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HAIR LOSS

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SUMMARY

  • Hair loss is a common problem, ultimately affecting at least half of all men and women.

  • While medical therapy is the mainstay approach, other interventional options such as hair transplantation are increasingly popular.

  • Low-level laser and light therapy show some promise for hair loss treatment, though large comparative nonindustry sponsored trials are lacking.

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  • Patients should understand that the degree of improvement seen with LLLT may be modest.

  • Frequent treatments may be necessary to see a meaningful response.

  • Patients should appreciate the distinction between a statistically significant improvement and a clinically significant improvement.

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  • Given the availability of relatively low-cost LED arrays, many patients now choose to attempt treatment using home-based devices.

  • In-office laser or LED-based devices remain an option, and patients should be aware of the need for frequent treatments.

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  • While in theory low-energy settings on existing devices may be used to treat hair loss, care should be taken to keep settings low enough so as not to cause hair loss.

image Pitfalls and Cautions

  • Though hair counts may increase with LLLT treatment, it is not clear whether the clinical impact of therapy is sufficient to be meaningful to patients. Therefore, medical and transplant approaches should probably be considered the first line treatment for hair loss.

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  • Many treatments will be required, and the degree of improvement in hair loss may be modest.

  • LLLT can best be conceptualized as an adjunct approach to hair loss management.

image Billing Pearls

  • Almost all insurers in the United States exclude laser- and light-based treatments from coverage.

  • Patients may benefit from committing to a series of treatments, as this may allow significant cost savings.

  • Alternatively, many patients are opting for home-based units, as the one-time cost of purchase is significantly less than the cost of repeated treatments in a physician’s office.

INTRODUCTION

Alopecia is a common disorder, and androgenetic alopecia (AGA) is the most common form of hair loss in both men and women, with half of men over 50 and half of women over 80 affected. AGA is likely the product of a genetic predisposition (as revealed by high concordance rates among monozygotic twins) coupled with androgen hypersensitivity. The effect of testosterone and dihydrotestosterone on hair follicles has been thoroughly elucidated. With progression of AGA, both the proliferation of follicles and the period of time follicles are in anagen decrease, resulting in miniaturization of the hair follicle and conversion of terminal hairs into vellus hairs.

Hair loss can be detrimental to both the mental health and quality of life of patients. This is especially true of women, due largely to societal norms and expectations. Scalp hair is central to not only one’s identity, but also defines the perception of what is attractive for both men ...

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