Atypical Afta Major Healing after Photodynamic Therapy

Abstract

The aim of this study is to report a case of atypical Afta Major healing in a patient with recurrent aphthous stomatitis (SAR) with a type of photodynamic therapy. A female patient with SAR affected for about 2 years reported a history of hypothyroidism treated with Levothyroxine. The oral cavity clinical examination showed several major symptomatic ulcers, previously treated with topical and systemic therapies without any benefit. The largest of them is present for more than 40 days, in spite of topical cortisone applications, with significant pain symptoms reported by the patient. It was decided to perform a session of photodynamic therapy with a device that emits a LED light used in combination with a photosensitive reagent (Toluidine blue). The dye was applied on the entire surface of the lesion beyond the margins and even encroaching on healthy tissue. The light diode was turned on with a wavelength of 630 nm with cycles from 30 seconds, 10 consecutive times above it. After a few days, a curious phenomenon happened: healing of Afta Major starting from the center, which was almost completely healed towards the borders of the lesion. No previous literature reports this type of healing. Photodynamic therapy could be a successful treatment for SAR.

Topical photodynamic therapy in the treatment of benign oral mucosal lesions: A systematic review

“…In 2017, Casu et al 39 applied PDT for the treatment of recurrent aphthous stomatitis (RAS). Since standard RAS therapy may include analgesics, antibiotics, corticosteroids, and immunosuppressive drugs, the Authors researched an alternative to alleviate symptoms, reduce ulcer number and size, and prolong the periods of absence of lesions, avoiding the appearance of drug‐related side effects.…”

“…In some cases, such as the one treated by Casu et al 39 on RAS, patients are not responsive to traditional therapy and, in particular, to corticosteroids; in these cases, PDT is a valid alternative method. Furthermore, PDT has also effectively treated infectious diseases in other medicine branches, with only a few studies dealing with this tool applied to the oral mucosa 47‐49 .…”

Photodynamic therapy for the successful management of cyclosporine-related gum hypertrophy: A novel therapeutic option

“…32,33 In addition, PDT is painless, extremely practical, repeatable and simple to perform, making it particularly suitable for outpatient clinical practice. In fact, these properties are the reason why PDT is widely used in oral medicine and dentistry, [34][35][36][37][38][39][40] but the search for new PTs effective against the most common oral pathologies remains however worthy of note. The photosensitizer used in this case report was curcumin.…”

Potential of photodynamic therapy in the management of infectious oral diseases

“…A photosensitizer based on Curcuma longa /3% hydrogen peroxide, activated by polarized light (wavelength from 380 to 3400 nm), showed greater antifungal activity than activation with LED light at 460 nm (the wavelength most widely used in PDT to activate curcumin)[ 24 ]. Furthermore, PDT has also shown efficacy in other oral pathologies, perhaps by virtue of its antimicrobial action against microorganisms that colonize the damaged mucosal surfaces[ 25 ] or which may be at the basis of the pathogenic process[ 26 ]. The main photosensitizers used in PDT vs oral infections, with relative wavelength of activation, are summarized in Figure 1 .…”