50.93 ± 13.59 to 67.28 ± 15.63 μm, | Tolerable pain, warmth sensation, erythema, itchiness, scaling | 4 |
| 5 | WON‐SERK KIM (2010) [ | Clinical trial | 1550 nm Er: Glass fractional laser | 20 Patients | 20 M | 10 Weeks, every 2 weeks, the right side of the scalp is the treated side, and the left side is the control | Energy 5 mJ, the density of 300 spots/cm2 | Hair density, hair caliber | Significant increase in hair density but no significant increase in hair caliber, 4 months after the final treatment density decreased to baseline level. | Pain, transient shedding, erythema, pruritus, dryness, dandruff | 3 |
| 6 | Doris Day (2021) [ | Nonablative Er:YAG laser |
16 Patients | 7 M, 9 F | 16 Weeks, every 2 weeks, In 10 out of 16 patients, treatment was combined with PRP at every other session | SP Dynamis, Fotona, 2940 nm, 7 mm spot size, 7.00 J/cm2 pulse fluence, 3.3 Hz frequency | Clinical and blind evaluation | Reduction of AGA grade compared to baseline ( | Pain | 3 | |
| 7 | Yue Huang (2017) [ | Clinical trial | Ablative carbon dioxide (CO2) fractional laser | 27 Patients | 27 M | 6 Sessions, every 2 weeks, one side of the scalp treated, the other side left as control, topical hair growth factor on the entire scalp | Pixel CO2, 50‐mm tip, 12–18 mJ/spot, 361 spots/cm2, one pulse, and 40% density | 7‐Point global‐assessment scale (−3, +3), hair diameter, hair count | (+1, +2, +3) 25/27 (93%), (0) 2/27 (7%), (−1, −2, −3) 0, | Erythema, edema, pruritus, dryness, seborrheic dermatitis, and dandruff | 4 |
| 8 | Sung Bin Cho (2018) [ | Clinical trial | 1927‐nm fractionated thulium laser | 10 Patients | 10 M | 12 Weeks, every week, GF solution on a randomly half a | LASEMD™, power of 5 W and energy of 4 mJ (50.9 J/cm2) or 6 mJ (76.4 J/cm2), static operating mode | Hair diameter, Hair count | Hair diameter: before (0.047 ± 0.009 mm), after (0.059 ± 0.01 mm), ( | Mild transient scalp redness, mild itching, mild burning sensation, mild to moderate seborrheic dermatitis | 4 |
| 9 | Sung Bin Cho (2016) [ | Clinical trial | 1927‐nm fractionated thulium laser | 16 Patients | 12 M, 4 F | 12 weeks, every week, group A: Thulium laser and PDRN, group B: mesotherapy and PDRN | LASEMD™, power of 5 W, energy of 6 mJ under a static operating mode | Hair thickness, hair count | Thickness: before (4.038 ± 1.678), after (5.906 ± 1.946), | Itching sensations and desquamation | 3 |
| 10 | Joaquin J. Jimenez (2014) [ | Clinical trial | A low‐level laser device | 225 Patients | 103 M, 122 F | 26 Weeks, 3 times a week | HairMax Laser Comb, 7‐ and 9‐beam lasercombs655 nm, 12‐beam wavelength of 635 nm | Hair count | Female (9‐beam laser comb: (before 162.6 ± 46.2, change after 16w 14.8, after 26w 20.2, | Dry skin, pruritus, scalp tenderness, irritation, warm sensation | 5 |
| 11 | Jung Soo Yoon (2020) [ | Clinical trial | Low‐level light therapy (LLLT) | 59 Patients | 39 M, 20 F | 16 Weeks, every other day, group A: experimental device, group B: sham device | HAIRUP, 2.36 mW/cm2 (2.56 mW/cm2) at a wavelength of 655 nm | Hair count, hair diameter, patient satisfaction | Diameter: before: [treated 62.20 ± 23.23, sham 68.86 ± 21.22, | Nothing reported | 5 |
| 12 | Poonkiat Suchonwanit (2018) [ | Clinical trial | LLLT | 36 Patients | 19 M, 17 F | 24 Weeks, 3 times a week, 19 patients in laser and 17 patients in the sham group |
RAMACAP, 660 ± 10 nm, the power density of 3.5 mW/ cm2, fluence of 4 J/cm2 | Hair density, hair diameter | Diameter: treated [Baseline (53.8 ± 11.6), mean change 6.11 ± 2.15 μm], sham [Baseline (54.2 ± 15.1), mean change 3.76 ± 1.24 μm], | Increased hair shedding, mild scalp itching | 4 |
| 13 | Hyojin Kim (2013) [ | Clinical trial | LLLT | 40 Patients | 26 M, 14 F | 24 Weeks, 18 min daily, sham group, and treated group | The Oaze, 60.7 mW/cm2 for the 630‐nm LED, 182.8 mW/cm2 for the 660‐nm LED, and 115.4 mW/cm2 for the LD; total energy density of 92.15 mW/cm, Energy fluence 47.90 J/cm2 | Hair diameter, hair count, global assessment of hair regrowth (0–4) | G0= (sham2/14, LLLT0/15), G1= (sham11/14, LLLT7/15), G2 = (sham1/14, LLLT4/15), G3 = (sham0/14, LLLT3/15), G4 = (sham0/14, LLLT1/15), n = 29, | Headache, skin pain, pruritus, erythema, and acne | 4 |
| 14 | Sabrina Mai‐Yi Fan (2018) [ | Clinical trial | LLLT | 74 Patients | 61 M, 13 F | 24 Weeks, 3 times a week, half of the scalp received LLLT, the other half sham light | The iRestore ID‐520, 660 nm with 22 mW/cm2, or 659 nm with 4.6 mW | Investigator's global assessment (IGA), hair coverage, hair diameter, hair count | IGA: Week4 (1.2 ± 0.6), week12 (1.7 ± 0.6), | Eczema, pruritus, and acne | 4 |
| 15 | BehroozBarikbin (2017) [ | Clinical trial | Low‐level diode laser scanner | 90 Patients | 60 M, 30 F | Max. 4 months, 3 times a week, group 1: 655 nm with 3 J/cm2, group 2: 655 nm with 2 J/cm2 plus 808 nm with 1 J/cm2, group 3: control group | Laser scanner, 655 nm, and 808 nm | Hair count, patient satisfaction (G1–G4) | Patient satisfaction: Laser scanner: (end G4:2 G3:19 G2:11, 6 m F/U: G4:1 G3:6 G2:22 G1:1, 12 m F/U: G4:1 G3:5 G2:23 G1:1), Laser hat:(end G4:1 G3:17 G2:10 6 m G1:2, F/U: G3:8 G2:20 G1:2, 12 m F/U: G3:5 G2:21 G1:4), Count: Laser scanner: (before 52.06 ± 48.51, after 61.67 ± 53.11, | Mild headache, dry skin | 4 |
| 16 | Gita Faghihi (2018) [ | Clinical trial | LLLT | 45 Patients | 15 M, 30 F | 6 Months, 2 or 3 sessions per week, 22 patients received sham light, 23 received LLLT, both groups treated with topical minoxidil | With a 10–50 MW power and a 785‐nm wavelength | Hair diameter, hair count, patient satisfaction | Diameter: before (case 0.050 ± 0.006, control 0.051 ± 0.011 | Headache, itching, burning, erythema | 4 |
| 17 | Yang Liu (2020) [ | Clinical trial | LLLT | 83 Patients | 83 F | 6 Months, every other day, Group A: LLLT, Group B: Minoxidil, group C: Both | iHelmet, 200 5 mW laser diode source (650 nm) arrays | Hair count, hair diameter, scalp oil secretion | Diameter: before (49.89 ± 6.349), after (62.39 ± 6.932), | Scalp tenderness, mild scalp pruritus | 3 |
| 18 | Raymond J. Lanzafame (2014) [ | Clinical trial | LLLT | 42 Patients | 42 F | 16 Weeks, every other day, 24 patients in treated, and 18 patients in the sham group | TOPHAT655, 655 nm with 7 J/cm2 irradiance and 2.9 J dose | Hair count | Case: [before (335.4 ± 144.6), after (157.8 ± 50.5), | Nothing reported | 3 |
| 19 | Shelly Friedman (2017) [ | Clinical trial | LLLT | 40 Patients | 40 F | 17 Weeks, every other day, 19 patients in treated, and 21 patients in the sham group | Capillus272 Pro device, 650 nm, 1360 mW total delivered energy over 582 cm2 or 2.34 mW/cm2 | Hair count | Terminal hair count: before (189.3 ± 85.8), after (268.3 ± 117.7), | Nothing reported | 3 |
| 20 | Samia M. Esmat (2017) [ | Clinical trial | LLLT | 45 Patients | 45 F | 4 Months, 3 days weekly, group 1: topical minoxidil, group 2: LLLT, group 3: both | iGROW1 helmet device, < 5 mW CW and LED wavelength range from 650 to 670 nm | Patient satisfaction (0 = dissatisfied, 3 = satisfied), hair diameter, hair count | Patient satisfaction: 3/15 score 0, 7/15 score 1, 4/15 score 2, 1/15 score 3, Diameter: before (0.047 ± 0.013), after 2m (0.051 ± 0.017), | Irritation, scalp tenderness, warm sensation, the initial increase in the hair shedding | 4 |
| 21 | Raymond J. Lanzafame (2013) [ | Clinical trial | LLLT | 41 Patients | 41 M | 16 Weeks, every other day, 22 patients in active, and 19 patients in the sham group | TOPHAT655, 5 mW lasers (655 ± 5 nm), and 31 LEDS (655 ± 20 nm), 67.3 J/cm2 irradiance | Hair count | Case: before (142.0 ± 73.0), after (228.7 ± 102.8), sham: before (162.7 ± 95.9), after (162.4 ± 62.5), | Nothing reported | 3 |
| 22 | Kenneth Blum (2014) [ | Cold beam low‐level laser light |
119 (48 subjects completed all study visits) | 119 M | 26 Weeks, 70 patients as case and 49 as control | The novel cold X5 hair laser device, | Hair count | Baseline (159.00 ± 65.39), Week4 (167.90 ± 63.55), Week8 (169.30 ± 71.24), Week14 (178.90 ± 69.63), Week20 (170.00 ± 67.46), Week26 (174.80 ± 68.97), | Nothing reported | 4 | |
| 23 | AndréiaMunck (2014) [ | Clinical trial | LLLT | 32 Patients | 11 M, 21 F | 8.7 ± 5.2 months, 3 times weekly | HairMax Laser Comb, 655 nm | Global photographic assessment | 8 Patients showed significant, 20 moderate, and 4 no improvement | Nothing reported | 3 |
| 24 | Mohamed Amer(2021) [ | Clinical trial | LLLT | 13 Patients | 13 F | 16 Weeks, 2 sessions per week, | iGrow Hair Growth System (TOPHAT655), 655 nm | Hair count | Before 222.3 ± 33.5, after 255.3 ± 30.4, | Headache, dryness of hair, heat sensation, scalp tenderness | 4 |
| 25 | Fernanda Ferrara (2021) [ | Clinical trial | Low‐level laser irradiation | 19 Patients | 19 M | 6 Months, 2 times per day, the left half of the device emitted light, and the right half did not, topical minoxidil on both sides | Capellux®, 5 mW of 660 nm light, a total of 5.5 J/cm2/day | Hair count | Total hair count: sham (80.2 ± 20.3 to 110.3 ± 22.6, | Nothing reported | 4 |
| 26 | G. Lodi (2021) [ | Blue LED light | 20 Patients | 20 M | 10 Weeks, twice a week, | Blue LED light device, 417 ± 10 nm, fluence of 120 J/cm2, and power intensity of 60 mW/cm2 ± 20% | Hair density and hair shaft width | Density: (106 ± 66 to 117 ± 69 units/cm2, | Slight darkening of hair | 3 |
Table 4
| First author, year | Study type | Alopecia type | Light/laser type | Sample size | Sex | Intervention | Laser/light features | Judgment criteria | Results | Side effect | Risk of bias | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Pablo Fonda‐Pascual (2018) [ | Clinical trial | Lichen planopilaris (LPP) | Low‐level light therapy (LLLT) | 8 Patients | 3 M, 5 F | 6 Months, daily | Skymedic, 630 nm and a fluence of 4 J/cm2 | Lichen planopilarisactivity index (LPPAI), terminal hair thickness (THT) | LPPAI (0–10): before mean 3.35 (range 2.50‐4.50), after 3 m mean 2.417 (range 1–7.5), | Not reported | 4 |
| 2 | AgnieszkaGerkowicz (2019) [ | Clinical trial | frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) | novel superluminescent light‐emitting diodes (sLEDs) |
16 Patients (8 with FFA and 8 with LPP) | 16 F | 10 Weeks, weekly | Red Beam Pro + 630 ± 5 nm with a maximum power density of 100–120 mW/cm2, dose per session 44.45 J/cm2 and light power density of 70 mW/cm2 | Lichen Planopilaris Activity Index (LPPAI) 1‐10, Frontal Fibrosing Alopecia Severity Score (FFASS) 0‐25 | LPPAI: before (median 4.66, IR 3.23), after (median 1.33, IR 1.88), | Stinging sensation, pleasant warmth, and skin dryness | 4 |
| 3 | SUHYUN CHO (2013) [ | Clinical trial | Ophiasis ( | 1550‐nm erbium – glass laser (NAFL), CO2 laser (AFL) | 17 Patients | 9 M, 8 F | 8–22 sessions (mean = 15.2), every 2–4 weeks | For NAFL fluence of 6–8 mJ and a density of 300 spots/cm2/pass, for AFL fluence of 30–50 mJ, a density of 150 spots/cm2 | Global improvement score scale (0–4), patient satisfaction (1–4) | Mean clinical improvement score = 2.2, patient satisfaction score = 2.5, 12 (70.6%) demonstrated a clinical response | Pain, transient posttreatment crusting, scaling, erythema, and edema | 3 |
| 4 | Michael J. Randolph (2020) [ | Case series | LPP | LLLT | 4 Patients | 4 F | 6–18 months, daily | Tricoglam or CapillusPro or Capellux I9, 650 nm wavelength 5 mW power per light or 650nm wavelength with 1360 mW or 660 nm wavelength 25.5 mW/cm2 irradiance | Clinical assessment | All patients had improvement of symptoms and signs of disease on dermoscopy after 3 months. | Nothing reported | — |
| 5 | Lun Yang (2021) [ | Clinical trial | Folliculitis decalvans | 5‐aminolevulinic acid photodynamic therapy (ALA‐PDT) | 13 Patients | 13 M |
3 Sessions, every 10–14 days | 633 nm, intensity of 100 mW/cm2 | Recovery (symptoms disappearance), significant improvement (lesion reduction> =70%), moderate improvement (lesion reduction > =30%), ineffective (lesion reduction < 30%) | 4 Recovered, 7significantly improved, 2 moderately improved | Not reported | 3 |
Table 5
| First author, year | title | Light/laser type | Sample size | sex | intervention | Laser/light features | Judgment criteria | results | Side effect | Risk of bias |
|---|---|---|---|---|---|---|---|---|---|---|
| Mohamed Amer (2021) [ | Clinical trial | Low‐level light therapy (LLLT) | 7 Patients | 7 F |
16 Weeks, 2 sessions per week | TOPHAT655, 655 nm | Hair count | 271.2 ± 39.0 vs. 294.2 ± 38.1, | Headache, dryness of hair, heat sensation, scalp tenderness | 4 |
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