Photodynamic therapy for treating infected skin wounds: A systematic review and meta-analysis from randomized clinical trials

Author(s)

de Oliveira, Analu Barros ; Ferrisse, Tulio Morandin ; Fontana, Carla Raquel ; Basso, Fernanda Goncalves ; Brigheti, Fernanda Lourencao

• Document type: Journal article
• Source: Photodiagnosis and Photodynamic Therapy; v. 40, p. 11-pg., 2022-12-01.

Abstract

Background: Infected skin wounds represent a public health problem that effects 20 million people worldwide. Photodynamic therapy (PDT) is a treatment option with excellent results against several infections.Objective: This study aimed to perform a systematic review and meta-analysis on PDT efficacy for treating infected wounds based on randomized clinical trials (RCTs).Methods: PubMed, Scopus, Web of Science, SciELO, and the Cochrane library were searched. The Delphi List criteria and the Revised Cochrane risk-of-bias (Rob 2) were used for evaluating the quality of clinical trials. Metaanalyses were performed with the random-effect model. The odds ratio was the effect measure for binary outcomes, while the standard mean difference was used for continuous outcomes. The trim-and-fill method was used to detect small-study effects. The quality of evidence was verified for each outcome.Results: Only four out of 573 articles were selected for the qualitative and quantitative analyses. The most frequent cause of infected wounds was impaired venous circulation (75%). All studies used red LED light. PDT reduced healing time and improved the healing process and wound oxygenation. Patients treated with PDT showed 15% to 17% (p = 0.0003/ I2=0%) lower microbial cell viability in the wound and a significantly smaller wound size (0.72 cm2/p = 0.0187/I2=0%) than patients treated with placebo or red-light exposure. There was a high level of evidence for each meta-analysis outcome.Conclusion: PDT can be an excellent alternative treatment for infected skin wounds, though larger trials are needed. (AU)

• FAPESP's process: 13/07276-1 - CEPOF - Optics and Photonic Research Center
• Grantee: Vanderlei Salvador Bagnato
• Support Opportunities: Research Grants - Research, Innovation and Dissemination Centers - RIDC
• FAPESP's process: 18/23015-7 - Antimicrobial photodynamic therapy by continuous and switched mode irradiation against Enterococcus faecalis and Cutibacterium acnes
• Grantee: Carla Raquel Fontana
• Support Opportunities: Regular Research Grants
• FAPESP's process: 21/01191-0 - Tolerance induction and Candida albicans's biofilm characterization after antimicrobial photodymamic therapy application
• Grantee: Túlio Morandin Ferrisse
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 20/07110-0 - Potential of photodynamic therapy in modulating the inflammatory response and microbial virulence factors: evaluation in a model of three-dimensional co-cultures of gingival fibroblasts, Candida albicans and Staphylococcus aureus
• Grantee: Analú Barros de Oliveira
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 19/08375-0 - Maximization of the anti-caries and antibiofilm effect of conventional substances: evaluation in a polymicrobial biofilm model
• Grantee: Fernanda Lourenção Brighenti
• Support Opportunities: Regular Research Grants
• FAPESP's process: 18/18440-0 - Bioprospection of natural products in photodynamic therapy against microorganisms of medial and dental importance
• Grantee: Analú Barros de Oliveira
• Support Opportunities: Scholarships in Brazil - Master