Laser Photobiomodulation for a Complex Patient with Severe Hydroxyurea-Induced Oral Ulcerations

Abstract

Patients affected by polycythemia vera (PV), a myeloproliferative neoplasm characterized by an elevated red blood cell mass, are at high risk of vascular and thrombotic complications. Conventional therapeutic options aim at reducing vascular and thrombotic risk; low-dose aspirin and phlebotomy are first-line recommendations, for patients at low risk of thrombotic events, whereas cytoreductive therapy, usually hydroxyurea (HU) or interferon alpha, is recommended for high-risk patients. In the present study, we report the case of a patient with persistent oral ulcerations, possibly related to long-lasting HU treatment, firstly treated with topic and systemic corticosteroids and then more effectively with the addition of low-level laser therapy. Laser photobiomodulation has achieved pain control and has contributed to the healing of oral ulcers without any adverse effect; this has permitted a reduction in the dose of systemic corticosteroids and the suspension of the use of the topic ones, due to the long-term stability of oral health, even after the interruption of low-level laser therapy sessions.

Improved healing and macrophage polarization in oral ulcers treated with photobiomodulation (PBM)

“…16 To improve the recovery of oral ulcers, researchers have studied using low-level laser therapy (LLLT). 2,[17][18][19][20][21][22] Nowadays LLLT is more widely known as "photobiomodulation" (PBM) treatment because of its mechanism attributing to biostimulation through the use of light energy. [23][24][25] PBM treatment works within a certain energy output range thus, it is crucial to choose the correct parameters such as fluence, wavelength, and irradiation time.…”

“…To improve the recovery of oral ulcers, researchers have studied using low‐level laser therapy (LLLT) 2,17–22 . Nowadays LLLT is more widely known as “photobiomodulation” (PBM) treatment because of its mechanism attributing to biostimulation through the use of light energy 23–25 .…”

“…Most reports are focused on the clinical functions of PBM treatment in pain relief, inflammation reduction, and wound healing. 1,20,25 Compared to other studies that mainly focus on providing clinical outcomes, 19,20,22,25 this study is highly noteworthy as it is a primary account of correlating the use of PBM treatment with macrophage polarization and tissue cytokine profile in relation to enhancing the recovery of oral ulcers.…”