Treatment of herpes labialis by photodynamic therapy: Study protocol clinical trial (SPIRIT compliant)

Photodynamic Therapy Mediated by Curcumin and Blue Light for Recurrent Herpes Labialis: A Case Report

This study is the first to use photodynamic therapy (PDT) mediated by curcumin and blue light for the treatment of recurrent herpes labialis. According to our study, PDT effectively accelerated lesion healing and reduced its recurrence. PDT may represent a promising, safe, and cost-effective treatment option for this challenging disease.

The role of exfoliative cytology in diagnosis of oral lesions

OBJECTIVES

The study aimed to evaluate the use of oral exfoliative cytology and highlight its limited effectiveness in diagnosing oral diseases.

MATERIALS AND METHODS

A total of 1000 consecutive cases of oral cytology were retrieved from the files of an Oral Pathology Service, comprising the period between January 2002 and December 2022. Patient data and clinical details of the lesions were collected, and all slides were reviewed. Categorical data were presented in absolute and relative frequency (%), while numerical data were expressed as the median with minimum and maximum values. The Chi-square (X2) test was employed for frequency comparisons, with a significance level of 5%.

RESULTS

Men constituted 64.6% (n = 646) of the cases, with a statistically significant predominance of white individuals (69.4%; n = 694). Of the 1000 evaluated cases, 87.8% (n = 878) were graded using Papanicolaou staining. Regarding provisional diagnoses, most clinicians (79.1%) suspected fungal lesions (n = 817). Analysis of the agreement between provisional and final cytological diagnoses revealed a statistically significant disagreement.

CONCLUSIONS

This work reinforces the limited use of exfoliative cytology in diagnosing oral lesions.

CLINICAL RELEVANCE

Exfoliative oral cytology should be restricted to specific cases, particularly for diagnosing fungal disease, and occasionally when oral cancer is suspected, but a biopsy cannot be performed at that time.

Therapeutic effects of acyclovir and acyclovir-clobetasol nanofibers vs. cream formulation for recurrent herpes labialis

OBJECTIVES

This study aims to compare the therapeutic effects of acyclovir nanofiber and acyclovir-clobetasol nanofiber formulations with their non-nano formulations (cream formulation) on recurrent labial herpes.

MATERIALS AND METHODS

Eighty patients with labial herpes lesions were divided into four groups, each receiving one of the following treatments: acyclovir-clobetasol nano patch, acyclovir-clobetasol cream, acyclovir nano patch, or acyclovir cream. Pain levels and recovery times were assessed. The Wilcoxon test compared pain levels, while the log-rank test compared healing and scabbing times.

RESULTS

Acyclovir-clobetasol nanofiber and cream, along with acyclovir nanofiber, significantly reduced symptoms compared to the acyclovir cream. The recovery and scabbing times were shorter in patients who received acyclovir-clobetasol formulations compared to those receiving acyclovir alone.

CONCLUSION

Acyclovir-clobetasol combinations accelerated recovery times compared to acyclovir alone. Additionally, nanofiber formulations demonstrated enhanced healing efficacy over cream formulations.

TRIAL REGISTRATION

This trial was retrospectively registered by Iranian Registry of Clinical Trials (IRCT) at 14/11/2023.

TRIAL REGISTRATION NUMBER

IRCT20230926059521N1.

The impact of antimicrobial photodynamic therapy on pain and oral health-related quality of life: A literature review

Antimicrobial photodynamic therapy (aPDT) is a non-invasive approach used for microbial decontamination, and it can also be beneficial as an adjunctive strategy for oral infections. The success of treatment in the long term is increasingly recognized to be influenced by patient's perception of the disease and its improvement. Recently, aPDT has been suggested as a dual approach to tissue repair, pain relief, and enhancement of oral health-related quality of life (OHRQoL). The first pathway involves the antimicrobial and anti-inflammatory effects of aPDT. It not only eliminates microorganisms but also helps regulate the immune response and reduce inflammation, leading to a faster and more effective healing process. This, in turn, provides relief from pain and associated symptoms, aiding in the management of treatment complications. The second pathway involves aPDT's ability to modulate nociception and alleviate pain. aPDT induces analgesia by releasing neurotransmitters such as β-endorphin, serotonin, and acetylcholinesterase. It also interacts with mitochondria through photoreceptors, initiating intracellular processes that alleviate pain. Furthermore, the therapy inhibits nerve fibers, reducing nerve impulse conduction and altering the pain threshold. Considering that the impact on patients' pain and OHRQoL is an important aspect of the decision-making process, this study aimed to review patient-based outcome measures during aPDT and assess its effects on pain and OHRQoL in patients. Understanding these factors will contribute to a better assessment of the overall benefits and effectiveness of aPDT as a treatment option for oral infections.

Efficacy of ozone therapy for oral mucosa wound healing: a systematic review and meta-analysis

OBJECTIVES

To conduct a systematic review and meta-analysis to assess the effectiveness of ozone therapy in oral ulcers healing when compared to placebo or active treatments.

MATERIALS AND METHODS

The search was carried out using PubMed, EMBASE, Scopus, and Lilacs databases. Clinical trials involving human participants were included. The Risk Ratio (RR) and the standardized mean difference (SMD) with 95%CI (confidence interval) were calculated. The ROBINS-I (risk of bias in non-randomized studies of interventions) and RoB2 (risk of bias tool for randomized trials) assessment tool was used to detect bias.

RESULTS

After the selection process, 12 studies were included. The meta-analysis showed that ozone therapy helps to reduce the size of the traumatic and autoimmune ulcers (RR=-0.44; 95% CI -0.71,-0.17; I2=0%) in comparison to placebo. Regarding pain reduction, ozone was superior to placebo (RR = 1.29, 95% CI -1.6 to -0.95); I2=0%), and equivalent to topical corticosteroid and laser photobiomodulation (RR = 0.26, 95% CI -0.27,0.78, p = 0.34).

CONCLUSION

Ozone therapy is an alternative for accelerating healing and reducing pain for both traumatic and autoimmune ulcers. However, the quality of evidence is limited.

CLINICAL RELEVANCE

Oral ulcerations are usually painful and impact quality of life requiring different approaches to boost wound healing and reduce symptoms. For this purpose, ozone therapy is a promising strategy.

Potential of photodynamic therapy in the management of infectious oral diseases

Photodynamic therapy (PDT) can take place in the presence of three elements: Light with an appropriate wavelength; a photosensitizer; and the presence of oxygen. This type of treatment is very effective overall against bacterial, viral and mycotic cells. In the last 10 years many papers have been published on PDT with different types of photosensitizers (e.g., methylene blue, toluidine blue, indocyanine green, curcumin-based photosensitizers), different wavelengths (e.g., 460 nm, 630 nm, 660 nm, 810 nm) and various parameters (e.g., power of the light, time of illumination, number of sessions). In the scientific literature all types of PDT seem very effective, even if it is difficult to find a standard protocol for each oral pathology. PDT could be an interesting way to treat some dangerous oral infections refractory to common pharmacological therapies, such as candidiasis from multidrug-resistant Candida spp.

Herpesviruses and SARS-CoV-2: Viral Association with Oral Inflammatory Diseases

The oral cavity is a niche for diverse microbes, including viruses. Members of the Herpesviridae family, comprised of dsDNA viruses, as well as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an ssRNA virus, are among the most prevalent viruses infecting the oral cavity, and they exhibit clinical manifestations unique to oral tissues. Viral infection of oral mucosal epithelia triggers an immune response that results in prolonged inflammation. The clinical and systemic disease manifestations of HHV have been researched extensively, and several recent studies have illuminated the relationship between HHV and oral inflammatory diseases. Burgeoning evidence suggests the oral manifestation of SARS-CoV-2 infection includes xerostomia, dysgeusia, periodontal disease, mucositis, and opportunistic viral and bacterial infections, collectively described as oral post-acute sequelae of COVID-19 (PASC). These diverse sequelae could be a result of intensified immune responses initially due to the copious production of proinflammatory cytokines: the so-called "cytokine storm syndrome", facilitating widespread oral and non-oral tissue damage. This review explores the interplay between HHV, SARS-CoV-2, and oral inflammatory diseases such as periodontitis, endodontic disease, and peri-implantitis. Additionally, the review discusses proper diagnostic techniques for identifying viral infection and how viral diagnostics can lead to improved overall patient health.

Noninvasive Techniques for Management of Erythema Multiforme

An 18-year-old man was referred for a diagnosis of extensive oral lesions. During the interview, he reported a medical history of ganglionic tuberculosis, type 2 herpes infection, and significant weight loss due to dysphagia. Intraoral exam revealed multiple painful and ulcerated lesions covered by pseudomembrane. Lesions were observed on the labial and buccal mucosa, tongue, and soft palate. The laboratory findings included serum positivity for the Epstein-Barr virus, and salivary tests showed positive values for herpes simplex virus (HSV-2) and human herpesvirus (HHV-7). The diagnostic hypothesis was based on clinical findings and viral infection detected in the saliva, which triggered an immunological disorder, that is, erythema multiforme (EM). The treatment consisted of antimicrobial photodynamic therapy (aPDT), with substantial improvement in pain and healing as seen in the following twenty-four hours. Complete resolution of the lesions was achieved five days after the first session. Once the diagnosis of virus-induced EM was confirmed, noninvasive techniques (e.g., salivary tests and aPDT) were very successful and can be indicated for managing these lesions.

Combinations of Photodynamic Therapy with Other Minimally Invasive Therapeutic Technologies against Cancer and Microbial Infections

The rapid rise in research and development following the discovery of photodynamic therapy to establish novel photosensitizers and overcome the limitations of the technology soon after its clinical translation has given rise to a few significant milestones. These include several novel generations of photosensitizers, the widening of the scope of applications, leveraging of the offerings of nanotechnology for greater efficacy, selectivity for the disease over host tissue and cells, the advent of combination therapies with other similarly minimally invasive therapeutic technologies, the use of stimulus-responsive delivery and disease targeting, and greater penetration depth of the activation energy. Brought together, all these milestones have contributed to the significant enhancement of what is still arguably a novel technology. Yet the major applications of photodynamic therapy still remain firmly located in neoplasms, from where most of the new innovations appear to launch to other areas, such as microbial, fungal, viral, acne, wet age-related macular degeneration, atherosclerosis, psoriasis, environmental sanitization, pest control, and dermatology. Three main value propositions of combinations of photodynamic therapy include the synergistic and additive enhancement of efficacy, the relatively low emergence of resistance and its rapid development as a targeted and high-precision therapy. Combinations with established methods such as chemotherapy and radiotherapy and demonstrated applications in mop-up surgery promise to enhance these top three clinical tools. From published in vitro and preclinical studies, clinical trials and applications, and postclinical case studies, seven combinations with photodynamic therapy have become prominent research interests because they are potentially easily applied, showing enhanced efficacy, and are rapidly translating to the clinic. These include combinations with chemotherapy, photothermal therapy, magnetic hyperthermia, cold plasma therapy, sonodynamic therapy, immunotherapy, and radiotherapy. Photochemical internalization is a critical mechanism for some combinations.

Is low-level laser therapy effective in the treatment of herpes labialis? Systematic review and meta-analysis

The objective of this systematic review is to evaluate the effectiveness of low-level laser therapy in the treatment of herpes labialis. The searches were carried out independently by 2 researchers and the articles were selected through the electronic databases according to the inclusion and exclusion criteria previously established. Initially, 480 articles were found, of which 7 randomized clinical trials and 1 clinical trial were selected. In total, 928 patients were included. In the meta-analysis, the mean healing time for laser use was significant, showing a mean reduction of 1.37 [CI 95% = 0.92 to 1.82] days for tissue healing (p < 0.0001). In the meta-analysis to evaluate the time for crust formation, there was no significant difference between the groups and no significant reduction in the mean time for crust formation (p = 0.150). Only one of the selected studies had a low risk of bias. The use of low-level laser proved to be effective in the treatment of herpes labialis. However, due to the high risk of bias in the included studies, there is a need to carry out new standardized studies to prove the effectiveness of this therapy.

Photodynamic therapy for the successful management of cyclosporine-related gum hypertrophy: A novel therapeutic option

BACKGROUND

Drug-induced gingival overgrowth is associated with the intake of three classes of drugs: anticonvulsants, immunosuppressants, and calcium channel blockers. It is clinically characterized by hyperplasia of the gingival connective tissue which appears edematous, bloody, and purplish-red in color. In more severe cases, drug-induced gingival hyperplasia negatively affects the patient's quality of life, making it difficult to eat and practice good oral hygiene. Drug-induced gingival overgrowth therapy is controversial and, in fact, no studies in the literature highlight a well-defined therapeutic protocol. The therapies that are described provide primarily for non-surgical periodontal treatment and second-line surgical treatment. The aim of this work is to highlight a case of drug-induced gingival hyperplasia which was completely resolved thanks to photodynamic therapy which is completely free from side effects.

DESIGN AND METHODS

Photodynamic therapy was performed on an 18 year-old female patient with LEDs at a power of 450-470 nm and 5500 mW/cm2 + 7500 mW/cm2, combined with a Curcuma longa-based photosensitizer. A single session was performed, with applications of approximately 30 s for each interdental papilla.

RESULTS

The patient improved markedly after only one cycle of PDT. There was an absence of clinically detectable inflammation, edema, and rubor of the involved dental papillae. At the 4, 6, and 12 week follow-ups there were no recurrences.

CONCLUSIONS

This case report highlights the first case of drug-induced gingival hypertrophy entirely treated with photodynamic therapy to be described in the literature. Therefore, although it is only a case report, this therapy which is free from side effects should be investigated as an alternative to current therapies.

The role of Herpes Simplex Virus type 1 in oral diseases in children

Relevance. Herpes virus infections are the most common and poorly controllable viral infections. There are many difficulties in herpetic lesion verification and treatment in dental practice.

Purpose. The study aimed to present the results of a foreign publication investigation on the role of herpes simplex virus type 1 in the development of oral diseases in children.

Material and methods. Foreign scientific articles about the oral HSV-1 infections published from 2018 to 2022 formed the basis for the study. The study searched the publications on PubMed and Google Scholar bases.

Results. The article presents the newest data on the prevalence, clinical characteristics and diagnosis of oral HSV infection in children. Primary herpetic gingivostomatitis (PHGS), chronic recurrent herpetic gingivostomatitis, chronic recurrent herpes labialis are the main clinical presentations of herpes infection diagnosed in a dental practice. Primary herpetic gingivostomatitis is very common in children aged six months to fve years and occurs in newborns from 2 to 43 days of life. Modern virology success can improve diagnosis and treatment of oral herpetic lesions.

Conclusion. Primary herpetic gingivostomatitis is an acute infectious disease that requires the joint attention of a general practitioner and a dentist to ensure comprehensive treatment.

Antimicrobial efficacy of in vitro and ex vivo photodynamic therapy using porphyrins against Moraxella spp. isolated from bovine keratoconjunctivitis

Infectious bovine keratoconjunctivitis (IBK) is an ocular disease affecting bovine herds worldwide, and it causes significant economic loss. The etiologic agent of IBK is considered to be Moraxella bovis, but M. ovis and M. bovoculi are frequently recovered of animals presenting clinical signs of IBK. The therapeutic measures available for its control have limited efficacy. Antimicrobial photodynamic therapy (aPDT) using porphyrins as photosensitizing molecules is an alternative method that can be used to reduce microbial growth. We evaluated the antibacterial activity of aPDT using two water-soluble tetra-cationic porphyrins (H₂TMeP and ZnTMeP) against 22 clinical isolates and standard strains of Moraxella spp. in vitro and in an ex vivo model. For the in vitro assay, 4.0 µM of porphyrin was incubated with approximately 1.0 × 10⁴ CFU/mL of each Moraxella sp. isolate and exposed to artificial light for 0, 2.5, 5, and 7.5 min. Next, 50 µL of this solution was plated and incubated for 24 h until CFU measurement. For the ex vivo assay, corneas excised from the eyeballs of slaughtered cattle were irrigated with Moraxella spp. culture, followed by the addition of zinc(II) porphyrin ZnTMeP (4.0 μM). The corneal samples were irradiated for 0, 7.5, and 30 min, followed by swab collection, plating, and CFU count. The results demonstrated the in vitro inactivation of the strains and clinical isolates of Moraxella spp. after 2.5 min of irradiation using ZnTMeP, reaching complete inactivation until 7.5 min. In the ex vivo experiment, the use of ZnTMeP resulted in the most significant reduction in bacterial concentration after 30 min of irradiation. These results encourage future in vivo experiments to investigate the role of metalloporphyrin ZnTMeP in the inactivation of Moraxella spp. isolates causing IBK.

Graft-versus-host disease and herpes simplex virus oral injuries in onco-hematological patient: Case report

INTRODUCTION

Graft-versus-host disease (GVHD) is a systemic complication that can affect patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and the mouth is one of the places affected by the disease (oGVHD). Topical corticosteroids are used to control the painful symptoms, causing a local immunosuppression and increasing the risk for opportunistic infections.

OBJECTIVE

This study aims to report a case of a 42-year-old woman, diagnosed with Chronic Myeloid Leukemia, who developed oGVHD and herpes simplex virus (HSV) infection after HSCT.

CASE REPORT

oGVHD was confirmed by incisional biopsy and viral infection by HSV types 1 and 2 was confirmed by PCR. Topical and systemic corticotherapy and antiviral therapies were instituted. The immunosuppression intensified viral infection and antimicrobial photodynamic therapy (aPDT) was instituted as an adjuvant treatment. aPDT application, along with the patient's immune recovery, antivirals and corticosteroids resulted in clinical improvement of oral lesions.

FINAL CONSIDERATIONS

This study highlights aPDT as an effective adjunct therapy in the local treatment of opportunistic infections in onco-hematological patients.

A systematic review of photodynamic therapy as an antiviral treatment: Potential guidance for dealing with SARS-CoV-2

BACKGROUND

SARS-CoV-2, which causes the coronavirus disease (COVID-19), presents high rates of morbidity and mortality around the world. The search to eliminate SARS-CoV-2 is ongoing and urgent. This systematic review seeks to assess whether photodynamic therapy (PDT) could be effective in SARS-CoV-2 inactivation.

METHODS

The focus question was: Can photodynamic therapy be used as potential guidance for dealing with SARS-CoV-2?". A literature search, according to PRISMA statements, was conducted in the electronic databases PubMed, EMBASE, SCOPUS, Web of Science, LILACS, and Google Scholar. Studies published from January 2004 to June 2020 were analyzed. In vitro and in vivo studies were included that evaluated the effect of PDT mediated by several photosensitizers on RNA and DNA enveloped and non-enveloped viruses.

RESULTS

From 27 selected manuscripts, 26 publications used in vitro studies, 24 were exclusively in vitro, and two had in vitro/in vivo parts. Only one analyzed publication was exclusively in vivo. Meta-analysis studies were unfeasible due to heterogeneity of the data. The risk of bias was analyzed in all studies.

CONCLUSION

The in vitro and in vivo studies selected in this systematic review indicated that PDT is capable of photoinactivating enveloped and non-enveloped DNA and RNA viruses, suggesting that PDT can potentially photoinactivate SARS-CoV-2.

Treatment of recurrent herpes of the lower lip skin region with photodynamic therapy and photobiomodulation: case report

The aim of the present study is to describe a case report on the treatment of recurrent herpes using Photodynamic therapy (PDT) and Photobiomodulation as the treatments of choice. A 21-year-old white man checked in in the clinic for evaluation of vesicles arranged in the lower lip skin region. The clinical diagnosis was recurrent herpes and, for treatment, PDT was chosen, using 0.1% methylene blue as a photosensitizer and a pre-irradiation time of five minutes. The Therapy XT laser was used, with a wavelength of 660 nm, power of 100 mW, in a spot area of 0.028 cm², using 4 J energy per point, having been applied on 4 points, one in the center of the lesion and three on its laterals, so that it involved the entire extension of the lesion, totaling 16 J. After 24 hours after the application of the PDT, the patient returned for photobiomodulation with a low-power laser with a wavelength of 660 nm, power of 100 mW, using energy of 1 J per point, for 10 s, being applied on 4 points, totaling 4 J. It was possible to observe complete healing after 10 days of treatment, and the patient remains in follow-up for eight months without any recurrences.