Oriental journal of medicine and natural sciences




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ORIENTAL JOURNAL OF MEDICINE AND NATURAL SCIENCES 
“Innovative World” Scientific Research Support Center www.inno-world.uz
arresting viral replication. Notably, a study comparing topical antiviral therapy, 
aPDT, and aPDT combined with topical antiviral therapy revealed that the 
combined approach significantly improved pain scores, HSV-1 quantification, and 
pro-inflammatory cytokine levels. 
Honey, used as an adjunct treatment, demonstrated benefits in combination 
with ACV, significantly improving pain, eating and drinking ability, and reducing 
the need for painkillers compared to ACV alone. Honey's anti-inflammatory
antibacterial, and wound healing properties contribute to these effects. However, 
the cariogenic nature of honey should be considered, and the long-term 
consequences of its use in children require further evaluation. 
In conclusion, while ACV remains a key therapeutic agent for PHGS, the 
identified studies emphasize the need for more research on effective and well-
tolerated treatments, considering the challenges in prompt diagnosis and the 
potential complications associated with delayed intervention. 
As previously mentioned, alleviating symptoms, particularly pain, is a primary 
objective of PHGS therapy. Bardellini et al. compared the efficacy of non-alcoholic 
chlorhexidine rinses alone and in combination with hyaluronic acid gel or 
Mucosyte® [19]. While all therapies demonstrated effectiveness, a significant 
improvement in pain scoring and lesion severity was observed with the 
combination of non-alcoholic chlorhexidine rinses and Mucosyte®. Mucosyte® is 
a solution composed of verbascoside, polyvinylpyrrolidone, and sodium 
hyaluronate with reparative action, forming a protective film on the oral mucosa. 
Faden reported the use of a mixture of maalox and diphenhydramine, although 
lacking scientific evidence on its benefits [18]. Concerns were raised about the 
dose, method, and frequency of administration, considering the potential risks of 
sedation in infants with diphenhydramine ingestion and the association of 
viscous lidocaine ingestion with seizures. Surprisingly, ACV was relatively 
infrequently used in Faden's report [18]. 
This systematic review has certain limitations. Firstly, the lack of a 
standardized research protocol in the included studies hinders the comparison of 
results. The heterogeneity of outcomes among studies further limits comparisons. 
Secondly, caution in interpreting results is advised due to methodological 
limitations, incomplete data in one study (study 3), and the potential for bias in 
outcomes assessment. Thirdly, the clinical applicability of findings is limited to 
treating symptoms secondary to PHGS. Most proposed treatments consist of 
empiric regimens of symptomatic drugs, which are ineffective against viral 
replication. Regarding ACV-based therapy, commonly used as the primary drug 
for PHGS treatment, current evidence on its therapeutic benefits is limited, with 
only one out of the five included studies providing weak evidence of its 
effectiveness. Standardizing protocols through well-structured randomized 
clinical trials (RCTs) is crucial for ensuring consistency in PHGS therapy, reducing 
treatment variability, and achieving better outcomes. However, the rapid onset 
and remission of the disease pose challenges for conducting RCTs, as the 
diagnostic delay of approximately 72 hours decreases the effectiveness of 
antiviral drugs. 
In conclusion, despite the high global prevalence of PHGS, the absence of 
consensus on therapeutic management underscores existing evidence gaps. The 



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Oriental journal of medicine and natural sciences

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