The Effect of the Fractional Carbon Dioxide Laser on Improving Minoxidil Delivery for the Treatment of Androgenetic Alopecia

Abstract

Introduction: Recently, laser treatment for hair loss has become very popular. Laser-assisted drug delivery (LAD) is an evolving technology with potentially broad clinical applications. This work aims at inspecting the effect of the fractional carbon dioxide laser (CO2 ) on improving the delivery of minoxidil in patients with androgenetic alopecia and detecting the role of the fractional CO2 laser in its treatment. Methods: We enrolled 45 Egyptians with male androgenetic alopecia (MAGA); clinical grading was assessed based on Norwood-Hamilton classification. The patients were divided into 3 groups: the first group (combined group) received the fractional CO2 laser session followed by topical application of minoxidil and also in between sessions; the second group received fractional CO2 laser sessions only and 6 sessions with 2-week intervals were performed; the third group applied topical minoxidil only for 3 months. Global photographs and dermoscopic assessments were performed before treatment and 3 months after the treatment. Results: Several dermoscopic findings were detected, including peripilar sign, hair diversity, yellow spot, white dots, and arborizing red lines. The number of double hair units significantly increased after the treatment in the combined group. The mean number of hair after the treatment in the 3 groups significantly increased, mostly in the combined group. The hair thickness (thin & thick) significantly increased after the treatment in the combined group and the fractional group; however, in the minoxidil group, only thin hair thickness increased. In all the 3 groups, there was a significant improvement in hair count and thickness. Conclusion: The ablative fractional CO2 laser alone or combined with minoxidil may serve as an additional treatment for MAGA.

Comparative Study of The Effect of Topical Minoxidil 5% Versus Combined Fractional CO2 Laser and Topical Minoxidil 5% in Treatment of Male Androgenetic Alopecia

“…At 3 months follow up, the mean number of vellus hair in the minoxidil + fractional laser therapy-treated group was 27.46 ± 6.017/cm 2 , which was statistically significantly lower as compared to the minoxidil-treated group (35.4 ± 7.33/cm 2 ) (p=0.017). In agreement with the results of the present study, Salah et al (11) found a statistically significant decrease in the number of vellus hair in the two studied groups along the duration of follow up, but the mean percentage of change was higher in the minoxidil + fractional laser therapy treated group (42.9%) as compared to the minoxidil group (25.6%).…”

“…In the current study, the mean age of the studied patients was 26.8  1.7 years versus 26.9  1.8 with no significant difference between the two groups (p=0.78). Similarly, a previous study by Salah et al (11) on 45 Egyptians with male androgenetic alopecia (MAGA) whose ages ranged from 21 to 45 years with a mean of 31.48 ± 6.62 years. All patients had a positive family history.…”

“…The combined-therapy side therefore had a higher degree of improvement than the monotherapy side in both mean hair count (P = 0.01) and mean hair thickness (P = 0.02). Salah et al (11) found a significant increase in the mean number of hairs after treatment in each group, where it was the most significant in the combined patient group, then in the fractional group, and then in the minoxidil group. However, there was no significant difference in comparing the 3 groups after treatment.…”

“…There was a statistically significant increase in the number of terminal hairs in the two studied groups along the duration of follow up, but the mean percentage of change was higher in the minoxidil + fractional laser therapy-treated group (36.5%) as compared to the minoxidil group (23.5%). Salah et al (11) found a significant increase in the thickness of thin and thick hairs after treatment in the combined patient group and the fractional group, but in the minoxidil group only the thin hair thickness increased. However, there was no significant difference in comparing between the 3 groups after treatment.…”

Lessons Learned from the First Decade of Laser-Assisted Drug Delivery

“…Forty-five male patients with androgenetic alopecia were treated with an ablative fractional CO 2 laser and minoxidil combination, the fractional CO 2 laser alone, or minoxidil alone. The application of the ablative fractional CO 2 laser alone or in combination with minoxidil produced the best results [ 49 ].…”