At-home therapy plus in-office treatment maximizes hair growth investment

by Deanne Mraz Robinson, MD

Androgenetic alopecia, or AGA, is the most common form of hair loss, affecting up to 80% of men and 50% of women.

Mraz Robinson, MD
Deanne Mraz Robinson

This disorder is located primarily on the central scalp with both male and female patterns of loss. Pathophysiological features include an alteration in the hair cycle via reduction of the anagen/growth phase, inflammation and follicular miniaturization.

The number of patients presenting in my practice with complaints about this chronic, nonscarring hair disorder is increasing, as are over-the-counter, prescription and in-office solutions that can help slow or stop hair loss and, in some cases, even help regrow hair.

By the time patients see me for a consultation, they have experimented with what is commercially available and have typically tried most of the medical-grade hair growth solutions. With the advent of websites such as Hims, Keeps and Roman, which offer a direct-to-consumer approach, it is relatively easy for patients to make their way through the gamut of available generic and OTC drugs before visiting a physician.

Platelet-rich plasma

Thus, by the time my professional opinion is sought, platelet-rich plasma (PRP) injections and hair transplant are usually among the remaining untapped interventions.

PRP and hair transplant represent a significant financial investment. So, when patients agree to these pricey out-of-pocket procedures, I suggest that they consider layering on at-home therapy, as well. The purpose of this concomitant approach is to protect their PRP or hair transplant investment by safeguarding against further hair loss or even augmenting the results by providing additional hair growth.

Some patients prefer to commit solely to in-office initiatives; others are open to my recommendation. They appreciate the pragmatic suggestion that home care enhances and supports what we are doing in the office.

It is akin to using SPF after laser for lentigines or hyperpigmentation. This strategy is also what I recommend to patients who undergo in-office aesthetic procedures. I routinely advise patients who get toxin or filler injections or aesthetic laser treatments to also adhere to a thorough, high-end skin care routine to protect and potentially lengthen the life span of the results.

The combined in-office and at-home treatment regimen keeps the patient engaged in the process. A tangential benefit that our practice has noticed is that this continued “engagement” fosters a willingness to cooperate with scheduled treatment and follow-up sessions.

For PRP and transplant patients who are open to layered treatment, I use a combination of oral finasteride, topical minoxidil and/or spironolactone, depending if it is a male or female patient.

Light therapy for hair growth

I am also starting to include light therapy in the mix. As clinical data build, light therapy is gaining a reputation as a solution that can be effective either alone or layered with other interventions.

PRP and light therapy are similar in that their efficacy is supported by the literature, but they are sometimes misunderstood. By way of explanation, PRP contains growth factors and cytokines that enhance the body’s inherent capacity to repair and regenerate. Platelet-derived growth factor, transforming growth factor, vascular endothelial growth factor, epidermal growth factor, fibroblast growth factor, connective tissue growth factor and insulin-like growth factor 1 are among the growth factors thought to stimulate hair regrowth.

Light therapy for hair growth could refer to low-level light therapy, laser light therapy, red light therapy and/or modulated light therapy.

Evidence suggests that photobiomodulation with red light acts on the mitochondria and may alter cell metabolism through increased advanced tricho pigmentation production as well as the release of nitric oxide, which leads to vasodilation and increased blood flow.

A particularly noteworthy self-administered, at-home light therapy apparatus is the all LED light Revian Red (PhotonMD). This FDA-cleared system appears promising based on top-line results from a prospective, randomized, placebo-controlled, double-blind study to evaluate the efficacy and safety of modulated light therapy in male and female participants with AGA.

Revian Red demonstrated the ability to stop hair loss and subsequently promote hair growth with a device that shines a two-color combination of red light. Based on this promising evidence, there is no reason not to recommend Revian Red as a supplemental, at-home treatment to be used in combination with office-based treatments.

A growing list of interventions in alopecia

The good news for patients is there is a growing list of interventions available for the treatment of AGA. Medications such as minoxidil, spironolactone and finasteride, as well as red light therapy, are available for at-home use. PRP injections and surgical hair transplant are among the in-office treatment options. When patients opt for high-cost, in-office procedures, I recommend they also include an at-home treatment to help prevent further hair loss, protect the hair growth already achieved or possibly even augment the process with additional hair growth.

 

References:

Afifi L, et al. Lasers Surg Med. 2017;doi:10.1002/lsm.22512.

Akiyama M, et al. J Invest Dermatol. 1996;doi:10.1111/1523-1747.ep12343381.

Avci P, et al. Lasers Surg Med. 2014;46:doi:10.1002/lsm.22170.

Bae JM, et al. Lasers Surg Med. 2015;doi:10.1002/lsm.22358.

Cranwell W, et al. Male androgenetic alopecia. In: Feingold KR, et al, eds. Endotext. South Dartmouth, MA: MDText; updated Feb. 29, 2016.

Dhillon RS, et al. Arthritis Res Ther. 2012;doi:10.1186/ar3914.

Marwah M, et al. Int J Trichology. 2014;doi:10.4103/0974-7753.136763.

Modulated light therapy in participants with pattern hair loss. clinicaltrials.gov/ct2/show/NCT04019795.

Piraccini BM, et al. G Ital Dermatol Venereol. 2014;149(1):15-24.

Stefanato CM. Histopathology. 2010;doi:10.1111/j.1365-2559.2009.03439.x.

Varothai S, et al. Am J Clin Dermatol. 2014;doi:10.1007/s40257-014-0077-5.

 

For more information:

Deanne Mraz Robinson, MD, is co-founder and president of Modern Dermatology in Westport, CT. She can be reached at: drobinson@moderndermct.com.

Disclosures: Robinson is a speaker for Alastin, Cynosure, ISDIN and Merz and a consultant for Alastin, Allergan, Galderma, Merz and skinbetter science.

by Deanne Mraz Robinson, MD

Androgenetic alopecia, or AGA, is the most common form of hair loss, affecting up to 80% of men and 50% of women.

Mraz Robinson, MD
Deanne Mraz Robinson

This disorder is located primarily on the central scalp with both male and female patterns of loss. Pathophysiological features include an alteration in the hair cycle via reduction of the anagen/growth phase, inflammation and follicular miniaturization.

The number of patients presenting in my practice with complaints about this chronic, nonscarring hair disorder is increasing, as are over-the-counter, prescription and in-office solutions that can help slow or stop hair loss and, in some cases, even help regrow hair.

By the time patients see me for a consultation, they have experimented with what is commercially available and have typically tried most of the medical-grade hair growth solutions. With the advent of websites such as Hims, Keeps and Roman, which offer a direct-to-consumer approach, it is relatively easy for patients to make their way through the gamut of available generic and OTC drugs before visiting a physician.

Platelet-rich plasma

Thus, by the time my professional opinion is sought, platelet-rich plasma (PRP) injections and hair transplant are usually among the remaining untapped interventions.

PRP and hair transplant represent a significant financial investment. So, when patients agree to these pricey out-of-pocket procedures, I suggest that they consider layering on at-home therapy, as well. The purpose of this concomitant approach is to protect their PRP or hair transplant investment by safeguarding against further hair loss or even augmenting the results by providing additional hair growth.

Some patients prefer to commit solely to in-office initiatives; others are open to my recommendation. They appreciate the pragmatic suggestion that home care enhances and supports what we are doing in the office.

It is akin to using SPF after laser for lentigines or hyperpigmentation. This strategy is also what I recommend to patients who undergo in-office aesthetic procedures. I routinely advise patients who get toxin or filler injections or aesthetic laser treatments to also adhere to a thorough, high-end skin care routine to protect and potentially lengthen the life span of the results.

The combined in-office and at-home treatment regimen keeps the patient engaged in the process. A tangential benefit that our practice has noticed is that this continued “engagement” fosters a willingness to cooperate with scheduled treatment and follow-up sessions.

For PRP and transplant patients who are open to layered treatment, I use a combination of oral finasteride, topical minoxidil and/or spironolactone, depending if it is a male or female patient.

PAGE BREAK

Light therapy for hair growth

I am also starting to include light therapy in the mix. As clinical data build, light therapy is gaining a reputation as a solution that can be effective either alone or layered with other interventions.

PRP and light therapy are similar in that their efficacy is supported by the literature, but they are sometimes misunderstood. By way of explanation, PRP contains growth factors and cytokines that enhance the body’s inherent capacity to repair and regenerate. Platelet-derived growth factor, transforming growth factor, vascular endothelial growth factor, epidermal growth factor, fibroblast growth factor, connective tissue growth factor and insulin-like growth factor 1 are among the growth factors thought to stimulate hair regrowth.

Light therapy for hair growth could refer to low-level light therapy, laser light therapy, red light therapy and/or modulated light therapy.

Evidence suggests that photobiomodulation with red light acts on the mitochondria and may alter cell metabolism through increased advanced tricho pigmentation production as well as the release of nitric oxide, which leads to vasodilation and increased blood flow.

A particularly noteworthy self-administered, at-home light therapy apparatus is the all LED light Revian Red (PhotonMD). This FDA-cleared system appears promising based on top-line results from a prospective, randomized, placebo-controlled, double-blind study to evaluate the efficacy and safety of modulated light therapy in male and female participants with AGA.

Revian Red demonstrated the ability to stop hair loss and subsequently promote hair growth with a device that shines a two-color combination of red light. Based on this promising evidence, there is no reason not to recommend Revian Red as a supplemental, at-home treatment to be used in combination with office-based treatments.

A growing list of interventions in alopecia

The good news for patients is there is a growing list of interventions available for the treatment of AGA. Medications such as minoxidil, spironolactone and finasteride, as well as red light therapy, are available for at-home use. PRP injections and surgical hair transplant are among the in-office treatment options. When patients opt for high-cost, in-office procedures, I recommend they also include an at-home treatment to help prevent further hair loss, protect the hair growth already achieved or possibly even augment the process with additional hair growth.

 

References:

Afifi L, et al. Lasers Surg Med. 2017;doi:10.1002/lsm.22512.

Akiyama M, et al. J Invest Dermatol. 1996;doi:10.1111/1523-1747.ep12343381.

Avci P, et al. Lasers Surg Med. 2014;46:doi:10.1002/lsm.22170.

Bae JM, et al. Lasers Surg Med. 2015;doi:10.1002/lsm.22358.

Cranwell W, et al. Male androgenetic alopecia. In: Feingold KR, et al, eds. Endotext. South Dartmouth, MA: MDText; updated Feb. 29, 2016.

Dhillon RS, et al. Arthritis Res Ther. 2012;doi:10.1186/ar3914.

Marwah M, et al. Int J Trichology. 2014;doi:10.4103/0974-7753.136763.

Modulated light therapy in participants with pattern hair loss. clinicaltrials.gov/ct2/show/NCT04019795.

Piraccini BM, et al. G Ital Dermatol Venereol. 2014;149(1):15-24.

Stefanato CM. Histopathology. 2010;doi:10.1111/j.1365-2559.2009.03439.x.

Varothai S, et al. Am J Clin Dermatol. 2014;doi:10.1007/s40257-014-0077-5.

 

For more information:

Deanne Mraz Robinson, MD, is co-founder and president of Modern Dermatology in Westport, CT. She can be reached at: drobinson@moderndermct.com.

Disclosures: Robinson is a speaker for Alastin, Cynosure, ISDIN and Merz and a consultant for Alastin, Allergan, Galderma, Merz and skinbetter science.