Photodynamic therapy for treating infected skin wounds: A systematic review and meta-analysis from randomized clinical trials |
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| Affiliation: | 1. São Paulo State University (UNESP), School of Dentistry - Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Araraquara, São Paulo, Brazil;2. São Paulo State University (UNESP), School of Dentistry – Department of Dental Materials and Prosthodontics, Araraquara, São Paulo, Brazil;3. São Paulo State University (UNESP), School of Pharmaceutical Sciences - Department of Clinical Analysis, Araraquara, São Paulo, Brazil;4. Universidade de Ribeirão Preto, UNAERP - Department of Dentistry, Ribeirão Preto, SP, Brazil;1. Dermatology Department, Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, PR China;2. Dermatology Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China;1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, United States;2. Department of Dermatology, Cleveland Clinic, Cleveland 44195, United States;3. Lerner Research Institute, Cleveland Clinic, Cleveland 44195, United States;1. Department of Biopyhsics, Faculty of Medicine, Usak University, Usak 64000, Turkey;2. Department of Medical Biology, Faculty of Medicine, Usak University, Usak, Turkey;3. Faculty of Medicine, Student at Usak University, Usak, Turkey;4. Department of Medical Parasitology, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey;1. Department of Dermatology, Tongji Medical College, Wuhan No. 1 Hospital, Huazhong University of Science and Technology, Wuhan, China;2. Hubei Key Laboratory of Infectious and Immune Skin Diseases, Tongji Medical College, Wuhan No. 1 Hospital, Huazhong University of Science and Technology, Wuhan, China;1. Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China;2. State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China;3. Chongqing Key Laboratory for Disease Proteomics, Chongqing 400038, China |
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| Abstract: | BackgroundInfected 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.ObjectiveThis study aimed to perform a systematic review and meta-analysis on PDT efficacy for treating infected wounds based on randomized clinical trials (RCTs).MethodsPubMed, 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. Meta-analyses 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.ResultsOnly 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.ConclusionPDT can be an excellent alternative treatment for infected skin wounds, though larger trials are needed. |
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