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Photodiagnosis and Photodynamic Therapy 49 (2024) 104282

Contents lists available at ScienceDirect

Photodiagnosis and Photodynamic Therapy

journal homepage: www.elsevier.com/locate/pdpdt

Research Paper

Efficacy of adjuvant photobiomodulation therapy in recurrent herpes
labialis, a randomized clinical trial study

a
b
a
Seyyed Amir Seyyedi , Zahra Mirzaei Gobaran , Sepideh Yekani , Saman Taram b,*
a
Department of Oral Medicine, Dental School, Urmia University of Medical Sciences, Urmia, Iran
b
Urmia University of Medical Sciences, Urmia, Iran
ARTICLE INFO ABSTRACT
Keywords: Objective: This study aimed to determine the effect of Photobiomodulation therapy (PBMT) in the treatment of
Herpes simplex virus recurrent herpes labialis (RHL), one of the most common herpes simplex virus type 1 infections.
Low-level laser therapy
Material and Methods: In this randomized double blind controlled trial, Twenty-two symptomatic patients with
Recurrent herpes labialis RHL were enrolled. The patients were randomly allocated into one group (5 % acyclovir cream with 940±10 nm
PBMT
2
wavelength and 4 J/cm energy density and 100 mW output power) and another group (5 % Acyclovir 5 times/5
days and sham laser). Lesion size, and pain intensity were considered as the outcome at baseline, 1st 2nd and 3rd
days postoperatively.
Results: Pain intensity in PBM + Acyclovir group was significantly lower than Acyclovir without PBM group in
both two and three days after intervention (p < 0.001). The lesion size in case group was significantly lower on 7
and 10 days (p < 0.05). Patients in the treatment group were significantly more satisfied with their treatment
process (p = 0.008).
Conclusion: PBMT can be used as an adjuvant tool to acyclovir cream, due to higher potential in reducing
postoperative pain, lesion size and also patients satisfaction.

1. Introduction penetration to subcutaneous area and subsequently lower absorption
rate [10-12]. All these limitations led to look for novel
Recurrent herpes labialis (RHL), also known as fever blisters or cold non-pharmacological agents with higher efficacy and lower toxicity
sores is one of the most common viral infections of orofacial region [13].
mainly caused by herpes simplex virus-1 (HSV1). RHL is a global health Photobiomodulation therapy (PBMT) has been widely reported
issue, and occurs in approximately 20 to 40 % of the young adult pop- across the medical literature (e.g. in the treatment of musculoskeletal
ulation [1-3]. Recurrence maybe caused by different factors like phys- diseases, wound healing, skin burn treatment) [14,15]. Nowadays,
ical or emotional stress, endocrine disorders and immunosuppression much more is known about the effects of laser light on biochemical and
[4]. The lesions are mostly in vesicular form at first 24 h, where the viral cellular function such as cellular metabolic activation [16], cell prolif-
load is highest [5]. RHL begins with prodromal symptoms such as eration stimulation [17], anti-inflammatory effect [16], microcircula-
burning, itching, and swelling, followed by vesicular lesions gradually tion activation [18,19], increased endorphin release and analgesic
ulcerating and crust over 72 to 96 h [6]. The disease is self-limiting and effects [19], increased antioxidant activity [20], stimulation of eryth-
resolves within 10 to 14 days [7]. ropoiesis, vasodilatation [16] and reflexogenic effects on the functional
Treatment for RHL is often conservative and includes the consump- activity of different organs and systems [17,21,22]. Whereas, there are
tion of soft foods, fluids, and analgesics for reducing symptoms [8]. In some limitations in using PBMT alone like high cost and also risk of local
immune-compromised patients, and cases with severe symptoms and irritations [6]. In this regard, combination therapy can be more useful in
frequent recurrence, antiviral drugs prescription (such as acyclovir) are these cases with balance use of both items will be useful in treatment
considered as a gold standard. The cream and ointment formulations of plan.
acyclovir are used frequently for accelerating healing process [9]. On Few studies have reported PBMT application as an alternative
the other hand, their efficacy is limited mainly due to their low method for accelerated healing, reducing symptoms and lowering the

* Corresponding author.
E-mail address: taram.saman@yahoo.com (S. Taram).
https://doi.org/10.1016/j.pdpdt.2024.104282
Received 28 May 2024; Received in revised form 28 June 2024; Accepted 12 July 2024
Available online 14 July 2024
1572-1000/© 2024 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC license ( http://creativecommons.org/licenses/by-
nc/4.0/ ).