PracticalDermatology

The popularity of home-use laser and light-based devices for treatments such as hair growth, hair removal, and acne reduction has grown exponentially over the past 10 years and shows no signs of abating. Having been involved in the FDA studies of many of these devices, I was acutely aware of my peers’ earlier fears that these home-use devices (HUD) would displace office visits. Over the years, these concerns have dissipated and been replaced by awareness that, when used as an adjunct to in-office treatments, HUDs offer advantages to patients as well as to those of us who support their use. When your patients ask you to recommend a home-use device or they mention that they’re already using one, just keep in mind that the at-home aesthetic device market will always be as robust as your clients’ desire to look good—so there will always be plenty of business to go around.

HUDs empower patients to play an integral role in their overall treatment plan. In some instances, these devices help patients achieve additional improvement when used in tandem with on-going office treatments; in other instances circumstances preclude patients from presenting for in-office treatment, and in those cases HUDS help patients maintain and/or achieve additional gains. Never has this been more relevant than it is today: The COVID-19 pandemic and its associated call to shelter in place make the ability for patients to perform treatments at home an unanticipated benefit. No one could have foreseen that our offices would be closed for an extended period of time, or that routine, non-emergent care would be temporarily halted. Despite these unprecedented circumstances, HUDs enable our patients to continue treatment.

HUDs provide patients with a vehicle to enable them to continue their care while they’re at home and provide us with an 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 up” means a device is safe and effective, so guiding patients toward this technology and away from items that have not been sufficiently vetted means we can comfortably vouch for the device’s safety and ability to provide results.

Hair Growth

Androgenetic alopecia, which affects more than 80 million Americans and results in pattern hair loss in both men and women is among the leading motivators of those who seek help with hair growth or restoration. Hair growth in patients who have androgenetic alopecia has been successfully achieved through a range of energy-based devices, including fractional lasers and home-use Low-Level Laser therapy (LLLT) devices. The delivery of this non-thermal, low intensity light (10mW–500mW) triggers biochemical changes whereby photons of light are absorbed by cellular photoreceptors and result in downstream alterations to gene expression or cell signaling cascades.¹ Light administered either through low powered lasers or LEDs with a wavelength in the red to near infrared region of the spectrum (660nm–905nm), had been proven in clinical trials to have a good effect on pain, inflammation and tissue repair before it became clear that low-level laser induced hair growth. Research suggests that when LLLT 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 likely achieved through improved microvascular circulation, reduced inflammation, and increased cell energy in the form of adenosine triphosphatase (ATP).²

Light therapy is an attractive option for patients in search of hair growth solutions—especially those who are interested in at-home treatment—and patients with patterned hair loss have impressive levels of success with at-home LLLT devices. In 2007, the first at-home LLLT hair growth device, the HairMax Laser Comb, was cleared by the FDA. Patients using the comb had a greater increase in mean terminal hair density compared with those using a sham device,³ however, the device did not provide uniform light delivery and was also limited by weak patient adherence. Laser helmets and caps were among the products that followed the laser comb, and research, as well as anecdotal experience, indicates that light delivered in a wearable helmet or cap resolves the dose uniformity issue.

Lightweight LEDs make wearable light-based technology, such as caps, less bulky, and integrated smart-device apps enable users to plan and monitor treatment sessions. These features are among the trends supporting the ubiquitous use of laser and light-based HUDs. Revian Red is an example of a HUD that incorporates both of those features, as well as several other perks that make it a standout among home-use hair growth devices. Revian Red is built around a wearable, wireless “smart cap” controlled by a mobile app. Bluetooth connectivity keeps patients on track by both activating and logging treatments. The FDA-cleared Revian Red system has demonstrated the ability to stop hair loss and subsequently promote hair growth. Revian has proven that the more patients use the app, the more hair they will grow. The company conducted a double-blind, placebo-controlled study to test the effectiveness of the dual band LED light therapy and found that subjects, on average, may experience a greater net increase in total hair counts than those published for alternative chemical-based topicals, prescription drugs, and laser devices, based on cross-study comparisons.⁴

The lightweight, cordless cap is easy to use and gives patients freedom of movement during treatment, which they say enables them to wear the cap while going about their daily routines. This system is the first and only dual band, all LED light therapy system. It features a patented combination of two wavelengths of LED light—620nm and 660nm—that work together to unlock the body’s natural ability to accelerate healing by stimulating nitric oxide (NO). Simulation of NO leads to vasodilation and increased blood flow, which is associated with renewal of cells that grow hair.

Hair Removal

The global hair removal devices market was valued at USD 1.2 billion in 2017 and is expected to expand at a CAGR of 14.9 percent throughout the period ending 2025. The home-use segment of the hair removal devices market is anticipated to exhibit impressive growth over the forecast period, as well, due to widespread demand and easy availability of these devices through retail and online distribution channels.⁵

A number of at-home hair removal devices have been developed in the past decade. These devices are based on the technology used in office-based devices that selectively heat the hair follicles, minimizing injury to surrounding tissue. Diode lasers held the maximum share of the global laser hair removal market in 2018 owing to their precision; these lasers are mostly effective for dark terminal hair. Lasers including the ruby, the long-pulsed alexandrite, and the neodymium: yttrium, aluminum, and garnet (Nd:YAG) have shown efficacy in the reduction of unwanted hair, but the Intense Pulsed Light (IPL) devices have shown both safety and efficacy in hair removal. I played an integral role as a clinical investigator in many of the IPL clinical trials, and several of these devices have received FDA clearance for permanent hair reduction.⁵

Silk’N (Home Skinovations Inc./Unilever) hair removal devices are an ideal example of IPL home use hand-held epilation technology. Silk’N was the first pulsed-light hair removal product for home use, as well as the first to be cleared by the FDA. The small, portable, low-energy IPL device is now among the main players in this sector. The specifications for the Silk’N device include wavelengths of light from 475nm to 1200nm, a maximum energy density of 5J/cm², a spot size of 20x30mm, and a pulse rate of one pulse every 3.5 seconds. Post-treatment cooling of the skin is not required because of the low energy utilized with this device, and protective eyewear is not required or necessary because the light delivered is self-contained within the device.⁵ These features make it user friendly, while still effective.

In one study of the Silk’N device by Mulholland and colleagues, 34 individuals utilized the Silk’N device, with each subject receiving three treatments at two-week intervals; they were followed for three months. The two-week hair reduction was 74 percent, and the four-week reduction was 84 percent. At the three-month follow-up mark, 95 percent of all of the patients noted improvement with an average reduction of 64 percent.⁶

Many laser-based home hair-removal devices are available outside the United States and it is imperative that we stress to our patients that they choose only FDA- cleared or approved devices that are available in the US. The clinical outcomes of devices coming in from outside of the US may not live up to their claims.

IPL technology has been used in hair removal mainly for skin types I to IV (and occasionally on skin type V) when appropriate cut-off filters were used.¹⁰ At-home devices offer the advantage of constant availability and greater privacy,¹¹ but as with all heat-producing light sources, these devices are designed to cause biologic damage. As such, a level of caution is necessary when using these laser- or light-based hair removal devices.^12,13 Although clinical results have confirmed the safety and efficacy of hair removal at home in skin types I to IV, use of HUDs for hair removal of darker skin types (V–VI) is more challenging. Combined electro-optical technology, integrating optical IPL energy with bipolar radio frequency (RF) energy, has shown significant results in different dermatologic applications, such as hair removal and skin rejuvenation.^14-17

Performing hair removal with an at-home use device takes a lot longer than it does in my office, but, for patients who are interested and are good candidates, we sell a HUD IPL system as a maintenance device. If it ever becomes more than maintenance, then we get the patient back in the office to reestablish the primary treatment and once again relegate the HUD to an adjunctive role.

At-Home Acne Devices

A variety of home use devices are affective for mild to moderate acne treatment. Demand for these devices is steady and will continue to flourish as long as there are teens and young adults who are committed to perfecting the selfie.

Blue-light LED therapy has become widely used for the treatment of inflammatory acne. One important study where we evaluated the efficacy of a home use hand-held blue-light LED application found that using blue-light LED therapy on a daily basis—which is possible with a HUD—resulted in better improvement and faster resolution of inflammatory acne lesions. There was a significant difference in the response of lesions to the blue-light LED application as opposed to the placebo in terms of reduction in lesion size and lesion erythema, as well as improvement in the overall skin condition. Signs of improvement were observed as early as after two treatments. Time to resolution was significantly shorter for the blue-light LED therapy.¹⁸

Researchers have used blue light, a combination of blue and red light, and a combination of blue and infrared light to treat acne. We like blue light sources and we did all the original work evaluating blue light for home-use acne devices. Regardless of the device used, it’s important for patients to understand that home use acne treatment devices do not replace doctor visits or devices that can only be accessed in the doctor’s office. Just as with laser and light-based hair growth and removal tools, acne HUDs can augment the therapies that we provide. Price is very important in this sector, because a large population of those interested in these solutions are teenagers or the parents of teenagers. Similarly, safety is a crucial element for any HUD, but it is perhaps even more of priority in this category because of the vast number of young people who purchase these devices.

Here to Stay

Home use laser and light based devices are here to stay. If you want to ensure that your patients use devices that have been cleared or approved by the FDA, your practice can act as the middle man between manufacturers and clients. By doing so, you guarantee that your patients are using safe and effective technology and that they will maintain their relationship with you and your practice while using HUDs as an adjunct to the treatments you provide.

Financial Disclosure: Dr. Gold is a consultant and performs clinical research for Home Skinovations and REVIAN.

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