Globally, infective stage), later forming pustular ulcers (2 to

Globally, Herpes
labialis is a contagious oro-facial infection caused by the herpes simplex serotype-1
virus (HSV-1) in 20-40% of young adults and can have an adverse effect on the
quality of life.(1,2,d1).

HSV-1 disseminates
primarily through direct contact with a lesion or with infected body fluids
(saliva, genital fluids and exudates of active lesions) and can cause
significant discomfort/pain.(1,4) After primary infection, the virus
establishes a life-long latency in sensory nerve ganglia, usually the
trigeminal ganglion.(9)Later, internal or external stimuli such as immunosuppression,
stress, menstruations, fever, injury, sunlight exposure and dental procedures may
trigger and reactivates to secondary or recurrent infection that results in
clinical infection.(1,d2,d1)In healthy individuals, recurrent herpes
labialis (RHL) is the most common presentation of recrudescent HSV infection.(d1)

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Usually, HSV-1
infection is asymptomatic, majority of patients experience prodromal symptoms (paresthesia,
tenderness, pain, burning or itching sensation at the site of lesion
development) lasting approximately 6 hours and progress to red macules that
rapidly become vesicular within the first 24 h after the onset of infection (highly
infective stage), later forming pustular ulcers (2 to 10 mm) in the front of and
around the mouth, on the tongue, and on the lips. Formation of a hard crust, dry
flaking/residuals swelling, and normal healed skin occurs within 7–10 days.(2,4,9,d2)

The diagnosis of RHL is
usually made on the basis of clinical presentation and history, specific
laboratory tests may be required in some cases.(7,d1,d2) Although, RHL
is a common self-limited ailment, the immune system can never eradicate HSV from
the host body. Recurrence can result in frequent pain, discomfort and disfigurement
and thus causing a psychologic impact for individuals that experience them on a
regular basis.(3,4)  Management
of RHL is dependent upon frequency, severity and distribution of lesions.(d1)  Conventional treatment method include the use
of antiviral drugs which reduces viral shedding and infectivity, decrease pain
level, lesion size and duration of symptoms slightly by restraining the multiplication
of the virus. But the limitations of antiviral drugs are its relatively short
half-life, frequent topical use throughout the day, risk of drug nephrotoxicity
on systemic administration, the emergence of drug-resistant HSV strains and its
limited efficacy in preventing the recurrence of lesions and complete
eliminating the virus from the host body has made the researchers to consider
on different alternative treatment for the prevention of RHL poses a big
challenge for the 21st century. (1,2,4,7)

Recently, Low level
laser therapy (LLLT) has gained a wide acceptance  for the treatment and prevention of RHL and
the clinical results showed that LLLT was as effective as traditional methods.(4).
The laser phototherapy has analgesic and anti-inflammatory properties and
stimulates tissue regeneration, fibroblast proliferation and neo-vascularization
potential and effective for stimulating the immune response of patients. (1,2)
Dougal and Lee reported that the patients
with RHL showed a significant reduction in healing time with 1072 nm LLL. (A2,1) Sanchez et al compared the effect of LLLT, 670 nm, on herpes
labialis with acyclovir and reported that LLLT was an effective therapy with no
side effects. (A7,1)  Honarmand et al concluded in his study
that treatment with diode laser (870nm) reduced the length of recovery time and
pain severity of RHL faster than treatment with acyclovir cream. (1)
According to Schindl et al, there was
increase in relapse time after using LLLT which was not observed with
conventional methods.(A8,8)Since different kinds of laser treatment
and different protocols have been proposed for the management of RHL, the aim
of this systematic review to evaluate the efficacy of LLLT in the management of