Corticosteroids and laser therapy

Photomed Laser Surg. 2011 Jun;29(6):421-5. Epub 2011 Jan 8.

A comparative pilot study of low intensity laser versus topical corticosteroids in the treatment of erosive-atrophic oral lichen planus.

Jajarm HH, Falaki F, Mahdavi O.

Source

Department of Oral Medicine and Dental Research Center, Faculty of Dentistry, Mashhad, Iran.

Abstract

BACKGROUND AND OBJECTIVE:

Treatment of oral lichen planus (OLP) remains a great challenge for clinicians. The aim of our study was to compare the effect of low intensity laser therapy (LILT) with topical corticosteroids in the treatment of oral erosive and atrophic lichen planus.

MATERIALS AND METHODS:

Thirty patients with erosive-atrophic OLP were randomly allocated into two groups. The experimental group consisted of patients treated with the 630? nm diode laser. The control group consisted of patients who used Dexamethason mouth wash. Response rate was defined based on changes in the appearance score and pain score (Visual Analogue Scale) of the lesions before and after each treatment.

RESULTS:

Appearance score, pain score, and lesion severity was reduced in both groups. No significant differences were found between the treatment groups regarding the response rate and relapse.

CONCLUSION:

Our study demonstrated that LILT was as effective as topical corticosteroid therapy without any adverse effects and it may be considered as an alternative treatment for erosive-atrophic OLP in the future.

Photomed Laser Surg. 2009 Oct;27(5):825-8.

Laser light may improve the symptoms of oral lesions of cicatricial pemphigoid: a case report.

Oliveira PC, Reis Junior JA, Lacerda JA, Silveira NT, Santos JM, Vitale MC, Pinheiro AL.

Laser Center, School of Dentistry, Federal University of Bahia, Salvador, BA, Brazil.

OBJECTIVE: The aim of this work is to report the handling of a patient suffering from cicatricial pemphigoid (CP) treated with laser phototherapy (LPT) and systemic steroids.

BACKGROUND DATA: CP is a group of rare chronic autoimmune blistering diseases that predominately affect the mucous membranes and occasionally the skin. The gingiva is most commonly involved, followed by the palate and the buccal mucosa. High-dosage systemic steroids are widely used for its treatment. LPT has been shown to improve wound healing and relieve pain. Its efficacy depends on the amount of energy delivered to the tissue, exposure time, and delivery method.

MATERIALS AND METHODS: A white 47-y-old man with CP who used systemic steroids for the previous 5 y was examined at our clinic. Extra- and intraoral examination revealed classic signs of the condition. LPT (GaAlAs diode laser, 660 nm wavelength, 30 mW, continuous wave, diameter approximately 3 mm, 60 J/cm(2) per session) was used in association with the steroids. LPT was performed in a punctual contact manner every other day on the oral mucosa. Maintenance of the treatment was carried out weekly because interruption of the LPT resulted in the recurrence of the lesions. At the time that this report was written, the patient had been undergoing twice weekly treatments for 6 months without signs of lesion recurrence.

CONCLUSION: Concomitant use of systemic steroids and LPT showed a positive effect on controlling oral CP lesions and on improving both oral health and the quality of life of the patient.

Lasers Med Sci. 2009 Jul;24(4):539-47. Epub 2008 Aug 21.

Effect of equal daily doses achieved by different power densities of low-level laser therapy at 635 nm on open skin wound healing in normal and corticosteroid-treated rats.

Gál P, Mokrý M, Vidinský B, Kilík R, Depta F, Harakalová M, Longauer F, Mozes S, Sabo J.Department of Medical Biophysics, Pavol Jozef Safárik University, Kosice, Slovak Republic. galovci@yahoo.com

Optimal parameters of low-level laser therapy (LLLT) for wound healing are still discussed. Hence, our study was aimed to compare effects of different power densities of LLLT at 635 nm in rats. Four, round, full-thickness, skin wounds were made on the backs of 48 rats that were divided into two groups (non-steroid laser-treated and steroid laser-treated). Three wounds were stimulated daily with a diode laser (daily dose 5 J/cm(2)) each with different power density (1 mW/cm(2), 5 mW/cm(2), and 15 mW/cm(2)), whereas the fourth wound served as a control. Two days, 6 days, and 14 days after surgery, eight animals from each group were killed and samples were removed for histological evaluation. In the non-steroid laser-treated rats, significant acceleration of epithelization and collagen synthesis 2 days and 6 days after surgery was observed in stimulated wounds. In steroid laser-treated rats, 2 days and 14 days after surgery, a decreased leucocyte/macrophage ratio and a reduction in the area of granulation tissue were recorded, respectively. In conclusion, LLLT, by the method we used, improved wound healing in the non-steroid laser-treated rats, but it was useless after corticosteroid treatment.

Photomed Laser Surg. 2008 Aug;26(4):307-13.

Effect of 670-nm laser therapy and dexamethasone on tissue repair: a histological and ultrastructural study.

Reis SR, Medrado AP, Marchionni AM, Figueira C, Fracassi LD, Knop LA.

Department of Propaedeutics and Integrated Clinic, School of Dentistry, Federal University of Bahia, Salvador, Brazil.

OBJECTIVE: In this study we investigated the role of extracellular matrix elements and cells during the wound healing phases following the use of low-level laser therapy (LLLT) and anti-inflammatory drugs.

BACKGROUND DATA: There are few scientific studies that characterize the possible interactions of LLLT and anti-inflammatory medications.

MATERIALS AND METHODS: Thirty-two rats submitted to a wound inflicted with a 6-mm-diameter punch. The animals were divided into four groups: sham treated, those treated with the GaAlAs laser (4 J/cm(2), 9 mW, lambda = 670 nm, spot size 28.27 x 10(2) cm(2)), those treated with dexamethasone (2 mg/kg), and those treated with both LLLT and dexamethasone. After 3 and 5 d, the cutaneous wounds were assessed by histopathology using polarized light and ultrastructural assessment using transmission electron microscopy. Changes seen in polymorphonuclear inflammatory cells, edema, mononuclear cells, and collagen fiber deposition were semi-quantitatively evaluated.

RESULTS: The laser-treated group demonstrated increased collagen content and better arrangement of the extracellular matrix (p < 0.05). Fibroblasts in these tissues were increased in number and were more synthetically active. In the dexamethasone group, the collagen was shown to be non-homogenous and disorganized, with a scarcity of fibroblasts. In the group treated with both types of therapy, fibroblasts were more common and they exhibited vigorous rough endoplasmic reticulum, but they had less collagen production compared to those seen in the laser group.

CONCLUSION: LLLT alone accelerates post-surgical tissue repair and reduces edema and the polymorphonuclear infiltrate even in the presence of dexamethasone.

Eur J Dermatol. 2008 Nov-Dec;18(6):671-6. Epub 2008 Oct 27.

Nd: YAG laser (1,064 nm) fails to improve localized plaque type psoriasis: a clinical and immunohistochemical pilot study.

van Lingen RG, de Jong EM, van Erp PE, van Meeteren WS, van De Kerkhof PC, Seyger MM.

Department of Dermatology, Radboud University Medical Centre, P.O. Box 9101, NL- 6500 HB Nijmegen, The Netherlands. r.vanlingen@derma.umcn.nl

Chronic and localized plaque-type-psoriasis is often therapy resistant as a result of which dermatologists often have trouble finding a suitable treatment option. Traditional therapies for psoriasis merely focus on the inhibition of epidermal proliferation, inflammation, or both. The earliest changes, however, in a novel psoriatic lesion concern abnormal microvasculature. The position of lasers in the treatment of psoriatic lesions is debatable, as different views exist with respect to efficacy and tolerability. The current investigation evaluates the clinical and immunohistochemical effect of the Nd:YAG (1,064 nm) laser in chronic localized psoriasis, as this laser can penetrate up to the deeper abnormal psoriatic vasculature. The effects are compared to treatment with the well-established calcipotriol/betamethasone dipropionate ointment. The use of the Nd:YAG laser with treatment-intervals of four weeks was found not to be of additional value in the array of treatment modalities for chronic localized plaque-psoriasis. Targeting the more superficially located microvasculature in psoriasis seems of stronger significance for achieving a clinical effect than the deeper vasculature targeted by the Nd:YAG laser. Therefore, the present data are of importance in preserving dermatologists from treating psoriatic lesions with a Nd:YAG laser. However, further studies incorporating changes in methodology, in particular shortened time-intervals between treatments, are needed in order to refute or confirm this position.

Braz J Med Biol Res. 2007 Jun;40(6):877-84.

Influence of He-Ne laser therapy on the dynamics of wound healing in mice treated with anti-inflammatory drugs.

 

Gonçalves WL, Souza FM, Conti CL, Cirqueira JP, Rocha WA, Pires JG, Barros LA, Moysés MR.

Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo.

We determined the effects of helium-neon (He-Ne) laser irradiation on wound healing dynamics in mice treated with steroidal and non-steroidal anti-inflammatory agents. Male albino mice, 28-32 g, were randomized into 6 groups of 6 animals each: control (C), He-Ne laser (L), dexamethasone (D), D + L, celecoxib (X), and X + L. D and X were injected im at doses of 5 and 22 mg/kg, respectively, 24 h before the experiment. A 1-cm long surgical wound was made with a scalpel on the abdomens of the mice. Animals from groups L, D + L and X + L were exposed to 4 J (cm(2))-1 day-1 of He-Ne laser for 12 s and were sacrificed on days 1, 2, or 3 after the procedure, when skin samples were taken for histological examination. A significant increase of collagen synthesis was observed in group L compared with C (168 +/- 20 vs 63 +/- 8 mm(2)). The basal cellularity values on day 1 were: C = 763 +/- 47, L = 1116 +/- 85, D = 376 +/- 24, D + L = 698 +/- 31, X = 453 +/- 29, X + L = 639 +/- 32 U/mm(2). These data show that application of L increases while D and X decrease the inflammatory cellularity compared with C. They also show that L restores the diminished cellularity induced by the anti-inflammatory drugs. We suggest that He-Ne laser promotes collagen formation and restores the baseline cellularity after pharmacological inhibition, indicating new perspectives for laser therapy aiming to increase the healing process when anti-inflammatory drugs are used.

Photomed Laser Surg. 2007 Apr;25(2):112-7.

Effect of low-level laser therapy on hemorrhagic lesions induced by immune complex in rat lungs.

Aimbire F, Lopes-Martins RA, Albertini R, Pacheco MT, Castro-Faria-Neto HC, Martins PS, Bjordal JM.

Laboratory of Animal Experimentation, Research and Development Institute (IP&D), Vale do Paraíba University (UNIVAP), São José dos Campos, Brazil.

OBJECTIVE: The aim of this study was to investigate if low-level laser therapy (LLLT) can modulate formation of hemorrhagic lesions induced by immune complex.

BACKGROUND DATA: There is a lack of information on LLLT effects in hemorrhagic injuries of high perfusion organs, and the relative efficacy of LLLT compared to anti-inflammatory drugs.

METHODS: A controlled animal study was undertaken with 49 male Wistar rats randomly divided into seven groups. Bovine serum albumin (BSA) i.v. was injected through the trachea to induce an immune complex lung injury. The study compared the effect of irradiation by a 650-nm Ga-Al-As laser with LLLT doses of 2.6 Joules/cm(2) to celecoxib, dexamethasone, and control groups for hemorrhagic index (HI) and myeloperoxide activity (MPO) at 24 h after injury.

RESULTS: The HI for the control group was 4.0 (95% CI, 3.7-4.3). Celecoxib, LLLT, and dexamethasone all induced significantly (p < 0.01) lower HI than control animals at 2.5 (95% CI, 1.9-3.1), 1.8 (95% CI, 1.2-2.4), and 1.5 (95% CI, 0.9-2.1), respectively, for all comparisons to control. Dexamethasone, but not celecoxib, induced a slightly, but significantly lower HI than LLLT (p = 0.04). MPO activity was significantly decreased in groups receiving celecoxib at 0.87 (95% CI, 0.63-1.11), dexamethasone at 0.50 (95% CI, 0.24-0.76), and LLLT at 0.7 (95% CI, 0.44-0.96) when compared to the control group, at 1.6 (95% CI, 1.34-1.96; p < 0.01), but there were no significant differences between any of the active treatments.

CONCLUSION: LLLT at a dose of 2.6 Joules/cm(2) induces a reduction of HI levels and MPO activity in hemorrhagic injury that is not significantly different from celecoxib. Dexamethasone is slightly more effective than LLLT in reducing HI, but not MPO activity.

EMLA Laser Health J 2007;2:46-67
European Medical Laser Association (EMLA)

Effects of LLLT on the periarthritis of the shoulder: A clinical study on different treatments with low level laser therapy, corticosteroid injections or a wait-and-see policy

G. Tam

Laser Center, Villa Santina – Italy

Low level laser irradiation is a treatment method widely used in medical science. Many disorders, such as osteoarthritis and musculoskeletal conditions with pain, have been treated with LLLT. With respect to pain the action of the laser interferes in the cytokines TNF-a, interleukin-1, interleukin-6 that drive inflammation in the arthritis and are secreted from CD4 and T cells. LLLT also increases the endorphin synthesis in the dorsal horn of the spinal cord, stopping the production of bradykinin and serotonin, and increases the production of nitric oxide into the endothelia cells and into the smooth muscular cells of the vessels walls having a vasodilatory, anti-inflammatory and analgesic action.

Patients, suffering from periarthritis of the shoulder of at least 6 weeks’ duration, were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment n. 20 (33%) with corticosteroid injection, n. 21 (35%) with LLLT and with wait-and-see policy n.19 (31%). We applied a number of 12 sessions with infrared Diode Laser Ga-As (904 nm), 60 W maximum power, peak power per pulse 27 W, pulse frequency 1280 Hz, average point region 2-8 J; dose/point = 3-4 J; total energy density 24 J/cm 2. Outcome measures included general improvement, severity of the main complaint, pain, shoulder disability, and patient satisfaction. Severity of shoulder complaints, abduction and elevation of the arm, and the pressure pain threshold were assessed. The principal analysis was done on an intention treatment basis. We assessed all outcomes at 3, 6, 12, 26, 52 weeks.

We randomly assigned 60 patients. At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 90% (18) compared with 52% (11) for LLLT and 35% (7) for wait-and-see policy. Long-term differences between injections and LLLT were significantly in favour of LLLT. Success rate at 52 weeks were 14 (70%) for injections, 19 (90.5%) for LLLT, and 16 (83%) for wait-and-see policy. Low Level Laser Therapy had better results than a wait-and-see policy, but differences were not significant (p <0.001).

Patients should be properly informed about the advantages and disadvantages of the treatment options for the periarthritis of the shoulder. The decision to treat with LLLT or to adopt a wait-and-see policy might depend on available resources, since the relative gain of Low Level Laser Therapy is better, but also small at long-term.

Oral Health Prev Dent. 2007;5(1):63-71.

Macroscopic and microscopic effects of GaAlAs diode laser and dexamethasone therapies on oral mucositis induced by fluorouracil in rats.

Lara RN, da Guerra EN, de Melo NS.

Oral Medicine, Department of Dentistry, School of Health Science, University of Brasília, Brasília, Brazil. nemetala@unb.br

PURPOSE: To present an animal model for mucositis induced by fluorouracil in rats, and test two therapeutic options, the GaAIAs laser and topical dexamethasone, analysing them with regard to the quality and quantity of tissue alterations and comparing them with the phases of mucositis.

MATERIALS AND METHODS: Forty-five Wistar rats (250 g) were treated with fluorouracil (60 mg/kg) and, in order to mimic the clinical effect of chronic irritation, the palatal mucosa was irritated by superficial scratching with an 18-gauge needle. When all of the rats presented oral ulcers of mucositis, they were randomly allocated to one of three groups: group I was treated with laser (GaAIAs), group II was treated with topical dexamethasone, and group III was not treated. Excisional biopsies of the palatal mucosa were then performed, and the rats were killed. Tissue sections were stained with haematoxylin and eosin for morphological analyses, and with toluidine blue for mast-cell counts. RESULTS: Group I specimens showed higher prevalence of ulcers, bacterial biofilm, necrosis and vascularisation, while group II specimens showed higher prevalance of granulation tissue formation. There were no significant statistical differences in the numbers of mast cells and epithelial thickness between groups.

CONCLUSION: For the present model of mucositis, rats with palatal mucositis treated with laser (GaAIAs) showed characteristics compatible with the ulcerative phase of oral mucositis, and rats treated with topical dexamethasone showed characteristics compatible with the healing phase of mucositis. Topical dexamethasone was more efficient in the treatment of rats’ oral mucositis than the laser.

Int J Oral Maxillofac Surg. 2007 Mar;36(3):226-9. Epub 2006 Dec 8.

Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: a clinical trial.

Markovic A, Todorovic Lj.

Clinic of Oral Surgery, Faculty of Dentistry, Dr Subotica 4, 11000 Belgrade, Serbia. valentinam@sbb.co.yu

Postoperative oedema is common following removal of impacted lower third molars. Several types of drug therapy (corticosteroids, non-steroidal anti-inflammatory drugs, enzymes) have been tried. The aim of this study was to compare the effectiveness of low-power laser (LPL) and dexamethasone after surgical removal of impacted lower third molars under local anaesthesia (2% lidocaine/epinephrine).

MATERIAL AND METHODS: There were 120 healthy patients divided into four groups of 30 each. Group 1 received LPL irradiation immediately after operation (energy output 4 J/cm2 with constant power density of 50 mW, wavelength 637 nm); group 2 also received i.m. injection of 4 mg dexamethasone (Dexason) into the internal pterygoid muscle; group 3 received LPL irradiation supplemented by systemic dexamethasone (Dexason), 4 mg i.m. in the deltoid region, followed by 4 mg of dexamethasone intraorally 6h postoperatively; and the fourth (control) group received only the usual postoperative recommendations (cold packs, soft diet, etc.).

RESULTS: LPL irradiation with local use of dexamethasone (group 2) resulted in a statistically significant reduction of postoperative oedema in comparison to the other groups. No adverse effects of the procedure or medication were observed.

CONCLUSION: LPL irradiation after lower third molar surgery can be recommended to minimize swelling. The effect is enhanced by simultaneous local intramuscular use of dexamethasone.

Lik Sprava. 1995 May-Jun;(5-6):77-80.

The combined use of diprospan and laser irradiation of the joints in rheumatoid arthritis patients

[Article in Ukrainian]

Lysenko HI, Handzha IM, Matiukha LF, Volobuieva ZV.

Abstract

An evaluation was done of effectiveness of diprospane (prolonged action glucocorticosteroid) in rheumatoid arthritis. There have been studied parameters characterizing the articular syndrome, laboratory values during the course of complex therapy that incorporated intraarthrous administration of diprospane and a course of laser irradiation of the joints against a background of intake of non-steroid antiinflammatory preparations and basis therapy with methotrexate. Topical therapy incorporated into the complex of therapeutic measures applied in patients with rheumatoid arthritis was found to be associated with most stable and pronounced effect, especially in the arthrous form of the malady. Combined use of intraarthrous administration of diprospane and a course of laser therapy permits achieving a favourable effect after a single administration of this drug preparation.