How to use Photobiomodulation and Photodynamic Therapy to Treat the Herpes Simplex Labial Vírus?

In the manifestation of the herpes simplex labial virus, the 3 clinical periods of the disease can be distinguished: prodromal, active clinical (or vesicular) and reparative (or healing) [1,2]. Herpes labialis usually has a prodromal period lasting a few hours up to 4 days, which includes local itching associated or not with burning and pain, and may also include fever, anorexia, irritability, malaise, drowsiness and headache [1-4]. The vesicular phase corresponds to the presence of vesicles full of viruses that, after a few days, can unite and rupture [5]. The lesions involve the oral mucosa, tongue, gums, hard palate and pharynx, with the lips and perioral skin being affected in 2/3 of the cases. Cycles have a duration of 7 days in mild cases, and 14 to 21 days or more in more severe cases [1,6]. It is the most contagious phase of the virus and it is important that we find a way to contain the virus.

Photodynamic Therapy (PDT) has been used in dentistry as a new alternative for the treatment of herpes in this vesicular phase [7,8], consisting of the application of a photosensitive dye and the use of laser light at the red wavelength to achieve the desired effect: In this case, the antimicrobial and destructive action of viruses. Photo biomodulation therapy, on the other hand, is used in lesions in the crust phase for causing a stimulus in the microcirculation, causing vasodilation of arterioles and capillaries and for vascular neoformation, thus leading to an increase in blood flow in the irradiated area [1]. Thus, it is used to heal various tissues, as it stimulates an increase in the production of cellular Adenosine Triphosphate (ATP), causing acceleration in cellular mitotic activity [4].

Accelerating the healing period. The patient attended the laser clinic at the Federal University of Maranhao complaining of the vesicles on the upper lip on the left side (Figure 1). After the diagnosis of herpes simplex labial, the vesicles were drained carefully and the methylene blue 0.005% was applied (Chimiolux, DMC, São Carlos, SP, Brazil) (Figure 2) and then irradiation with the low-level laser power (606nm, 100mW, 3J, 30s per point in 6 points) (Figure 3).

Figure 1: Initial appearance. Vesicular phase of the clinical manifestation of the herpes simplex virus.

Figure 2: Application of the methylene blue photosensitizer 0,005%.

Figure 3: Low power laser irradiation (Laser Therapy XT, DMC, São Carlos, SP, Brazil).

After 24 hours of photodynamic therapy, the patient was no longer in the contagious phase, as the viruses were inactivated and now the clinical manifestation was in the crust phase (Figure 4), starting photo biomodulation therapy to reduce the healing time. Thus, the laser is an excellent option for treating the clinical manifestations of the herpes simplex labialis virus, both in the vesicle phase using photodynamic therapy and, in the crust, phase using photo biomodulation therapy to accelerate the healing time. In the prodromal phase, photo biomodulation therapy can also be used to relieve symptoms and, in most cases, it does not evolve into the vesicular phase.

Figure 4: Aspect 24 h after photodynamic therapy. Observe the crust aspect

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