Evaluación de la efectividad de la terapia láser de baja potencia en alopecia frontal fibrosante

Abstract

Introduction and Objectives: Frontal fibrosing alopecia (FFA) is a lymphocytic scarring alopecia with a rising prevalence in society. It represents a therapeutical challenge as treatment options are limited. Furthermore, there are not any randomized controlled trials involving this disease. Low level-light therapy (LLLT) has demonstrated its effectiveness in androgenetic alopecia and it may help in scarring alopecias, like lichen planopilaris. In patients with FFA we evaluated the anti-inflammatory, antifibrotic efficacy of domiciliary LLLT to control disease and symptomatology. Methods: A single-centre, double-blinded, randomized clinical trial was designed. Helmetshaped devices composed by 246 high-powered red LEDs at a wavelength of 630 nm were given to patients. They used it 15 minutes daily for 6 months. Each device had a sham side and an active side, and intervention side was masked and randomized for all 37 patients. The active side emitted at a fluence of 4,5 J/cm2 whereas sham side was 10 times weaker at a fluence of 0,45 J/cm2. Patients were evaluated at baseline and each 12 weeks for a total duration of 6 months. The primary endpoint was the effect of LLLT in the disease, assessed with improvement in inflammatory clinical-trichoscopical (perifollicular erythema and scaling) and symptom-related variables in a qualitative scale (none/moderate/severe pruritus and trichodynia). Other principal endpoints were to evaluate its role in frontal regression and cicatricial band (in centimetres). We included those features into the FFA severity scale (FFASS) to assess changes in follow-up visits. Other variables were analysed too. Biopsy was performed in 5 patients. Results: Thirty-five patients completed treatment. All of them were women with a mean age of 63,3 years (range 49-81). After 6 months of LLLT there were global statistically significant differences with a worsening in mean frontal regression (8,7 cm at baseline versus 9,0 cm; p<0,001), with no differences in the cicatricial band (p>0,05). We observed an improvement in local symptoms, with lower pruritus (p=0,002) and burning (p=0,013). Perifollicular erythema decreased (p<0,001), with no differences in perifollicular scaling after 6 months of therapy (p=0,827). There were differences in perifollicular hyperkeratosis, frontal recession and terminal hair width favoring sham side (0,45 J/cm2) versus active side (4,5J/cm2). Analyzed biopsies showed a slight increase in lymphocytic infiltrate and a subtle decrease in fibrosis. Conclusion: LLLT could be an effective therapy for improving symptoms and inflammation associated to FFA.