Laser-based interventions for scarring alopecia: a meta-analytic review of clinical outcomes

Abstract

Scarring alopecias are a group of inflammatory disorders resulting in irreversible hair loss and significant psychosocial burden. Standard therapies often yield incomplete responses, prompting exploration of alternative treatments. Laser-based therapies, including low-level laser therapy (LLLT), superluminescent diode (sLED) therapy, long-pulsed Nd:YAG, and excimer lasers, have emerged as potential options. This meta-analysis aims to evaluate the clinical effectiveness of laser-based interventions in treating scarring alopecias. A systematic search of PubMed, Cochrane CENTRAL, and Scopus was conducted, following PRISMA guidelines. Studies included were non-randomized clinical studies reporting outcomes after laser-based interventions for scarring alopecias. Data extraction and risk of bias assessment (ROBINS-I) were performed independently by two reviewers. Due to heterogeneity, descriptive synthesis and qualitative forest plots were generated. Seven studies involving 51 patients were included. Conditions studied included lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), dissecting cellulitis (DCS), folliculitis decalvans (FD), and acne keloidalis nuchae (AKN). Laser interventions were associated with clinical or trichoscopic improvement in all studies. Two studies reported complete or near-complete disease remission. No significant adverse events were reported. Risk of bias was serious or critical in all studies, primarily due to small sample sizes and lack of controls. Laser-based therapies demonstrate promising clinical benefits in scarring alopecias, particularly in disease stabilization and symptom improvement. However, due to the high risk of bias and methodological limitations, high-quality randomized controlled trials are needed to confirm these findings.