Post Herpetic Neuralgia – Herpes

Clin J Pain. 2013 Oct;29(10):e6-9. doi: 10.1097/AJP.0b013e31828b8ef8.

Postherpetic neuralgia: case study of class 4 laser therapy intervention.

Knapp DJ.



Postherpetic neuralgia (PHN) is a neuropathic sequelae in 8% to 27% of individuals with prior varicella zoster virus infection and herpes zoster resulting in retrograde demyelination, neurotoxic reactive oxygen species levels, and proinflammatory cytokine activation of microglia. Pain management strategies are well documented, but not always effective. Laser therapy has shown utility in nerve injury-related pain disorders and was considered a potentially efficacious intervention.


Case report.


Class 4 therapeutic laser treatment was applied with a dual wavelength GaAlAs (810 nm), GaAl (980 nm) laser, 2 to 4 W, 50% duty cycle, 10 Hz pulse active phase, 2.5 cm diameter aperture, scanning technique with skin contact, 10-minute treatment, 600 to 1200 J total, energy density of 3.5 to 7.1 J/cm average per session, and power density from 0.41 to 0.82 W/cm for 8 treatments. Outcome measures included the Neuropathy Pain Scale Questionnaire as the primary outcome measure, with the Numeric Pain Scale and total area of allodynia touch sensitivity as secondary outcome measurements.


The author reports a case of PHN of 15-year duration resistant to prior interventions. Weekly laser therapy treatment over 8 weeks resulted in reduced 0 to 10 Numeric Pain Scale score from 8 to 0, Neuropathy Pain Scale Questionnaire total score from 39 to 4, and allodynia over a 60 cm surface area of the upper trunk and posterior arm totally resolved, with resolution continued at 14-month follow-up.


Theoretically, laser therapy induced tissue changes in this case occurring at and below the skin surface altering inflammatory and excitatory peripheral mechanisms noted to take place in the PHN patient. Peripheral nociceptor firing must be brought back to normal thresholds to resolve such chronic neuropathic pain and inhibit the possible central sensitization component. Anti-inflammatory cytokines, growth factors, nitric oxide, adenosine triphosphate (ATP), and other mechanisms stimulated by laser therapy as noted in medical literature may be central to the favorable response seen in this patient. Controlled clinical trials of class 4 laser therapy in the PHN patient population with similar doses would be beneficial to determine if this is an effective treatment option in PHN.

Lasers Med Sci.  2013 Apr 13. [Epub ahead of print]

Laser treatment of recurrent herpes labialis: a literature review.

de Paula Eduardo C, Aranha AC, Simões A, Bello-Silva MS, Ramalho KM, Esteves-Oliveira M, de Freitas PM, Marotti J, Tunér J.


Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry of the University of São Paulo (USP), Av. Prof. Lineu Prestes, 2227, 05508-000, São Paulo, SP, Brazil,


Recurrent herpes labialis is a worldwide life-long oral health problem that remains unsolved. It affects approximately one third of the world population and causes frequent pain and discomfort episodes, as well as social restriction due to its compromise of esthetic features. In addition, the available antiviral drugs have not been successful in completely eliminating the virus and its recurrence. Currently, different kinds of laser treatment and different protocols have been proposed for the management of recurrent herpes labialis. Therefore, the aim of the present article was to review the literature regarding the effects of laser irradiation on recurrent herpes labialis and to identify the indications and most successful clinical protocols. The literature was searched with the aim of identifying the effects on healing time, pain relief, duration of viral shedding, viral inactivation, and interval of recurrence. According to the literature, none of the laser treatment modalities is able to completely eliminate the virus and its recurrence. However, laser phototherapy appears to strongly decrease pain and the interval of recurrences without causing any side effects. Photodynamic therapy can be helpful in reducing viral titer in the vesicle phase, and high-power lasers may be useful to drain vesicles. The main advantages of the laser treatment appear to be the absence of side effects and drug interactions, which are especially helpful for older and immunocompromised patients. Although these results indicate a potential beneficial use for lasers in the management of recurrent herpes labialis, they are based on limited published clinical trials and case reports. The literature still lacks double-blind controlled clinical trials verifying these effects and such trials should be the focus of future research.

Rev Soc Bras Med Trop.  2011 May-Jun;44(3):397-9.

Recurrent herpes simplex infections: laser therapy as a potential tool for long-term successful treatment.

Ferreira DC, Reis HL, Cavalcante FS, Santos KR, Passos MR.


Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.


Herpes simplex virus types 1 and 2 are the main infectious agents associated with oral and genital ulcerations. These infections are now widely recognized as sexually transmitted diseases. Among treatment options, low-level laser therapy (LLLT) has shown promising clinical results as a longer-lasting suppression therapy. Two clinical cases are described with recurrent labial herpes for which LLLT was used. Following treatment, both patients remained symptom free during the 17-month clinical follow-up period.

Photomed Laser Surg.  2011 Nov 2. [Epub ahead of print]

The Effect of 670-nm Low Laser Therapy on Herpes Simplex Type 1.

Muñoz Sanchez PJ, Capote Femenías JL, Díaz Tejeda A, Tunér J.


1 Leonardo Fernández Sánchez Dental Clinic , Cienfuegos, Cuba .


Abstract Objective: The purpose of this work was to study the effect of low-level laser therapy (LLLT) on the healing and relapse intervals in patients with recurrent labial herpes simplex infections.

Background data: Several pharmaceuticals are available to reduce symptoms and improbé healing of labial herpes, but only LLLT has been reported to significantly influence the length of the recurrence period.

Material and methods: In an initial study, 232 patients with herpes simplex type 1 virus symptoms were consecutively selected for either LLLT or conventional therapy, including acyclovir cream or tablets. One of the dentists was responsible for the diagnosis, a second dentist for the treatment, and and a third for the evaluation, to allow for a semi-blinded procedure. Patients in the laser group received 670-nm laser irradiation, 40?mW, 1.6?J, 2.04?J/cm(2), 51?mW/cm(2) per blister in the prodromal stage and 4.8?J in the crust and secondarily infected stages, plus 1.2?J at the C2-C3 vertebrae. Patients were monitored daily during the first week to control healing, and monthly for 1 year to check on recurrence. In a consecutive study, 322 patients receiving LLLT were followed during 5 years to observe the period of ocurrences.

Results: An obvious effect of LLLT was found for both initial healing and for the length of the recurrence periods.

Conclusions: LLLTof herpes simples virus 1 (HSV-1) appears to be an effective treatment modality without any observed side effects.

Cutis.  2011 Sep;88(3):140-8.

Phototherapy in the treatment of cutaneous herpesvirus manifestations.

Kelley JP, Rashid RM.


University of Texas Medical School at Houston, USA.


There is a considerable need for effective and safe treatment of cutaneous herpesvirus lesions. Current common approaches are limited to expensive or multidose oral pills. This systematic review of evidence-based approaches to phototherapy for the various manifestations of the herpesvirus discusses original publications of controlled clinical trials and case reports that were identified through searches in PubMed, MEDLINE, and Ovid. Interventions included photodynamic therapy (PDT), UV light, and near-infrared lasers. Nearly all studies (10 of 11) saw reduction of most or all lesions and extended time before reactivation of the virus. Side effects often were minimal to nonexistent, usually mild erythema at sites of phototreatment. Serious side effects included first-degree burns and linear IgA dermatosis, which were not common. Evidence from the reviewed literature indicates that short-term efficacy from treatment with phototherapy is the most likely outcome. However, long-term effects and follow-up of this treatment modality are lacking but appear promising. We recommend future studies to include more patients, determine the most effective type of phototherapy, and assess long-term follow-up. Furthermore, light-based therapies can be considered a reasonable alternative in situations that preclude traditional drug-based therapies.

Rev Soc Bras Med Trop.  2011 Jun;44(3):397-9.

Recurrent herpes simplex infections: laser therapy as a potential tool for long-term successful treatment.

Ferreira DC, Reis HL, Cavalcante FS, Santos KR, Passos MR.


Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ.


Herpes simplex virus types 1 and 2 are the main infectious agents associated with oral and genital ulcerations. These infections are now widely recognized as sexually transmitted diseases. Among treatment options, low-level laser therapy (LLLT) has shown promising clinical results as a longer-lasting suppression therapy. Two clinical cases are described with recurrent labial herpes for which LLLT was used. Following treatment, both patients remained symptom free during the 17-month clinical follow-up period.

Photomed Laser Surg. 2010 Feb;28(1):135-9.

Low- and high-intensity lasers in the treatment of herpes simplex virus 1 infection.

Bello-Silva MS, de Freitas PM, Aranha AC, Lage-Marques JL, Simões A, de Paula Eduardo C.

Center of Research, Teaching and Clinics of Lasers in Dentistry, University of São Paulo, São Paulo, SP, Brazil.


Herpes simplex virus (HSV) is one of the most common viral infections of the human being. Although most of the seropositive persons do not manifest symptoms, infected individuals may present recurrent infections, characterized by cold sores. HSV-1 infection can result in potentially harmful complications in some patients, especially in those with compromised immunity. We report a clinical case of a patient with severe oral HSV-1 infection in the lower lip. The treatment of the lesions with the association of high-intensity (erbium-doped yttrium aluminum garnet, 2.94 mum, 80 mJ/pulse, 2-4 Hz) and low-intensity (indium gallium aluminum phosphide, 660 nm, 3.8 J/cm(2), 10 mW) lasers has not been reported in the literature. During treatment, no systemic or topical medication was used. Pain sensitivity was completely gone after the first irradiation with the low-intensity laser. During the healing process, lesions were traumatized twice, on the days 4 and 7. Even though the lesions were completely healed within 10 days.

Lasers Med Sci. 2010 May;25(3):397-402. Epub 2009 Aug 11.

Effect of laser phototherapy on recurring herpes labialis prevention: an in vivo study.

de Carvalho RR, de Paula Eduardo F, Ramalho KM, Antunes JL, Bezinelli LM, de Magalhães MH, Pegoretti T, de Freitas PM, de Paula Eduardo C.

Special Laboratory of Lasers in Dentistry, Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo 05508-000, SP, Brazil.


Alternative treatment for recurrent labial infection by herpes simplex virus (HSV) have been considered. The aim of this study was to evaluate the effectiveness of laser phototherapy in prevention and reduction of severity of labial manifestations of herpes labialis virus. Seventy-one patients, divided into experimental (n = 41) and control (n = 30) groups were followed up for 16 months. Patients in the control group were treated topically with aciclovir and patients in the experimental group were subjected to laser phototherapy (one session per week, 10 weeks): 780 nm, 60 mW, 3.0 J/cm(2) or 4.5 J/cm(2) on healthy (no HSV-1 infection) and affected (with HSV-1 infection) tissues. Patients in the experimental group presented a significant decrease in dimension of herpes labialis lesions (P = 0.013) and inflammatory edema (P = 0.031). The reduction in pain level (P = 0.051) and monthly recurrences (P = 0.076) did not reach statistical significance. This study represents an in vivo indication that this treatment should be further considered as an effective alternative to therapeutic regimens for herpes labialis lesions.

Clin Exp Dermatol. 2006 Sep;31(5):638-41. Epub 2006 Jun 15.

A randomised double-blind study comparing the effect of 1072-nm light against placebo for the treatment of herpes labialis.

Hargate G.

Newlands Medical Centre, Borough Road, Middlesbrough, UK.

BACKGROUND: Previous research demonstrated that 1072-nm narrowband laser light is effective in the treatment of cold sores. AIM: To evaluate the efficacy of an over-the-counter cold-sore treatment device (Virulite CS) incorporating 1072-nm light-emitting diodes. METHODS: A randomised, prospective, double-blind, self-reported study was performed to compare the efficacy of at least six 3-min treatments of 1072-nm narrowband light against placebo, in the treatment of herpes labialis. RESULTS: The 1072-nm light-emitting diode device reduced cold-sore healing time to 6.3 days compared with 9.4 days for placebo (P=0.048). The time the cold sore took to form a crust was also reduced from 2.00 days for those treated with 1072-nm light, compared with 2.88 days for placebo (P=0.059) CONCLUSIONS: The significant difference between the mean healing times in the two groups demonstrates that the Virulite CS device is an effective means of treating herpes labialis.

Used by the kind permission of the Czech Society for the Use of Laser in Medicine,

Laser Therapy of Human Herpes Simplex Lesions

Arturo Guerra Alfonso, Pedro José MuZoz

Clinic “Leonardo Fernández Sánchez“, Cienfuengos, Cuba


Herpes Simplex is rather a widespread illness caused by human herpes virus generally combining primary lesions with periods of latency. The authors evaluate results of treatment with a low power laser and with classical antivirals. Obtained results are demonstrated in attached tables.

By way of illustration the editor also attached a series of images showing typical history of a herpes lesion treated with a laser.


Herpes Simplex is an illness caused by the human herpes virus types 1 and 2 that generally present a primary lesion, with periods of latency and a tendency to relapse. It is also known as Button of fever or Bladder of fever. According to the World Health Organisation (WHO) an international prevalence of about 60 % is observed (1, 2).

An experimental study was carried out, where 232 patients affected by the Herpes Simplex type 1 virus were treated. All patients attended the clinic „Leonardo Fernández“ in Cienfuengos during the period of January 2001 to January 2003, with the objective of determining the time of recurrence of labial herpes in the groups, studied before and after treatment, and to evaluate the effectiveness of low power laser in the treatment of the infection of the virus.


Two groups were selected (study and control) with 116 patients in each group, distributed and classified according to the clinical stage in which they went to consultation. In the study group the patients were offered treatment with a GaAlAs diode laser (670 nm / 30 mW – 40 sec) in the prodromal stage and the stage of vesicles; or (670 nm /20 mW – 2 min) in the crust stage and in infections infected secondarily. To all these patients radiation among vertebras C2 – C3, where the resident ganglion of the virus is located during the latent periods (670 nm / 30 mW – 30 sec), was also applied.

Control group was offered indicated treatment with antivirals (Aciclovir in cream and in pills) and other paliative therapies.

After having carried out the analysis of the data obtained, the following results were obtained:

Study groupn = 116 Recurrence frequency
Once a month Every2 to 3 m Every4 to 5 m Every 6 months Once a year First time norecurrence
Before treatment 9 26 58 12 7 4 0
After treatment 0 0 37 22 25 0 32

Table 1: Patients of the study group, distribution according to the frequency of annual recurrence of the labial herpes before and after laser therapy.

When analysing Table 1 it is observed that the groups of patients suffering from herpes with high frequencies of recurrence (after being treated with laser an waiting one year prior to evaluation of the effectiveness) reported recurrence for more elongated periods of time and 32 patients did not even have any more recurrence.

Controlgroupn = 116 Recurrence frequency after receiving treatment
Once a month Every2 to 3 m Every4 to 5 m Every 6 months Once a year First time norecurrence
Before treatment 7 24 56 14 9 6 0
After treatment 6 21 46 27 14 0 2

Table 2: Patients of the control group, distribution according to the annual recurrence frequency of labial herpes before and after treatment.

In Table 2 the same previous aspects are reflected but in the control group. As it can be observed the cases diminished in number, although discreetely; those that presented more recurrence and of equal number of recurrencies increased in number of patients in the periods of more lingering recurrence. In this group 2 patients reported not having had any more lesions during the analyzed year.

  Recurrence frequency after receiving treatment
Once a month Every2 to 3 m Every4 to 5 m Every 6 months Once a year norecurrence
Study group (n = 116) 0 0 37 22 25 32
Control group (n = 116) 6 21 46 27 14 2

Table 3: Patients of both groups, distribution according to annual recurrence frequency of labial herpes after receiving treatment.

Table 3 compares both groups as for annual frequency of recurrence after having received corresponding treatment. When analyzing this, superiority of the group treated with laser becomes evident.

Clinical stage Time of cure
First 48 h. 3 to 4 days 5 to 7 days More than 7 days Total
Tot. % Tot. % Tot. % Tot. %
Study group(n = 116) Prodromal 26 100 0 0 0 0 0 0 26
Vesicles 40 95 2 4.8 0 0 0 0 42
Crust 31 91 3 8.8 0 0 0 0 34
Secondary infection 0 0 13 93 1 7.2 0 0 14
Control group(n=116) Prodromal 0 0 25 96 1 3.9 0 0 26
Vesicles 0 0 0 0 9 22 33 79 42
Crust 0 0 0 0 24 71 10 29 34
Secondary infection 0 0 0 0 0 0 14 100 14
Total 97 42 43 19 35 15 57 25 232

Table 4: Patients of both groups, distribution with relation to the clinical stage in which we intervened and the time of cure of the same ones.

As it can be observed in Table 4, in the study group 100 % of the prodromal stages, 95 % of the vesicular ones, and 91 % of the crust stages were able to cure during the first 48 hours. Patients with lesions infected secondarily needed more than 48 hours to cure, although they never surpassed 5 days.

These results, although astonishing, are corroborated by authors like Tunér and Schindl, where they highlight that treatment with a laser in the initial stages of Herpes Labialis has a percentage of superior success compared to conventional treatment, besides achieving an almost immediate relief of the symptoms (3, 4).

In the control group remarkable differencies are appreciated when comparing them with that of the study group. Therapy with Aciclovir in early stages (first 72 hours) has b een broadly suitable for many professionals and their use against Herpes Labialis has been studied by some authors (5).


Periods of annual recurrence in the study group were prolonged considerably after having received treatment, whilst in the control group such evident changes were not shown.

In the prodromal period the patients treated with laser all healed up in the first 48 hours, whilst those treated conventionally needed from 3 to 4 days to cure.

In the vesicular period and the period of crust, those of the study group cured in majority in the first 48 hours, whilst those of the control group needed more than 5 days.

In infected lesions those treated with laser cured mainly in 3 to 4 days, whilst those treated with medication needed more than 7 days to cure.


  1. Santana, J. C.: Altas of pathology of the buccal complex, Havana: Editorial scientific-technique, 1985:30-34
  2. Eversole, L. R.: Buccal pathology, Diagnosis and Treatment, Havana: Editorial scientific-technique, 1985:82-87
  3. Tunér, J., Hode, L.: Low Level Laser Therapy – clinical practice and scientific background, 1999, ISBN 91-630-7616-0
  4. Parker, J. et al.: The effects of laser therapy on tissue repair and pain control: a meta-analysis of literature, Proc. Third Congress WALT, Athens, Greece, May 10-13, 2000, p. 77
  5. Vélez-González, M. et al.: Treatment of relapse in herpes simplex on labial and facial areas and of primary herpes simplex on genital areas and area pudenda with low power He-Ne laser or Acyclovir administered orally, SPIE Proc. 1995, Vol. 2630:43-50
  6. Garrigó M. I., Valiant C.: Biological effects of radiation of low power laser in the repair histica, Rev. Cub. Estomat, 1996:33 (2)
  7. Simunovic, Z.: Lasers in Medicine and Dentistry, Vitagraf, Croatia, 2000.


Fig. 1: Herpes Day 1 (occurrence) Fig. 2: Herpes Day 1+ (first laser treatment)


Fig. 3: Herpes Day 2 (morning, condition after 2 treatments) Fig. 4: Herpes Day 2+ (afternoon, condition after 3 treatments)


Fig. 5: Herpes Day 3 (afternoon, cured after 4 treatments)  


J Investigative Dermatology. 1999; 113 (2): 221-223.

Low-intensity laser therapy is an effective treatment for recurrent herpes simplex infection.  Results from a randomized double-blind placebo controlled study.

Schindl A, Neuman R.

50 patients with recurrent perioral herpes simplex infections (at least once a month for more than 6 months) were treated with 690 nm, 80 mW laser, 48 J/cm2, in a double blind study. Patients received daily irradiations for two weeks, 10 treatments. The treatment was given in a recurrence-free period and the irradiation was given at the site of the original herpes simplex infection. If both lips were involved, both upper and lower lips were treated. Patients were monitored for 52 weeks. The mean recurrence-free interval in the laser group was 37.5 weeks (range; 2-52 weeks) and in the placebo group 3 weeks (range 1-20 weeks). No side effects were noted.


Kevin C Moore Naru Hira. Parswanath S. Kramer, Copparam S. Jayakumar and Toshio Oshiro

Post herpetic. neuralgia can he an extremely painful condition which in many cases proves resistant lo all the accepted forms of treatment. II is frequently most severe in the elderly and may persist for years with no predictable course.

This trial was designed as a double blind assessment of the efficacy of low level laser therapy in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with . established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received tour consecutive laser treatments. The results ides demonstrate a significant reduction in both pain intensity and distribution following a course of low level laser therapy.


Toshikazu Hashimoto, Osamu Kemmotsu, Hiroshi Otsuka, Rie Numazawa, and
Yoshihiro Ohta,

Department of Anaesthesia, Hokkaido University Hospital, Sapporo, Japan

In the present study we evaluate the effects of laser irradiation on the
area near the stellate ganglion on regional skin temperature and pain
intensity in patients with postherpetic neuralgia. A double blind, crossover
and placebo-controlled study was designed to deny the placebo effect of
laser irradiation. Eight inpatients (male 6, female 2) receiving laser
therapy for pain attenuation were enrolled in the study after institutional
approval and informed consent. Each patient received three session s of
treatment on a separate day in a randomised fashion. Three minutes
irradiation with a 150 mW laser (session 1), 3 minutes irradiation with a 60
mW laser (session 2), and 3 minutes placebo treatment without laser
irradiation Neither the patient nor the therapist was aware which session
type was being applied until the end of the study. Regional skin temperature
was evaluated by thermography of the forehead, and pain intensity was
recorded using a visual analogue scale(VAS). Measurement were performed
before treatment, immediately after (0 minutes) then 5, 10, 15, and 30 min
after treatment. Regional skin temperature increased following both 150 mW
and 60mW laser irradiation, whereas no changes were obtained by placebo
treatment. VAS decreased following both 150 mW and 60 mW laser treatments,
but no changes in VAS were obtained by placebo treatment. These changes in
the temperature and VAS were further dependent on the energy density, i.e
the dose. Results demonstrate that laser irradiation near the stellate
ganglion produces effects similar to stellate ganglion block. Our results
clearly indicate that they are not placebo effects but true effects of laser