key: cord-0964491-of2gtsp7
authors: Ramires, Marcia Christina Camargo Hernandes; Mattia, Muriele Barbara; Tateno, Ricardo Yudi; Palma, Luiz Felipe; Campos, Luana
title: A combination of phototherapy modalities for extensive lip lesions in a patient with SARS‐CoV‐2 infection
date: 2021-01-28
journal: Photodiagnosis Photodyn Ther
DOI: 10.1016/j.pdpdt.2021.102196
sha: ac46c3f6d977bb76bce140da666d321ac5dbfb2c
doc_id: 964491
cord_uid: of2gtsp7

Many oral signs and symptoms related to the novel coronavirus disease (COVID-19) have already been reported; however, both prevalence and etiology are still undetermined. Since the clinical features of the oral lesions seen in COVID-19 are highly heterogeneous and the treatments differ considerably in the literature, the present study aimed to report a clinical case in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for extensive lip lesions in a patient suffering from COVID-19. Within 4 days and without any systemic drug administration, after two sessions of aPDT and one session of PBMT, the lip lesions were completely healed, and the patient recovered her orofacial functions satisfactorily. According to the current case report and taking into consideration the evident lack of information about many aspects of COVID-19 infection, this combination of phototherapy modalities seems to be a promising tool for managing COVID-19-related lip lesions; however, much more studies are necessary.

seen in COVID-19 are highly heterogeneous and the treatments differ considerably in the literature, the present study aimed to report a clinical case in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for extensive lip lesions in a patient suffering from COVID-19. Within 4 days and without any systemic drug administration, after two sessions of aPDT and one session of PBMT, the lip lesions were completely healed, and the patient recovered her orofacial functions satisfactorily. According to the current case report and taking into consideration the evident lack of information about many aspects of COVID-19 infection, this combination of phototherapy modalities seems to be a promising tool for managing COVID-19-related lip lesions; however, much more studies are necessary.

Keywords: COVID-19; SARS-CoV-2; oral manifestations; antimicrobial photodynamic therapy; photobiomodulation therapy.

The novel coronavirus disease (COVID-19) is caused by a single-chain RNA virus popularly known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) [1, 2] . According to the World Health Organization on 29

December 2020, over 79 million cases and 1.7 million deaths have been reported globally since the start of the pandemic [3] .

Although most cases are asymptomatic or produce mild symptoms, severe respiratory symptoms may be seen, resulting in acute severe respiratory distress and even multiple organ failure [1] . The most common clinical manifestations of COVID-19 are fever and dry cough; however, shortness of breath, dysosmia, and dysgeusia may also be encountered [4] . Other atypical presentations have been increasingly reported worldwide, including gastrointestinal and dermatological manifestations and chemosensory dysfunctions [1] .

Several oral signs and symptoms related to COVID-19 have already been described, e.g, taste disorders, unspecific oral ulcerations, desquamative gingivitis, petechiae, and coinfections, but the exact prevalence is still J o u r n a l P r e -p r o o f undetermined [4] . It is yet not possible to know the etiology of these oral manifestations but two hypotheses have already been raised: 1) direct mechanisms related to local viral replication due to cellular invasion via the receptor angiotensin-converting enzyme-2 (ACE2) present in the epithelial cells that leads to an inflammation response; 2) indirect results from the viral infection, as a consequence of the patients' systemic and psychological status or secondary to drugs administered [1, 4] .

Since the clinical features of the oral lesions seen in COVID-19 are highly heterogeneous, the treatments differ considerably in the literature, varying from mouthwashes to topical or systemic drugs (antifungals, antibiotics, antivirals, corticosteroids) and even photobiomodulation therapy (PBMT) [2] . In light of these facts, the present study reports a clinical case in which a combination of antimicrobial photodynamic therapy (aPDT) and PBMT was used for lip lesions in a patient with SARS-CoV-2 infection.

A Brazilian 50-year-old female, with obesity, hypertension, and type-2 diabetes After 4 days from the first laser application, the lip lesions were completely healed and the patient recovered satisfactorily her basic orofacial functions ( Figure 1C) . Eventually, the patient recovered completely from the effects of COVID-19, no longer requiring intensive care after a few days. Considering that aPDT has proved effective in inhibiting bacterial, fungal, and viral infections (including those caused by viruses with an envelope such as the coronaviruses) [5] and the lack of reliable information on the etiology of oral lesions related to COVID-19 (maybe a direct local replication of SARS-CoV-2 or opportunistic coinfections) [4] , the protocol used herein was based on a previous report of the same research group in which lesions of oral cytomegalovirus reactivation on lips were successfully treated in a systemic compromised patient [6] .

PBMT, in its turn, reduces the concentration of signaling molecules such as nuclear factor-kappa beta and tumor necrosis factor-alpha and inhibits prostaglandin E2, cyclooxygenase-2, and interleukin 1 beta, resulting in analgesia and mitigation of the inflammatory process [6] .

As shown in the current case report and taking into consideration the evident J o u r n a l P r e -p r o o f lack of information about many aspects of SARS-CoV-2 infection, this combination of phototherapy modalities seems to be a promising tool for managing COVID-19-related labial lesions; however, much more studies are necessary.

J o u r n a l P r e -p r o o f

Orofacial manifestations of COVID-19: a brief review of the published literature

Oral manifestations of COVID -19 disease: A review article

World Health Organization, Weekly epidemiological update -29

Oral Manifestations in Patients with COVID-19: A Living Systematic Review

Antimicrobial Photodynamic Therapy in the Control of COVID-19

Photobiomodulation and antimicrobial photodynamic therapy for oral cytomegalovirus reactivation following acute graft-versus-host disease