madman
Super Moderator
Abstract
There is increasing demand for home-based devices for the treatment of dermatologic conditions and cosmesis. Commercially available devices include intense pulsed light, laser diodes, radiofrequency, light-emitting diodes, and ultraviolet B phototherapy. The objective of this report is to evaluate the current evidence regarding the efficacy and safety of home-based devices for the treatment of skin conditions. A systematic search of PubMed, Embase, and Cinahl was conducted on November 9, 2020, using PRISMA guidelines. Original research articles that investigated the efficacy and safety of home-based devices for dermatologic use were included. Bibliographies were screened for additional relevant articles. The strength of evidence was graded using the Oxford Centre for Evidence-Based Medicine guidelines. Clinical recommendations were then made based on the quality of the existing literature. After review, 37 clinical trials were included—19 were randomized controlled trials, 16 were case series, and 2 were non-randomized controlled trials. Ultimately, from our analysis, we recommend the home-based use of intense pulsed light for hair removal, laser diodes for androgenic alopecia, low power radiofrequency for rhytides and wrinkles, and light-emitting diodes for acne vulgaris. Trials investigating ultraviolet B phototherapy for psoriasis revealed mixed evidence for home treatments compared to clinic treatments. All devices had favorable safety profiles with few significant adverse events. Limitations to our review include a limited number of randomized controlled trials as well as a lack of data on the long-term efficacy and safety of each device.
Introduction
In recent years, dermatology has witnessed a major transition to home-based care for some cosmetic and medical problems [23]. Undesirable body hair, androgenic alopecia, acne, skin aging, and psoriasis are among the conditions with treatments that can be done at home. While these conditions were traditionally treated by dermatologists in a clinical setting, they often required frequent visits and expensive therapies [2, 3]. Given their low cost and convenience, home-based therapies are increasing in popularity [3]. For example, the hair removal industry, a $9 billion market, now consists largely of home treatments, including home devices, waxing, and depilatories [3]. The home medical equipment market accounted for $30.54 billion in 2019 and is estimated to reach $56.45 billion by 2027, with therapeutic equipment being the highest contributor [24]. Due to consumer demand, numerous Food and Drug Administration (FDA) approved products are currently on the market for home use in dermatology, many of which are light-based devices [23].
The recent advent of teledermatology may accelerate this transition to home-based care [8]. A recent review identified 229 dermatology-related mobile apps available to consumers [6]. This increase in teledermatology illustrates an emerging direction of dermatologic care that provides more patients with access to dermatologists from home [8]. We anticipate home-based devices becoming increasingly relevant as a consequence of this transition. This systematic review aims to summarize the existing literature on home-based devices in dermatology and provide evidence-based clinical recommendations on their efficacy and safety.
*Intense pulsed light for hair removal
*Laser diodes for androgenic alopecia
*Radiofrequency for rhytides and wrinkles
*Light-emitting diode for acne vulgaris
*Ultraviolet Phototherapy for Psoriasis
*The major limitation of our review is the lack of double-blinded RCTs evaluating home-based devices for dermatologic treatment. Thus, many of the included studies (19 of 37) were not RCTs. While these studies do provide meaningful insights into the efficacy of these devices, they may not provide the same strength of evidence as RCTs. Additionally, most of the studies included in our review were conducted over a period of months, and thus the long-term efficacy of the devices remains uncertain. To further our understanding of the subject, double-blinded, placebo-controlled RCTs should be conducted. In addition, future studies should include long-term follow-ups to investigate the long-term effects of home-based dermatologic treatments as well as the need for maintenance treatments.
Conclusion
Home-based devices represent the future of dermatologic treatment for a multitude of conditions given their efficacy, safety, cost-effectiveness, and convenience. We determined that home-based devices are efficacious and safe for a number of dermatologic conditions, including IPL for hair removal, laser diodes for androgenic alopecia, RF for rhytides and wrinkles, and LED-BL/RL for acne. Conflicting evidence exists regarding phototherapy for home treatment of psoriasis. All treatment modalities demonstrated favorable safety profiles. Dermatologists should consider these home-based devices to address patients’ dermatologic needs.
There is increasing demand for home-based devices for the treatment of dermatologic conditions and cosmesis. Commercially available devices include intense pulsed light, laser diodes, radiofrequency, light-emitting diodes, and ultraviolet B phototherapy. The objective of this report is to evaluate the current evidence regarding the efficacy and safety of home-based devices for the treatment of skin conditions. A systematic search of PubMed, Embase, and Cinahl was conducted on November 9, 2020, using PRISMA guidelines. Original research articles that investigated the efficacy and safety of home-based devices for dermatologic use were included. Bibliographies were screened for additional relevant articles. The strength of evidence was graded using the Oxford Centre for Evidence-Based Medicine guidelines. Clinical recommendations were then made based on the quality of the existing literature. After review, 37 clinical trials were included—19 were randomized controlled trials, 16 were case series, and 2 were non-randomized controlled trials. Ultimately, from our analysis, we recommend the home-based use of intense pulsed light for hair removal, laser diodes for androgenic alopecia, low power radiofrequency for rhytides and wrinkles, and light-emitting diodes for acne vulgaris. Trials investigating ultraviolet B phototherapy for psoriasis revealed mixed evidence for home treatments compared to clinic treatments. All devices had favorable safety profiles with few significant adverse events. Limitations to our review include a limited number of randomized controlled trials as well as a lack of data on the long-term efficacy and safety of each device.
Introduction
In recent years, dermatology has witnessed a major transition to home-based care for some cosmetic and medical problems [23]. Undesirable body hair, androgenic alopecia, acne, skin aging, and psoriasis are among the conditions with treatments that can be done at home. While these conditions were traditionally treated by dermatologists in a clinical setting, they often required frequent visits and expensive therapies [2, 3]. Given their low cost and convenience, home-based therapies are increasing in popularity [3]. For example, the hair removal industry, a $9 billion market, now consists largely of home treatments, including home devices, waxing, and depilatories [3]. The home medical equipment market accounted for $30.54 billion in 2019 and is estimated to reach $56.45 billion by 2027, with therapeutic equipment being the highest contributor [24]. Due to consumer demand, numerous Food and Drug Administration (FDA) approved products are currently on the market for home use in dermatology, many of which are light-based devices [23].
The recent advent of teledermatology may accelerate this transition to home-based care [8]. A recent review identified 229 dermatology-related mobile apps available to consumers [6]. This increase in teledermatology illustrates an emerging direction of dermatologic care that provides more patients with access to dermatologists from home [8]. We anticipate home-based devices becoming increasingly relevant as a consequence of this transition. This systematic review aims to summarize the existing literature on home-based devices in dermatology and provide evidence-based clinical recommendations on their efficacy and safety.
*Intense pulsed light for hair removal
*Laser diodes for androgenic alopecia
*Radiofrequency for rhytides and wrinkles
*Light-emitting diode for acne vulgaris
*Ultraviolet Phototherapy for Psoriasis
*The major limitation of our review is the lack of double-blinded RCTs evaluating home-based devices for dermatologic treatment. Thus, many of the included studies (19 of 37) were not RCTs. While these studies do provide meaningful insights into the efficacy of these devices, they may not provide the same strength of evidence as RCTs. Additionally, most of the studies included in our review were conducted over a period of months, and thus the long-term efficacy of the devices remains uncertain. To further our understanding of the subject, double-blinded, placebo-controlled RCTs should be conducted. In addition, future studies should include long-term follow-ups to investigate the long-term effects of home-based dermatologic treatments as well as the need for maintenance treatments.
Conclusion
Home-based devices represent the future of dermatologic treatment for a multitude of conditions given their efficacy, safety, cost-effectiveness, and convenience. We determined that home-based devices are efficacious and safe for a number of dermatologic conditions, including IPL for hair removal, laser diodes for androgenic alopecia, RF for rhytides and wrinkles, and LED-BL/RL for acne. Conflicting evidence exists regarding phototherapy for home treatment of psoriasis. All treatment modalities demonstrated favorable safety profiles. Dermatologists should consider these home-based devices to address patients’ dermatologic needs.
