Khalil Marwa, Hamadah Omar
Department of Oral Medicine, Damascus University Faculty of Dentistry, Damascus, Syrian Arab Republic.
Photobiomodul Photomed Laser Surg. 2022 May;40(5):299-307. doi: 10.1089/photob.2021.0186. Epub 2022 Apr 27.
This systematic review aims to analyze the effectiveness of the association of photodynamic therapy (PDT) and photobiomodulation (PBM) in the treatment of recurrent herpes labialis and to analyze the very many variables of parameters applied, number of sessions, photosensitizer concentration, and the timing of the intervention to offer clinicians an indication of the most likely optimal techniques and parameters required to achieve clinical success. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA Checklist and registered at the International Prospective Register of Systematic Reviews (PROSPERO). We searched and identified articles of the subsequent bibliographic databases: PubMed and Cochrane. Since there are no clinical trials regarding the association of PDT and PBM in the treatment of herpes labialis, we only included case reports in our review. All studies used methylene blue solution as the photosensitizer and the laser (diode laser or low-power laser) with a wavelength of 660 nm as the light source. Power output, power density, number of irradiation points, number of PBM sessions, and irradiation duration varied between the included studies. Despite the diversity in parameters between studies, all case reports showed good results regarding relieving symptoms, accelerating healing, as well as reducing the incidence of recurrence without side effects. The association of PDT in the vesicular phase and PBM in the crust phase can be considered a promising solution for recurrent labial herpes. Despite the many successful cases reported, establishing an effective clinical protocol for the treatment of herpes labialis using PDT followed by PBM will only be possible through double-blind placebo studies that would elucidate the exact action of this treatment modality, the appropriate irradiation parameters for both therapies, optimal timing, and number of PBM sessions following PDT. This review has been registered at the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42021290757.
本系统评价旨在分析光动力疗法（PDT）与光生物调节（PBM）联合应用于复发性唇疱疹治疗的有效性，并分析所应用参数的众多变量、治疗次数、光敏剂浓度以及干预时机，为临床医生提供最有可能实现临床成功所需的最佳技术和参数的参考。本研究按照系统评价和Meta分析的首选报告项目（PRISMA）清单进行，并在国际前瞻性系统评价注册库（PROSPERO）登记。我们检索并识别了以下文献数据库中的文章：PubMed和Cochrane。由于尚无关于PDT与PBM联合治疗唇疱疹的临床试验，我们的综述仅纳入了病例报告。所有研究均使用亚甲蓝溶液作为光敏剂，以波长660 nm的激光（二极管激光或低功率激光）作为光源。纳入研究之间的输出功率、功率密度、照射点数、PBM治疗次数和照射持续时间各不相同。尽管各研究之间参数存在差异，但所有病例报告均显示在缓解症状、加速愈合以及降低复发率方面取得了良好效果，且无副作用。在水疱期应用PDT并在结痂期应用PBM联合治疗可被视为复发性唇疱疹的一种有前景的解决方案。尽管报告了许多成功案例，但只有通过双盲安慰剂研究才能建立使用PDT后接PBM治疗唇疱疹的有效临床方案，该研究将阐明这种治疗方式的确切作用、两种疗法的合适照射参数、最佳时机以及PDT后PBM的治疗次数。本综述已在国际前瞻性系统评价注册库（PROSPERO）登记，登记号为CRD42021290757。
