Comparação da eficácia de diferentes protocolos de terapia de fotobiomodulação no tratamento do herpes labial: uma revisão sistemática de ensaios clínicos

Abstract

Objective: To compare the clinical efficacy of different photobiomodulation therapy (PBMT) protocols in the treatment of herpes labialis. Methods: A systematic review of clinical trials was conducted according to the PRISMA guidelines and registered in PROSPERO. Searches were performed in the PubMed/MEDLINE, Scopus, and Web of Science databases. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool version 2.0 (RoB 2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results: eight studies were included, comprising a total of 535 participants. The PBMT protocols showed considerable variability in terms of equipment and irradiation parameters, using low and high-power lasers and light-emitting diodes (LEDs), with wavelengths from 650 to 1072 nm, output power between 60 and 100 mW, while one study employed high-laser power with a peak power of 80 W in defocused mode. The energy density varied between 3 and 22.22 J/cm2. Compared with control groups, PBMT demonstrated favorable clinical outcomes, including pain reduction, shorter healing time, decreased lesion size and edema, as well as lower recurrence rates and longer intervals between episodes. Risk of bias assessment using RoB 2 indicated that four studies had a low risk of bias, two raised some concerns, and one presented a high risk of bias. The non-randomized study was classified as having a serious risk of bias according to the ROBINS-I tool. Conclusion: Available evidence suggests that PBMT is a promising therapeutic alternative for treating herpes labialis, primarily promoting pain relief and reducing healing time. However, the heterogeneity of PBMT application parameters, combined with differences in sample sizes and methodological designs, limits the comparison of clinical efficacy across the various protocols evaluated, preventing the establishment of a standardized clinical protocol. Nevertheless, the clinical resolution observed in all included studies highlights the versatility and broad applicability of this therapy, reinforcing the need for future trials with greater methodological rigor, standardized protocols, and longer follow-up to establish PBMT as a potential alternative to topical antivirals.