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

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.