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Home-Use Laser and Light Devices: Just What the Doctor Ordered

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Home-Use Laser and Light Devices: Just What the Doctor Ordered ENERGY-BASED DEVICES ENERGY-BASED DEVICES LASER Plasma Radiofrequency Ultrasound ASSISTED MICRONEEDLING Electromagnetic Pulse Picosecond Acoustic Pulse Nd:YAG LED thulium IPL COMBINED ENERGIES CO2Superficial Radiation Blue Light Home-Use Laser and Light Devices: Just What the Doctor Ordered Laser and light-based devices are more at home than ever as lightweight LEDs, wearable technology, and “smart” apps support adherence and enhance efficacy. BY MICHAEL GOLD, MD The popularity of home-use laser and light-based devic- up” means a device is safe and effective, so guiding patients >> es for treatments such as hair growth, hair removal, toward this technology and away from items that have not and acne reduction has grown exponentially over the past 10 been sufficiently vetted means we can comfortably vouch for years and shows no signs of abating. Having been involved in the device’s safety and ability to provide results. the FDA studies of many of these devices, I was acutely aware of my peers’ earlier fears that these home-use devices (HUD) HAIR GROWTH would displace office visits. Over the years, these concerns have Androgenetic alopecia, which affects more than 80 million dissipated and been replaced by awareness that, when used as Americans and results in pattern hair loss in both men and an adjunct to in-office treatments, HUDs offer advantages to women is among the leading motivators of those who seek patients as well as to those of us who support their use. When help with hair growth or restoration. Hair growth in patients your patients ask you to recommend a home-use device or who have androgenetic alopecia has been successfully they mention that they’re already using one, just keep in mind achieved through a range of energy-based devices, includ- that the at-home aesthetic device market will always be as ing fractional lasers and home-use Low-Level Laser therapy robust as your clients’ desire to look good—so there will always (LLLT) devices. The delivery of this non-thermal, low intensity be plenty of business to go around. light (10mW–500mW) triggers biochemical changes whereby HUDs empower patients to play an integral role in their photons of light are absorbed by cellular photoreceptors and overall treatment plan. In some instances, these devices help result in downstream alterations to gene expression or cell patients achieve additional improvement when used in tandem signaling cascades.1 Light administered either through low with on-going office treatments; in other instances circum- powered lasers or LEDs with a wavelength in the red to near stances preclude patients from presenting for in-office treat- infrared region of the spectrum (660nm–905nm), had been ment, and in those cases HUDS help patients maintain and/ or achieve additional gains. Never has this been more relevant Home-use devices (HUDs) enable patients to continue their care than it is today: The COVID-19 pandemic and its associated while they’re at home and provide us with an opportunity to guide call to shelter in place make the ability for patients to perform our patients to options that will augment our onsite treatments and treatments at home an unanticipated benefit. No one could interventions. We must counsel patients who purchase HUDs to have foreseen that our offices would be closed for an extended have realistic expectations and must advise that they choose only period of time, or that routine, non-emergent care would be devices that are FDA approved or cleared. The FDA’s “thumbs up” temporarily halted. Despite these unprecedented circumstanc- means a device is safe and effective, so guiding patients toward es, HUDs enable our patients to continue treatment. this technology and away from items that have not been sufficiently HUDs provide patients with a vehicle to enable them to con- vetted means we can comfortably vouch for the device’s safety and tinue their care while they’re at home and provide us with an ability to provide results. opportunity to guide our patients to options that will augment our onsite treatments and interventions. First and foremost, we must counsel patients who purchase HUDs to have realistic expectations; second, we must advise that they choose only devices that are FDA approved or cleared. The FDA’s “thumbs thebottomline AUGUST 2020 PRACTICAL DERMATOLOGY 51 ENERGY-BASED DEVICES ENERGY-BASED DEVICES LASER Plasma Radiofrequency Ultrasound ASSISTED MICRONEEDLING Electromagnetic Pulse Picosecond proven in clinical trials to have a good effect on pain, inflam- nitric oxide (NO). Simulation of NO leads to vasodilation mation and tissue repair before it became clear that low-level and increased blood flow, which is associated with renewal laser induced hair growth. Research suggests that when LLLT of cells that grow hair. is applied to the scalp, it acts to increase the number of hair follicles as well as hair’s tensile strength and that this is HAIR REMOVAL likely achieved through improved microvascular circulation, The global hair removal devices market was valued at USD reduced inflammation, and increased cell energy in the form 1.2 billion in 2017 and is expected to expand at a CAGR of of adenosine triphosphatase (ATP).2 14.9 percent throughout the period ending 2025. The home- Light therapy is an attractive option for patients in search use segment of the hair removal devices market is anticipated of hair growth solutions—especially those who are inter- to exhibit impressive growth over the forecast period, as well, ested in at-home treatment—and patients with patterned due to widespread demand and easy availability of these hair loss have impressive levels of success with at-home LLLT devices through retail and online distribution channels.5 devices. In 2007, the first at-home LLLT hair growth device, A number of at-home hair removal devices have been the HairMax Laser Comb, was cleared by the FDA. Patients developed in the past decade. These devices are based on using the comb had a greater increase in mean terminal the technology used in office-based devices that selectively hair density compared with those using a sham device,3 heat the hair follicles, minimizing injury to surrounding tissue. however, the device did not provide uniform light delivery Diode lasers held the maximum share of the global laser hair and was also limited by weak patient adherence. Laser hel- removal market in 2018 owing to their precision; these lasers mets and caps were among the products that followed the are mostly effective for dark terminal hair. Lasers including laser comb, and research, as well as anecdotal experience, the ruby, the long-pulsed alexandrite, and the neodymium: indicates that light delivered in a wearable helmet or cap yttrium, aluminum, and garnet (Nd:YAG) have shown efficacy resolves the dose uniformity issue. in the reduction of unwanted hair, but the Intense Pulsed Lightweight LEDs make wearable light-based technol- Light (IPL) devices have shown both safety and efficacy in hair ogy, such as caps, less bulky, and integrated smart-device removal. I played an integral role as a clinical investigator in apps enable users to plan and monitor treatment sessions. many of the IPL clinical trials, and several of these devices have These features are among the trends supporting the ubiq- received FDA clearance for permanent hair reduction.5 uitous use of laser and light-based HUDs. Revian Red is an Silk’N (Home Skinovations Inc./Unilever) hair removal example of a HUD that incorporates both of those features, devices are an ideal example of IPL home use hand-held epila- as well as several other perks that make it a standout among tion technology. Silk’N was the first pulsed-light hair removal home-use hair growth devices. Revian Red is built around a product for home use, as well as the first to be cleared by wearable, wireless “smart cap” controlled by a mobile app. the FDA. The small, portable, low-energy IPL device is now Bluetooth connectivity keeps patients on track by both acti- among the main players in this sector. The specifications for vating and logging treatments. The FDA-cleared Revian Red the Silk’N device include wavelengths of light from 475nm system has demonstrated the ability to stop hair loss and to 1200nm, a maximum energy density of 5J/cm2, a spot size subsequently promote hair growth. Revian has proven that of 20x30mm, and a pulse rate of one pulse every 3.5 seconds. the more patients use the app, the more hair they will grow. Post-treatment cooling of the skin is not required because of The company conducted a double-blind, placebo-controlled the low energy utilized with this device, and protective eye- study to test the effectiveness of the dual band LED light wear is not required or necessary because the light delivered is therapy and found that subjects, on average, may experience self-contained within the device.5 These features make it user a greater net increase in total hair counts than those pub- friendly, while still effective. lished for alternative chemical-based topicals, prescription In one study of the Silk’N device by Mulholland and col- drugs, and laser devices, based on cross-study comparisons.4 leagues, 34 individuals utilized the Silk’N device, with each The lightweight, cordless cap is easy to use and gives subject receiving three treatments at two-week intervals; patients freedom of movement during treatment, which they were followed for three months. The two-week hair they say enables them to wear the cap while going about reduction was 74 percent, and the four-week reduction was their daily routines. This system is the first and only dual 84 percent.
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