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group, high grade of lesions size was less frequent than acyclovir without PBM group, seventh and tenth
day after treatment (p = 0.03 and p = 0.001 respectively) (Table 2).

As Table 3 shows, the mean recovery time (day) was 8.7 ± 1.5 in the acyclovir whit PBM, 10.5 ± 1.1 in the
turned-off laser group, and 3.4 ± 1.142 in the acyclovir group, which showed a statistically signi cant
difference (p = 0.005).

As results yield, the patients in the acyclovir with PBM group compared to the other group patient were
more satis ed whit their treatment method (p = 0.008) (Table 4).

Discussion

This study we aimed to determine the effect of PBM in the treatment of recurrent herpes labialis.
According to the results of this study, pain intensity in 48 and 72 hours after treatment in the acyclovir
with PBM group treatment was signi cantly less than acyclovir without PBM group. Few other studies
have shown that PBM had a signi cant effect on pain reduction of RHL which is similar to our ndings

[26–28]. For example, Bojovic et al. [29] found that 810-nm PBM could have a signi cant effect on
reducing the RHL pain. In contrast to our ndings, Carvalho et al. [30] found no signi cant difference in
the pain intensity in patients who were treated by laser was lower compared to the patients who were
treated by antiviral drug.

PBM has several physiological effects such as reducing in ammation, analgesic effects, and stimulating
wound healing. Low-level laser, also known as recovery laser, has an energy of fewer than 500 milliwatts

and does not increase the temperature in the target tissue. As well as that, this laser also has a
photobiological and photochemical effect on the target tissue [31, 32]. In other words, PBM increases
adenosine triphosphate (ATP) production in the mitochondria and reduces oxygen consumption in the
cell. PBM also increases serotonin and endorphin levels, decreases prostaglandin levels, and increases

cytokine and growth factors, which accelerates the healing process. Moreover, the laser increases blood
ow and lymphatic drainage, consequently reducing edema [33]. Regarding pain relief, PBM could acts
temporally disrupt the cytoskeleton (like an anesthetic agent). It can cause mitochondria “pile up”.
Additionally, PBM decreases mitochondrial membrane potential in dorsal root ganglion neurons and ATP

production reduction. Therefore, lack of ATP could cause neural blockade, and the most immediate effect
of nociceptor blockade is pain relief [34].

Admittedly, the results of the present study showed that on the 7th and 10th days after treatment,
patients who were treated with PBM and acyclovir had lower lesion size grades than other patients. Also,
healing time in patients who were treated with PBM along with antiviral drugs was signi cantly shorter
than patients who were treated with antiviral drugs alone. In the study of Honarmand et al.[33], which was

performed to compare the effect of diode laser with acyclovir cream on RHL, as well as the results of our
study, wound healing time in patients who received laser irradiation was signi cantly shorter than
patients who treated with antiviral cream alone. Furthermore, Sanches et al. [35] found that treatment
RHL with PBM could reduce the duration of initial recovery time in patients, which is similar to our results.

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