6039657
6039657
6039657
1
Associated Professor, Oral and Dental Disease Research Center, Department of Oral Medicine, School of Dentistry, Zahedan
University of Medical Sciences, Zahedan, Iran
2
Associated professor, Oral and Dental Disease Research Center, Department of Oral Medicine, School of Dentistry, Zahedan
University of Medical Sciences, Zahedan, Iran
3
Postgraduate Student, Dep of Oral Medicine, School of Dentistry, Zahedan University of Medical Science, Zahedan, Iran
Correspondence:
Oral and Dental Disease Research Center
Department of Oral Medicine, School of Dentistry
Zahedan University of Medical Sciences, Zahedan, Iran
lm_farhad.zaums@yahoo.com
Abstract
Background: Recently alternative therapies such as the use of diode laser therapy have been introduced for recu-
rrent herpes labial infection. The aim of this study was to evaluate the effectiveness of diode laser for treatment of
recurrent herpes labialis.
Material and Methods: This was single-blind randomized clinical trial to evaluate the efficacy of diode laser for the
treatment of recurrent herpes labial. In total, 60 patients whit recurrent herpes simplex labialis were selected and
randomly divided in to three groups. 20 patients received treatment whit diode laser (at a wavelength of 870 nm,
energy density 4.5 j/cm2), 20 patients were treated with acyclovir cream 5%, 20 patients received treatment with
laser-off (placebo). The end point was lesions crusting. Data analyzed by Tukey HSD Test and One-way ANOVA
(at a significance level of 0.05) in SPSS-20 software.
Results: The mean length of recovery time (day) in the laser, off laser, and acyclovir groups was 2.20±0.41, 4.30±1.03,
and 3.4±1.142, respectively. There is a significant difference between three groups in this regard (P<0.0001). The
mean duration of pain (day) was 1.35±0.74, 2.65±1.27, and 2.30±0.92 for laser, off laser, and acyclovir groups,
respectively (P<0.0001).
Conclusions: Treatment with diode laser reduced the length of recovery time and pain severity faster than treatment
with acyclovir cream.
Key words: Recurrent herpes labial, Acyclovir, Low level laser therapy.
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J Clin Exp Dent. 2017;9(6):e729-32. Spanish production in implantology
Introduction sex. The first group was treated using acyclovir cream
Recurrent herpes labialis (RHL) occurs in 20% to 40% (5%) 5 times per day.
of young adult population. The lesions have prodromal The second group was treated with diode laser [(LO7
symptoms, including itching, tingling or burning in probe, Mustang 2000, Russia), wavelength 870nm, ener-
50% of cases and eventually develop papules, vesicles, gy density 4.5j/cm2, frequency 600Hz and maximum
ulcers, and crust. The pain often exists during the first pulse radiation power 80W for a minute/ day]. The tip of
two days (1). Internal or external stimuli such as stress, the probe was held 6-8mm from the lesion.
immunosuppression, high fever, trauma, and ultraviolet In the third group, laser therapy was performed using a
light can trigger recurrences (2). The lesions usually re- turned-off device. It should be noted that we used the
solve within 7 to 10 days (3). protective eyewear for the safety of patients. Patients
Although RHL is a self-limiting condition, the use of were not informed about the possible benefits of laser
topical antiviral medications reduces viral shedding and treatment.
infectivity. These agents also decrease pain level, lesion The treatment was performed by an oral medicine spe-
size and duration of symptoms (1). Antiviral medica- cialist, and the patients were examined on daily basis
tions such as acyclovir cream 5% and docosanol cream using a dental chair light source. Intended parameters in-
10% can be beneficial if initiated during the onset of le- cluded lesion size, pain level and length of time for crust
sions. Since these agents have relatively a short half-life, development. The examination was done by an oral me-
they should be used several times throughout the day dicine assistant who was blinded to treatment.
(1). Risk of drug nephrotoxicity should be considered The lesion size was determined by measuring the two
for systemic administration (4,5). main diameters of the lesion in square millimeters using
Low level laser therapy (LLLT) has been considered as a a transparent graph paper.
possible treatment for herpes labialis in recent years. The The pain intensity was evaluated based on the visual
laser phototherapy has analgesic and anti-inflammatory analogue scale (VAS) before treatment and at each fo-
properties and stimulates tissue regeneration, fibroblast llow-up session. According to this scale, 0 represented
proliferation and neo-vascularization potential (6). no pain and 10 represented the most severe pain ever
Many studies have examined the influence of LLLT experienced. Crust formation and erythema resolution
wavelengths on herpes labialis. were healing signs. The aforementioned information
Dougal and Lee (2) assigned 87 patients with herpes la- was recorded in relevant data sheets.
bialis randomly in two groups. They used low level laser, Data analyzed by Tukey HSD Test and One-way ANOVA
1072 nm, for the experimental group. The control group (at a significance level of 0.05) in SPSS-20 software.
was treated with the laser turned off. The experimental
group showed a significant reduction in healing time. Results
Muñoz Sanchez et al. (7) conducted a study in 2012 in This study aimed to compare the effect of diode laser
which they compared the effect of LLLT, 670 nm, on on herpes labialis with acyclovir. Sixty participants were
herpes labialis with acyclovir. They reported that LLLT divided into three groups. The laser group consisted of
was an effective therapy with no side effects. 15 males (75%) and 5 females (25%) with the mean age
This study aimed to evaluate the effect of Low level la- of 31.30±10.032. The turned-off laser group consisted of
ser therapy on the treatment of patients with herpes la- 15 males (75%) and 5 females (25%) with the mean age
bialis compared to acyclovir cream. of 32.85±6.808. The acyclovir-treated group consisted
of 14 males (70%) and 6 females (30%) with the mean
Materials and Methods age of 31.35±6.862. The mean age and the sex distribu-
This single-blind randomized clinical trial was carried tion were similar in all three groups.
out on 60 patients with herpes labialis referring to the The average area of the lesion in laser, turned-off la-
oral medicine department of Zahedan university of me- ser and acyclovir-treated groups was 25.55±15.99mm2,
dical science, Before entering the study, patients were 25.75±12.74mm2, and 25.90±15.05mm2, respectively.
informed regarding the purpose of this study and pro- There was no statistically significant difference between
vided a signed consent to participate in this study. The these groups (p=0.997). In addition, the pain level ba-
protocol was approved by Ethical Committee of Zahe- sed on VAS was 3.65±2.581 in laser group, 3.50±2.705
dan University of medical science (code 7030). The par- in turned-off laser group, and 3.50±2.065 in acyclovir-
ticipants had no systemic diseases or oral lesions and did treated group before the treatment, and no statistically
not take other medications during the study. All patients significant difference was observed among the three
had herpes labialis lesions developed 0-36 hours before groups (p=0.976).
the study. One-way ANOVA test demonstrated that there was a sta-
The patients were randomly divided into three 20-mem- tistically significant difference among the three groups
ber groups. The three groups were matched for age and during the treatment process in terms of pain intensity
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J Clin Exp Dent. 2017;9(6):e729-32. Spanish production in implantology
(Table 1). Two-group assessment using Tukey HSD acyclovir was 1.35±0.74, 2.65±1.27, and 2.30±0.92, res-
showed a significant difference among the groups in pectively, which showed a statistically significant diffe-
terms of pain intensity. rence (p<0.0001). Tukey HSD test also showed that the
One-way ANOVA test for the mean and standard devia- two-group difference was significant.
tion of lesion area showed that there was a statistically
significant difference among the three groups (Table 2). Discussion
Two-group assessment using Tukey HSD showed a sig- Recurrent herpes labialis infection occurs in more than
nificant difference among the groups in terms of lesion one fifth of young adult population. Transmission may
area. Table 2 demonstrates the mean and standard de- occur via contact with an infected person. The virus
viation of lesion area in the three evaluated groups on remains in a latent state in neural tissues, and internal
different days of treatment. or external stimuli such as stress, immunosuppression,
It is noteworthy that in the turned-off laser group on the high fever, trauma, and ultraviolet light can trigger re-
fifth and sixth days, only 7 and 2 patients were still under currences (2).
treatment, respectively. The other participants’ lesions Herpes labialis not only causes pain and discomfort, but
had developed crust on the fourth day. also periods of feeling sick during the infection which
In the acyclovir group, on the fourth, fifth, and sixth can affect a person’s work and social activities (8).
days, only 5, 5, and 1 patient were still under treatment, Effective antiviral medications on herpes labialis such
respectively considering their lesion, and the other pa- as acyclovir have the most influence while using at the
tients of this group had recovered during the first three onset of the lesion; however, late treatment is associa-
days of treatment. ted with prolonged symptoms and persistent lesions. In
As table 3 shows, the mean recovery time (day) was addition, these agents should be administered several ti-
2.20±0.41 in the laser group, 4.30±1.03 in the turned-off mes on consecutive days that can have even sometimes
laser group and 3.4±1.142 in the acyclovir group, which interactions with other medications (2).
showed a statistically significant difference (p<0.0001). Acyclovir is an effective treatment for herpes labialis
In addition, the mean treatment duration of pain in terms with a short half-life, whereas famciclovir and vala-
of days in the three groups of laser, turned-off laser, and cyclovir have longer half-lives; however, they are not
Day First day Second day Third day Fourth day Fifth day
Pain intensity Mea ± SD Mean± SD Mean± SD Mean± SD Mean± SD
Table 2: Mean and standard deviation of lesion area in the three evaluated groups on different days of treatment.
Day First day Second day Third day Fourth day Fifth day Sixth day
Group Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD
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available as topical agents. Some acyclovir and famci- tions, it can be concluded that low level laser therapy
clovir-resistant strains of HSV have emerged mainly due reduces the length of recovery time and pain level and
to cavalier use of these agents. In addition, systemic me- promotes the healing process compared to acyclovir.
dications can increase the risk of nephrotoxicity in case
the patient gets dehydrated (4,5). References
In general, these difficulties with conventional medica- 1. Arain N, Paravastu SC, Arain MA. Effectiveness of topical corticos-
teroids in addition to antiviral therapy in the management of recurrent
tions have directed investigators toward other therapeutic herpes labialis: a systematic review and meta-analysis. BMC Infect
approaches. Attention has been given to laser therapy as Dis. 2015;15:82.
a new treatment method for herpes labialis. 2. Dougal G, Lee SY. Evaluation of the efficacy of low-level light the-
Low level laser therapy has physiological effects such rapy using 1072 nm infrared light for the treatment of herpes simplex
labialis. Clin Exp Dermatol. 2013;38:713-8.
as anti-inflammatory, analgesic and healing-stimulating 3. de Carvalho RR, de Paula Eduardo F, Ramalho KM, Antunes JL,
characteristics (6). Bezinelli LM, de Magalhães MH, et al. Effect of laser phototherapy
Many studies have evaluated different wavelengths of on recurring herpes labialis prevention: an in vivo study. Lasers Med
low level laser on herpes labialis (7-10). Sci. 2010;25:397-402.
4. Izzedine H, Launay-Vacher V, Deray G. Antiviral drug-induced ne-
This study also aimed to evaluate the effect of diode la- phrotoxicity. Am J Kidney Dis. 2005;45:804-17.
ser on treatment of patients with herpes labialis compa- 5. Opstelten W, Neven AK, Eekhof J. Treatment and prevention of
red with acyclovir. The low level laser therapy (LLLT) herpes labialis. Can Fam Physician. 2008;54:1683-7.
significantly decreased the healing time, and pain inten- 6. Wagner VP, Meurer L, Martins MA, Danilevicz CK, Magnusson
AS, Marques MM, et al. Influence of different energy densities of laser
sity compared to acyclovir and turned-off laser groups, phototherapy on oral wound healing. J Biomed Opt. 2013;18:128002.
which is consistent with previous studies. 7. Muñoz Sanchez PJ, Capote Femenías JL, Díaz Tejeda A, Tunér J.
In a study conducted in 2013 by Dougal and Lee (2), the The effect of 670-nm low laser therapy on herpes simplex type 1. Pho-
effect of diode laser (1072 nm) on herpes labialis was tomed Laser Surg. 2012;30:37-40.
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Clin Exp Dermatol. 2006;31:638-41.
effect of diode laser (1072nm) on herpes labialis was 10. Eduardo Cde P, Bezinelli LM, Eduardo Fde P, da Graça Lopes RM,
assessed. The results showed that the mean crust time Ramalho KM, et al. Prevention of recurrent herpes labialis outbreaks
was two days for the experimental group and 2.88 days through low-intensity laser therapy: a clinical protocol with 3-year
for the control one. The mean healing time was 6.33 and follow-up. Lasers Med Sci. 2012;27:1077-83.
11. Marotti J, Aranha AC, Eduardo Cde P, Ribeiro MS. Photodyna-
9.40 days for the experimental and control groups, res- mic therapy can be effective as a treatment for herpes simplex labialis.
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Eduardo et al. (10) conducted a study in 2012 with a 3 12. Cotler HB, Chow RT, Hamblin MR, Carroll J. The Use of Low
year follow-up which showed that LLLT as a prophylac- Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthop
Rheumatol. 2015;2:00068.
tic treatment for recurrent herpes labialis not only redu-
ced lesion frequency, but also made healing quicker and Acknowledgements
symptoms less intense. The authors acknowledge their gratitude to the Re¬search Deputy of
De Carvalho et al. (3) (2010) reported that Ga-Al-As la- Zahedan University of Medical Sciences for approval and financial
ser (780nm) (one weekly session, 10 sessions in total) support of the current study.
reduced the lesion size and inflammation. Conflict of Interest
Marotti et al. (11) conducted a study in 2009 using dio- There was not conflict of interest of financial benefit to any parties
de laser, 660nm, to treat patients with herpes labialis in involved in this study.
the vesicle stage. They suggested that laser therapy re-
duced recurrence rates, relieved symptoms and has no
side effects.
Several mechanisms have been proposed for therapeutic
effects of LLLT. Laser induces more ATP production in
mitochondria and reduces cellular oxygen consumption.
Levels of serotonin and endorphins increase, prosta-
glandin production decreases, and cytokine and growth
factor expression promotes which eventually causes in-
flammation reduction and healing process promotion.
In addition, increased skin blood circulation, lymphatic
drainage and hyperpolarization reduce edema (12).
Based on the results of this study and other investiga-
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