Lichen Planopilaris and Low-Level Light Therapy: Four Case Reports and Review of the Literature About Low-Level Light Therapy and Lichenoid Dermatosis

Randolph, Michael J.; Salhi, Waleed Al; Tosti, Antonella

doi:10.1007/s13555-020-00359-x

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Lichen Planopilaris and Low-Level Light Therapy: Four Case Reports and Review of the Literature About Low-Level Light Therapy and Lichenoid Dermatosis

case-report

Author(s): Michael J. Randolph ¹ , Waleed Al Salhi ² , Antonella Tosti ³ ^,

Publication date (Electronic): 14 February 2020

Journal: Dermatology and Therapy

Publisher: Springer Healthcare

Keywords: Alopecia, Cicatricial alopecia, Fibrosing alopecia with a pattern distribution (FAPD), Hair loss, Hair regrowth, Lichenoid dermatosis, Lichen planopilaris (LPP), Lichen planus, Low-level light therapy (LLLT), Scarring alopecia

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Abstract

Lichen planopilaris (LPP) is a cell-mediated scarring alopecia that causes inflammation of the scalp and the eventual destruction of hair follicles in affected areas. Current literature on treatment of LPP remains limited with no definitive treatment approach being recognized, although a combination of topical/intralesional steroids and orally administered hydroxychloroquine remains the most utilized option. Low-level light therapy (LLLT) is an expanding technology shown to be effective in a variety of dermatologic conditions. We report here four patients with LPP who show a dramatic response to LLLT, including a reduction of inflammation, disappearance of symptoms, and evident hair regrowth with no side effects. We review the possible role of LLLT in LPP and other lichenoid conditions.

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Most cited references 18

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Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring.

Pinar Avci, Asheesh Gupta, Magesh Sadasivam … (2013)

Low-level laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude of conditions that require stimulation of healing, relief of pain and inflammation, and restoration of function. Although skin is naturally exposed to light more than any other organ, it still responds well to red and near-infrared wavelengths. The photons are absorbed by mitochondrial chromophores in skin cells. Consequently, electron transport, adenosine triphosphate nitric oxide release, blood flow, reactive oxygen species increase, and diverse signaling pathways are activated. Stem cells can be activated, allowing increased tissue repair and healing. In dermatology, LLLT has beneficial effects on wrinkles, acne scars, hypertrophic scars, and healing of burns. LLLT can reduce UV damage both as a treatment and as a prophylactic measure. In pigmentary disorders such as vitiligo, LLLT can increase pigmentation by stimulating melanocyte proliferation and reduce depigmentation by inhibiting autoimmunity. Inflammatory diseases such as psoriasis and acne can also be managed. The noninvasive nature and almost complete absence of side effects encourage further testing in dermatology.

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Lichen planopilaris is characterized by immune privilege collapse of the hair follicle's epithelial stem cell niche.

Christopher EM Griffiths, M Harries, Jennifer E. Kloepper … (2013)

Lichen planopilaris (LPP) is a chronic inflammatory disease of unknown pathogenesis that leads to permanent hair loss. Whilst destruction of epithelial hair follicle stem cells (eHFSCs) that reside in an immunologically protected niche of the HF epithelium, the bulge, is a likely key event in LPP pathogenesis, this remains to be demonstrated. We have tested the hypotheses that bulge immune privilege (IP) collapse and inflammation-induced eHFSC death are key components in the pathogenesis of LPP. Biopsies of lesional and non-lesional scalp skin from adult LPP patients (n = 42) were analysed by quantitative (immuno)histomorphometry, real-time quantitative polymerase chain reaction (qRT-PCR), laser capture microdissection and microarray analysis, or skin organ culture. At both the protein and transcriptional level, lesional LPP HFs showed evidence for bulge IP collapse (ie increased expression of MHC class I and II, β2microglobulin; reduced TGFβ2 and CD200 expression). This was accompanied by a Th1-biased cytotoxic T cell response (ie increased CD8(+) GranzymeB(+) T cells and CD123(+) plasmacytoid dendritic cells, with increased CXCR3 expression) and increased expression of interferon-inducible chemokines (CXCL9/10/11). Interestingly, lesional LPP eHFSCs showed both increased proliferation and apoptosis in situ. Microarray analysis revealed a loss of eHFSC signatures and increased expression of T cell activation/binding markers in active LPP, while bulge PPARγ transcription was unaltered compared to non-lesional LPP HFs. In organ culture of non-lesional LPP skin, interferon-γ (IFNγ) induced bulge IP collapse. LPP is an excellent model disease for studying and preventing immune destruction of human epithelial stem cells in situ. These novel findings raise the possibility that LPP represents an autoimmune disease in whose pathogenesis IFNγ-induced bulge IP collapse plays an important role. Therapeutically, bulge IP protection/restoration may help to better manage this highly treatment-resistant cicatricial alopecia. Copyright © 2013 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

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A prospective, randomized, placebo-controlled, double-blinded, and split-face clinical study on LED phototherapy for skin rejuvenation: clinical, profilometric, histologic, ultrastructural, and biochemical evaluations and comparison of three different treatment settings.

Jee Sung Lee, Seung Yoon Lee, Ki-Ho Park … (2007)

Light-emitting diodes (LEDs) are considered to be effective in skin rejuvenation. We investigated the clinical efficacy of LED phototherapy for skin rejuvenation through the comparison with three different treatment parameters and a control, and also examined the LED-induced histological, ultrastructural, and biochemical changes. Seventy-six patients with facial wrinkles were treated with quasimonochromatic LED devices on the right half of their faces. All subjects were randomly divided into four groups treated with either 830nm alone, 633nm alone, a combination of 830 and 633nm, or a sham treatment light, twice a week for four weeks. Serial photography, profilometry, and objective measurements of the skin elasticity and melanin were performed during the treatment period with a three-month follow-up period. The subject's and investigator's assessments were double-blinded. Skin specimens were evaluated for the histologic and ultrastructural changes, alteration in the status of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs), and the changes in the mRNA levels of IL-1ss, TNF-alpha, ICAM-1, IL-6 and connexin 43 (Cx43), by utilizing specific stains, TEM, immunohistochemistry, and real-time RT-PCR, respectively. In the results, objectively measured data showed significant reductions of wrinkles (maximum: 36%) and increases of skin elasticity (maximum: 19%) compared to baseline on the treated face in the three treatment groups. Histologically, a marked increase in the amount of collagen and elastic fibers in all treatment groups was observed. Ultrastructural examination demonstrated highly activated fibroblasts, surrounded by abundant elastic and collagen fibers. Immunohistochemistry showed an increase of TIMP-1 and 2. RT-PCR results showed the mRNA levels of IL-1ss, TNF-alpha, ICAM-1, and Cx43 increased after LED phototherapy whereas that of IL-6 decreased. This therapy was well-tolerated by all patients with no adverse effects. We concluded that 830 and 633nm LED phototherapy is an effective approach for skin rejuvenation.

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Author and article information

Contributors

Antonella Tosti: atosti@med.miami.edu

Journal

Journal ID (nlm-ta): Dermatol Ther (Heidelb)

Journal ID (iso-abbrev): Dermatol Ther (Heidelb)

Title: Dermatology and Therapy

Publisher: Springer Healthcare (Cheshire )

ISSN (Print): 2193-8210

ISSN (Electronic): 2190-9172

Publication date (Electronic): 14 February 2020

Publication date PMC-release: 14 February 2020

Publication date Collection: April 2020

Volume: 10

Issue: 2

Pages: 311-319

Affiliations

[1 ]GRID grid.26790.3a, ISNI 0000 0004 1936 8606, University of Miami Miller School of Medicine, ; Miami, FL USA

[2 ]GRID grid.449051.d, Department of Dermatology, College of Medicine, , Majmaah University, ; Al-Majmaah, 11952 Saudi Arabia

[3 ]GRID grid.26790.3a, ISNI 0000 0004 1936 8606, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, , University of Miami, ; Miami, FL USA

Article

Publisher ID: 359

DOI: 10.1007/s13555-020-00359-x

PMC ID: 7090134

PubMed ID: 32060796

SO-VID: a9f44ad2-5f07-4ce3-83b5-4c0f1fa7bfbc

History

Date received : 2 January 2020

Custom metadata

ScienceOpen disciplines: Dermatology

Keywords: alopecia,cicatricial alopecia,fibrosing alopecia with a pattern distribution (fapd),hair loss,hair regrowth,lichenoid dermatosis,lichen planopilaris (lpp),lichen planus,low-level light therapy (lllt),scarring alopecia

Data availability:

ScienceOpen disciplines: Dermatology

Keywords: alopecia, cicatricial alopecia, fibrosing alopecia with a pattern distribution (fapd), hair loss, hair regrowth, lichenoid dermatosis, lichen planopilaris (lpp), lichen planus, low-level light therapy (lllt), scarring alopecia

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