Energizing Alopecia Care: Laser and Energy Assisted Drug Delivery

Original Article: The role of laser and energy-assisted drug delivery in the treatment of alopecia.

What are the key takeaways of this article?

Laser and energy assisted drug delivery (LEADD) as articulated by Balzic et al. offers a strategy for the treatment of hair loss. It uses a spectrum of methodologies, blending topical and intralesional medications with advanced technologies such as laser, radiofrequency, and microneedling. By using a combination of these modalities, LEADD aims to optimize the delivery and efficacy of therapeutic agents like minoxidil and platelet-rich plasma (PRP).

The authors conducted a literature review using key words “laser-assisted drug delivery,” “laser,” and “alopecia.” Studies involving ablative fractional lasers (AFL), non-ablative fractional lasers (NAFL), and radiofrequency microneedling (RFMN) between 2018 and 2022 were included. Upon data analysis, it was found that LEADD therapies were used for two specific subtypes of alopecia: alopecia areata (AA) and androgenic alopecia (AGA).

Minoxidil is a commonly used topical treatment for AGA. Previous studies have showed increased hair count and thickness when combined with LEADD techniques such as radiofrequency microneedling (RFMN) or NAFL. However, the diversity in laser and energy devices used makes it challenging to determine the most effective LEADD approach for AGA/PHL. While not traditionally used for AA, one case series reported significant hair regrowth in some patients when LEADD was combined with topical minoxidil.

PRP is another emerging therapy for AGA. Studies showed mixed results, with some indicating improvements in hair density but lacking significant differences compared to monotherapy. Variability in treatment protocols, such as pulse settings for lasers or the addition of other treatments like topical minoxidil, complicates the assessment of LEADD with PRP efficacy for AGA. Overall, LEADD with PRP for AGA showed promise but requires further research to determine its superiority over monotherapy.

Topical and intralesional corticosteroids are commonly used in treating AA and can be paired with laser or energy devices for combination therapy. Studies have demonstrated the efficacy of microneedling or AFL, combined with triamcinolone acetonide (TAC) application, in reducing AA severity. In one included study, microneedling showed superior results. Positive outcomes have been observed in small case series investigating TAC delivery with AFL or radiofrequency microneedling (RFMN). In an RCT comparing microneedling-assisted drug delivery and PRP with TAC, microneedling was found to be more effective than AFL for drug delivery, with TAC application yielding better results than PRP. Although the evidence suggests LEADD with TAC was effective for AA, there is not enough evidence to suggest superior efficacy when compared with microneedling-assisted drug delivery.

Alternative topical corticosteroids like clobetasol and betamethasone were also investigated. Combination therapy involving AFL followed by clobetasol or betamethasone demonstrated significant improvement in AA severity scores compared to topical corticosteroid alone. Another study showed statistically significant decreases in AA severity scores with the combination of betamethasone and LEADD, as well as betamethasone and AFL exhibiting greater reductions in AA compared to the topical corticosteroid group. These findings suggest that combining topical corticosteroids with LEADD techniques may enhance treatment outcomes for AA.

Growth factors (GFs) combined with AFL were investigated in a split-scalp RCT for AGA. This study showed a significant increase in hair density compared to a control group. Another split-scalp study for pattern hair loss (PHL) demonstrated increased hair counts after weekly full-scalp NAFL treatment combined with GFs.

In summary, this review by Balzic et al. outlines how multiple traditional drug modalities can be combined with lasers for augmented effect. This included promising evidence combining LEADD techniques with minoxidil or topical corticosteroids for AA as well as combining ablative fractional laser with growth factors for AGA. Ultimately, prior to drawing more definitive conclusions, larger well designed studies are needed to inform treatment guidelines and standards.

Publication Date: May 6th, 2024

Reference: Balazic, E., et al. (2024). "The role of laser and energy-assisted drug delivery in the treatment of alopecia." Lasers in Medical Science 39(1): 73.

Summary By: Jaycie Dalson