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S.A. Seyyedi et al. Photodiagnosis and Photodynamic Therapy 49 (2024) 104282

Fig. 3. Comparison of pain intensity in the two groups at different time intervals after intervention (Acyclovir with PBM in blue and Acyclovir without PBM is in red).
triphosphate (ATP) production in the mitochondria and reduces oxygen
Table 2 consumption in the cell. PBM also increases serotonin and endorphin
Frequency of different lesions size in study groups.
levels, decreases prostaglandin levels, and increases cytokine and
Study group Lesion Before 1st 3rd 7th 10th growth factors, which accelerates the healing process. Moreover, the
grade treatment day day day day
laser increases blood flow and lymphatic drainage, consequently
Acyclovir reducing edema [26]. Regarding pain relief, PBM could acts temporally
with PBM disrupt the cytoskeleton (like an anesthetic agent). It can cause mito-
Zero 0 0 0 5 12
(41.6) (100.0) chondria “pile up”. Additionally, PBM decreases mitochondrial mem-
One 1 (8.3%) 1 1 2 0 brane potential in dorsal root ganglion neurons and ATP production
(8.3) (8.3) (16.6) reduction. Therefore, lack of ATP could cause neural blockade, and the
Two 3 (25.0%) 2 7 3 0 most immediate effect of nociceptor blockade is pain relief [34].
(16.7) (53.8) (25.0)
Three 8 (66.7%) 9 4 2 0 Admittedly, the results of the present study showed that on the 7th
(75.0) (33.3) (16.6) and 10th days after treatment, patients who were treated with PBM and
Acyclovir acyclovir had lower lesion size grades than other patients. Also, healing
without time in patients who were treated with PBM along with antiviral drugs
PBM
was significantly shorter than patients who were treated with antiviral
Zero 0 0 0 0 3 (25.0)
One 0 0 1 4 2 (16.6) drugs alone. In the study of Honarmand et al. [26], which was per-
(8.3) (33.3) formed to compare the effect of diode laser with acyclovir cream on
Two 5 (41.7) 5 5 6 6 (50.0) RHL, as well as the results of our study, wound healing time in patients
(41.7) (41.7) (50.0) who received laser irradiation was significantly shorter than patients
Three 7 (58.3) 7 6 2 1 (8.3) who treated with antiviral cream alone. Furthermore, Sanches et al. [35]
(58.3) (50.0) (16.6)
p-value 0.45 0.28 0.69 0.03 0.001 found that treatment RHL with PBM could reduce the duration of initial
recovery time in patients, which is similar to our results.
PBM: low-level laser therapy.
Additionally, patients who received PBM + Acyclovir were signifi-
cantly more satisfied with the treatment method and outcome than
patients who received antiviral agents without PBM. It should be noted
Table 3
that in various studies such as Schindl et al. [23], Sanchez et al. [36],
Frequency of various satisfaction levels between two groups.
and Ferriera et al. [37] it was shown that low diode laser treatment
Study group Patient satisfaction
reduces the recurrence of the lesion in patients, which were not evalu-
Very Good Intermediate Weak Very ated in the recent study. Apart from this, one of the important limita-
good weak tions of this study was that the PBM procedure was expensive and time
Acyclovir with 6 (50.0) 3 3 (25.0) 0 0 consuming for patients. In this regard, it can be noted that some recent
PBM (25.0) studies on the impact of devices with different wavelengths that are sold
Acyclovir without 1 (8.3) 0 4 (33.3) 5 2 (16.6)
PBM (41.6) without a prescription and are used by the patient himself [38,39].
Total 7 (29.1) 3 7 (29.1) 5 2 (8.3) There are several mechanisms indicating the antiviral potential of
(12.5) (20.8) laser therapy in RHL, including heat production and photobiological
p-value 0.008 effect of lasers [31]. Visible light rays are absorbed via mitochondrial of
PBM: low-level laser therapy. respective cells and resulted in increasing reactive oxygen species. ATP

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