Globally, Herpeslabialis is a contagious oro-facial infection caused by the herpes simplex serotype-1virus (HSV-1) in 20-40% of young adults and can have an adverse effect on thequality of life.
(1,2,d1). HSV-1 disseminatesprimarily through direct contact with a lesion or with infected body fluids(saliva, genital fluids and exudates of active lesions) and can causesignificant discomfort/pain.(1,4) After primary infection, the virusestablishes a life-long latency in sensory nerve ganglia, usually thetrigeminal ganglion.(9)Later, internal or external stimuli such as immunosuppression,stress, menstruations, fever, injury, sunlight exposure and dental procedures maytrigger and reactivates to secondary or recurrent infection that results inclinical infection.
(1,d2,d1)In healthy individuals, recurrent herpeslabialis (RHL) is the most common presentation of recrudescent HSV infection.(d1)Usually, HSV-1infection is asymptomatic, majority of patients experience prodromal symptoms (paresthesia,tenderness, pain, burning or itching sensation at the site of lesiondevelopment) lasting approximately 6 hours and progress to red macules thatrapidly become vesicular within the first 24 h after the onset of infection (highlyinfective stage), later forming pustular ulcers (2 to 10 mm) in the front of andaround the mouth, on the tongue, and on the lips. Formation of a hard crust, dryflaking/residuals swelling, and normal healed skin occurs within 7–10 days.(2,4,9,d2)The diagnosis of RHL isusually made on the basis of clinical presentation and history, specificlaboratory tests may be required in some cases.(7,d1,d2) Although, RHLis a common self-limited ailment, the immune system can never eradicate HSV fromthe host body. Recurrence can result in frequent pain, discomfort and disfigurementand thus causing a psychologic impact for individuals that experience them on aregular basis.
(3,4) Managementof RHL is dependent upon frequency, severity and distribution of lesions.(d1) Conventional treatment method include the useof antiviral drugs which reduces viral shedding and infectivity, decrease painlevel, lesion size and duration of symptoms slightly by restraining the multiplicationof the virus. But the limitations of antiviral drugs are its relatively shorthalf-life, frequent topical use throughout the day, risk of drug nephrotoxicityon systemic administration, the emergence of drug-resistant HSV strains and itslimited efficacy in preventing the recurrence of lesions and completeeliminating the virus from the host body has made the researchers to consideron different alternative treatment for the prevention of RHL poses a bigchallenge for the 21st century. (1,2,4,7)Recently, Low levellaser therapy (LLLT) has gained a wide acceptance for the treatment and prevention of RHL andthe clinical results showed that LLLT was as effective as traditional methods.(4).The laser phototherapy has analgesic and anti-inflammatory properties andstimulates tissue regeneration, fibroblast proliferation and neo-vascularizationpotential and effective for stimulating the immune response of patients. (1,2)Dougal and Lee reported that the patientswith 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 herpeslabialis with acyclovir and reported that LLLT was an effective therapy with noside effects.
(A7,1) Honarmand et al concluded in his studythat treatment with diode laser (870nm) reduced the length of recovery time andpain severity of RHL faster than treatment with acyclovir cream. (1)According to Schindl et al, there wasincrease in relapse time after using LLLT which was not observed withconventional methods.(A8,8)Since different kinds of laser treatmentand different protocols have been proposed for the management of RHL, the aimof this systematic review to evaluate the efficacy of LLLT in the management ofRHL.