Photobiomodulation and photodynamic therapy in the treatment of pressure injuries: a scoping review

Silva, Alexsandra Martins da; Silva, Gabriela Machado; Martins, Jerusa Celi; Bavaresco, Taline; Echevarría-Guanilo, Maria Elena

doi:10.1590/1518-8345.7495.4488

person Alexsandra Martins da Silva

Study concept and design · Obtaining data · Data analysis and interpretation · Statistical analysis · Obtaining financing · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content · Others (Contribution to the study design - methodology) · Others (Approval of the final version to be published) · All authors approved the final version of the text

school Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.school Scholarship holder at Fundo Estadual de Apoio à Manutenção e ao Desenvolvimento da Educação Superior (UNIEDU/FUMDES), Brazil.

0000-0001-9147-9990

person Gabriela Machado Silva

Data analysis and interpretation · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content · Others (Contribution to the study design - methodology) · Others (Approval of the final version to be published) · All authors approved the final version of the text

school Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.

0000-0001-9409-1916

person Jerusa Celi Martins

Data analysis and interpretation · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content · Others (Contribution to the study design - methodology) · Others (Approval of the final version to be published) · All authors approved the final version of the text

school Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.

0000-0003-4295-3996

person Taline Bavaresco

Data analysis and interpretation · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content · Others (Contribution to the study design - methodology) · Others (Approval of the final version to be published) · All authors approved the final version of the text

school Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

0000-0001-5944-1941

person Maria Elena Echevarría-Guanilo

school Universidade Federal de Santa Catarina, Departamento de Enfermagem, Florianópolis, SC, Brazil.

0000-0003-0505-9258

personCorresponding author: Alexsandra Martins da Silva E-mail:
alexsandrams.enf@gmail.com

Conflict of interest:

the authors have declared that there is no conflict of interest

Associate Editor:

Maria Lúcia Zanetti

Database	Search strategy
PubMed/MEDLINE*	(“Low-Level Light Therapy” OR “LLLT^†” OR “Laser Biostimulation” OR “Laser Phototherapy” OR “Low Level Laser” OR “LowLevel Light” OR “Low Power Laser” OR “Low-Level Laser” OR “Low-Level Light” OR “Low-Power Laser” OR Photobiomodula* OR “Laser Therapy” OR “Laser Therapies” OR Photodynamic) AND (“Wound Healing”[Mesh] OR “Wound Healing” OR “Wound Healings” OR “Cicatrization” OR “Cicatrix” OR “Cicatrization” OR “Scar” OR “Scarring” OR “Scars” OR epithelializ) AND (“Pressure Ulcer” OR “Bed Sore” OR “Bed Sores” OR Bedsore* OR “Decubitus Ulcer” OR “Decubitus Ulcers” OR “Pressure Sore” OR “Pressure Sores” OR “Pressure Ulcers”) AND (journal article[Publication Type])
Embase (Elsevier)	(“Low-Level Light Therapy” OR “LLLT^†” OR “Laser Biostimulation” OR “Laser Phototherapy” OR “Low Level Laser” OR “LowLevel Light” OR “Low Power Laser” OR “Low-Level Laser” OR “Low-Level Light” OR “Low-Power Laser” OR Photobiomodula* OR “Laser Therapy” OR “Laser Therapies” OR Photodynamic) AND (“Wound Healing” OR “Wound Healings” OR “Cicatrization” OR “Cicatrix” OR “Cicatrization” OR “Scar” OR “Scarring” OR “Scars” OR epithelializ) AND (“Pressure Ulcer” OR “Bed Sore” OR “Bed Sores” OR Bedsore* OR “Decubitus Ulcer” OR “Decubitus Ulcers” OR “Pressure Sore” OR “Pressure Sores” OR “Pressure Ulcers”)
CINAHL^‡ (EBSCO)	(“Low-Level Light Therapy” OR “LLLT^†” OR “Laser Biostimulation” OR “Laser Phototherapy” OR “Low Level Laser” OR “LowLevel Light” OR “Low Power Laser” OR “Low-Level Laser” OR “Low-Level Light” OR “Low-Power Laser” OR Photobiomodula* OR “Laser Therapy” OR “Laser Therapies” OR Photodynamic) AND (“Wound Healing” OR “Wound Healings” OR “Cicatrization” OR “Cicatrix” OR “Cicatrization” OR “Scar” OR “Scarring” OR “Scars” OR epithelializ) AND (“Pressure Ulcer” OR “Bed Sore” OR “Bed Sores” OR Bedsore* OR “Decubitus Ulcer” OR “Decubitus Ulcers” OR “Pressure Sore” OR “Pressure Sores” OR “Pressure Ulcers”)
Cochrane Library	(“Low-Level Light Therapy” OR “LLLT^†” OR “Laser Biostimulation” OR “Laser Phototherapy” OR “Low Level Laser” OR “LowLevel Light” OR “Low Power Laser” OR “Low-Level Laser” OR “Low-Level Light” OR “Low-Power Laser” OR Photobiomodula* OR “Laser Therapy” OR “Laser Therapies” OR Photodynamic) AND (“Wound Healing” OR “Wound Healings” OR “Cicatrization” OR “Cicatrix” OR “Cicatrization” OR “Scar” OR “Scarring” OR “Scars” OR epithelializ) AND (“Pressure Ulcer” OR “Bed Sore” OR “Bed Sores” OR Bedsore* OR “Decubitus Ulcer” OR “Decubitus Ulcers” OR “Pressure Sore” OR “Pressure Sores” OR “Pressure Ulcers”)
Scopus (Elsevier)	(“Low-Level Light Therapy” OR “LLLT^†” OR “Laser Biostimulation” OR “Laser Phototherapy” OR “Low Level Laser” OR “LowLevel Light” OR “Low Power Laser” OR “Low-Level Laser” OR “Low-Level Light” OR “Low-Power Laser” OR Photobiomodula* OR “Laser Therapy” OR “Laser Therapies” OR Photodynamic) AND (“Wound Healing” OR “Wound Healings” OR “Cicatrization” OR “Cicatrix” OR “Cicatrization” OR “Scar” OR “Scarring” OR “Scars” OR epithelializ) AND (“Pressure Ulcer” OR “Bed Sore” OR “Bed Sores” OR Bedsore* OR “Decubitus Ulcer” OR “Decubitus Ulcers” OR “Pressure Sore” OR “Pressure Sores” OR “Pressure Ulcers”)
Web of Science (Clarivate Analytics)	(“Low-Level Light Therapy” OR “LLLT^†” OR “Laser Biostimulation” OR “Laser Phototherapy” OR “Low Level Laser” OR “LowLevel Light” OR “Low Power Laser” OR “Low-Level Laser” OR “Low-Level Light” OR “Low-Power Laser” OR Photobiomodula* OR “Laser Therapy” OR “Laser Therapies” OR Photodynamic) AND (“Wound Healing” OR “Wound Healings” OR “Cicatrization” OR “Cicatrix” OR “Cicatrization” OR “Scar” OR “Scarring” OR “Scars” OR epithelializ) AND (“Pressure Ulcer” OR “Bed Sore” OR “Bed Sores” OR Bedsore* OR “Decubitus Ulcer” OR “Decubitus Ulcers” OR “Pressure Sore” OR “Pressure Sores” OR “Pressure Ulcers”)
LILACS^§	(“Terapia com Luz de Baixa Intensidade” OR “Luz de Baixa Intensidade” OR “Bioestimulação a Laser” OR “Laser de Baixa Intensidade” OR “Laser de Baixa Potência” OR Fotobiomodula* OR “Terapia a Laser” OR “laserterapia” OR Fotodinâmic* OR “Terapia por Luz de Baja Intensidad” OR “Luz de Baja Intensidad” OR “Bioestimulación por Láser” OR “Láser de Baja Potencia” OR “Láser de Bajo Poder” OR “Láser de Baja Intensidad” OR “Láser de Bajo Nivel” OR “Terapia por Láser” OR “Low-Level Light Therapy” OR “LLLT^†” OR “Laser Biostimulation” OR “Laser Phototherapy” OR “Low Level Laser” OR “LowLevel Light” OR “Low Power Laser” OR “Low-Level Laser” OR “Low-Level Light” OR “Low-Power Laser” OR Photobiomodula* OR “Laser Therapy” OR “Laser Therapies” OR Photodynamic) AND (“Cicatrização” OR “Cicatriz” OR “Cicatrizes” OR Escara OR epiteliza* OR “Cicatrización de Heridas” OR “Cicatrización” OR “Cicatrices” OR “Wound Healing” OR “Wound Healings” OR “Cicatrization” OR “Cicatrix” OR “Cicatrization” OR “Scar” OR “Scarring” OR “Scars” OR epithelializ) AND (“Lesão por pressão” OR “Lesão cutânea” OR “Lesão de pele” OR “Úlcera de Decúbito” OR “Úlcera de Pressão” OR “Úlcera por Pressão” OR “Úlceras por Pressão” OR “Úlcera por Presión” OR “Llaga por Presión” OR “Pressure Ulcer” OR “Bed Sore” OR “Bed Sores” OR Bedsore OR “Decubitus Ulcer” OR “Decubitus Ulcers” OR “Pressure Sore” OR “Pressure Sores” OR “Pressure Ulcers”)
BDENF^\|\|	(“Terapia com Luz de Baixa Intensidade” OR “Luz de Baixa Intensidade” OR “Bioestimulação a Laser” OR “Laser de Baixa Intensidade” OR “Laser de Baixa Potência” OR Fotobiomodula* OR “Terapia a Laser” OR “laserterapia” OR Fotodinâmic* OR “Terapia por Luz de Baja Intensidad” OR “Luz de Baja Intensidad” OR “Bioestimulación por Láser” OR “Láser de Baja Potencia” OR “Láser de Bajo Poder” OR “Láser de Baja Intensidad” OR “Láser de Bajo Nivel” OR “Terapia por Láser” OR “Low-Level Light Therapy” OR “LLLT^†” OR “Laser Biostimulation” OR “Laser Phototherapy” OR “Low Level Laser” OR “LowLevel Light” OR “Low Power Laser” OR “Low-Level Laser” OR “Low-Level Light” OR “Low-Power Laser” OR Photobiomodula* OR “Laser Therapy” OR “Laser Therapies” OR Photodynamic) AND (“Cicatrização” OR “Cicatriz” OR “Cicatrizes” OR Escara OR epiteliza* OR “Cicatrización de Heridas” OR “Cicatrización” OR “Cicatrices” OR “Wound Healing” OR “Wound Healings” OR “Cicatrization” OR “Cicatrix” OR “Cicatrization” OR “Scar” OR “Scarring” OR “Scars” OR epithelializ) AND (“Lesão por pressão” OR “Lesão cutânea” OR “Lesão de pele” OR “Úlcera de Decúbito” OR “Úlcera de Pressão” OR “Úlcera por Pressão” OR “Úlceras por Pressão” OR “Úlcera por Presión” OR “Llaga por Presión” OR “Pressure Ulcer” OR “Bed Sore” OR “Bed Sores” OR Bedsore OR “Decubitus Ulcer” OR “Decubitus Ulcers” OR “Pressure Sore” OR “Pressure Sores” OR “Pressure Ulcers”)
SciELO^¶	(“Terapia com Luz de Baixa Intensidade” OR “Luz de Baixa Intensidade” OR “Bioestimulação a Laser” OR “Laser de Baixa Intensidade” OR “Laser de Baixa Potência” OR Fotobiomodula* OR “Terapia a Laser” OR “laserterapia” OR Fotodinâmic* OR “Terapia por Luz de Baja Intensidad” OR “Luz de Baja Intensidad” OR “Bioestimulación por Láser” OR “Láser de Baja Potencia” OR “Láser de Bajo Poder” OR “Láser de Baja Intensidad” OR “Láser de Bajo Nivel” OR “Terapia por Láser” OR “Low-Level Light Therapy” OR “LLLT^†” OR “Laser Biostimulation” OR “Laser Phototherapy” OR “Low Level Laser” OR “Low Level Light” OR “Low Power Laser” OR “Low-Level Laser” OR “Low-Level Light” OR “Low-Power Laser” OR Photobiomodula* OR “Laser Therapy” OR “Laser Therapies” OR Photodynamic) AND (“Cicatrização” OR “Cicatriz” OR “Cicatrizes” OR Escara OR epiteliza* OR “Cicatrización de Heridas” OR “Cicatrización” OR “Cicatrices” OR “Wound Healing” OR “Wound Healings” OR “Cicatrization” OR “Cicatrix” OR “Cicatrization” OR “Scar” OR “Scarring” OR “Scars” OR epithelializ) AND (“Lesão por pressão” OR “Lesão cutânea” OR “Lesão de pele” OR “Úlcera de Decúbito” OR “Úlcera de Pressão” OR “Úlcera por Pressão” OR “Úlceras por Pressão” OR “Úlcera por Presión” OR “Llaga por Presión” OR “Pressure Ulcer” OR “Bed Sore” OR “Bed Sores” OR Bedsore OR “Decubitus Ulcer” OR “Decubitus Ulcers” OR “Pressure Sore” OR “Pressure Sores” OR “Pressure Ulcers”)

Id*	Title	Autors	Year	Country	Journal
E^†1¹⁶	Lesão por pressão após COVID-19^‡ tratada com laserterapia adjuvante: estudo de caso	Lucena, Pinto, Disconzi, Fabris Mazui, Riquinho.	2023	Brazil	Revista Gaúcha de Enfermagem
E^†2¹⁷	The role of physical therapies in wound healing and assisted scarring	Fernández-Guarino, Bacci, Pérez González, Bermejo-Martínez, Cecilia-Matilla, Hernández-Bule.	2023	Spain	International Journal Of Molecular Sciences
E^†3¹⁸	Photobiomodulation therapy and low-level light therapy in wound healing	Aggarwa, Lio.	2023	USA^§	Lasers in Medical Science
E^†4¹⁹	Effectiveness of electrophysical agents for treating pressure injuries: a systematic review	Vieceli, Martins, Hendler, Santos, Neves, Barbosa, et al.	2022	Spain	Lasers in Medical Science
E^†5²⁰	Treatment of chronic wounds with methylene blue photodynamic therapy: a case report	Cesar, Winyk, Santo, Queiroz, Soares, Caetano, et al.	2022	Brazil	Photodiagnosis and Photodynamic Therapy
E^†6²¹	Laser de baixa intensidade na cicatrização de lesão por pressão estágio 3: relato de experiência	Sousa, Soares, Borges, Barreto, Caregnato.	2022	Brazil	Revista Enfermagem Atual in Derme
E^†7²²	Influence of physiotherapy in the vigilant revitalisation of decubitus ulcer: a case report	Bhagdewani, Sasun, Patil.	2022	India	Journal Of Clinical and Diagnostic Research
E^†8²³	Phototherapy (cluster multi-diode 630 nm^\|\| and 940 nm^\|\|) on the healing of pressure injury: a pilot study	Baracho, Chaves, Huebner, Oliveira, Ferreira, Lucas.	2021	Brazil	Journal of Vascular Nursing
E^†9²⁴	Eliminating non-healing wounds: a review	Kuffler.	2021	USA^§	Regenerative Medicine
E^†10²⁵	Skin surface infrared thermography in pressure ulcer outcome prognosis	Bilska, Stangret, Pyzlak, Wojdasiewicz, Szukiewicz.	2020	Poland	Journal of Wound Care
E^†11²⁶	Effect of photobiomodulation on repairing pressure ulcers in adult and elderly patients: a systematic review	Petz, Félix, Roehrs, Pott, Stocco, Marcos.	2019	Poland	Photochemistry and Photobiology
E^†12²⁷	Photobiomodulation therapy for wound care: a potent, noninvasive, photoceutical approach	Mosca, Ong, Albasha, Bass, Arany.	2019	USA^§	Advances in Skin & Wound Care
E^†13²⁸	Efeitos da laserterapia no tratamento de lesões por pressão: uma revisão sistemática	Bernardes, Jurado.	2018	Poland	Revista Cuidarte
E^†14²⁹	Effect of laser therapy on expression of angio-and fibrogenic factors, and cytokine concentrations during the healing process of human pressure ulcers	Taradaj, Shay, Dymarek, Sopel, Walewicz, Beeckman, et al.	2018	Poland	International Journal of Medical Sciences
E^†15³⁰	Application of photodynamic therapy, laser therapy, and a cellulose membrane for calcaneal pressure ulcer treatment in a diabetic patient: a case report	Rosa, Silva, Vieira, Tanajura, Gusmão, Oliveira, et al.	2017	Brazil	Photodiagnosis and Photodynamic Therapy
E^†16³¹	Efeitos dos lasers Hélio-Neônio (HeNe^¶ ) e Arseneto de Gálio (AsGa**) associados à educação em saúde com foco na promoção da saúde de portadores de úlcera por pressão	Fialho, Baron, Brandenburg, Martins.	2017	Brazil	Revista Médica de Minas Gerais
E^†17³²	Low-level laser therapy in the treatment of pressure ulcers: systematic review	Machado, Viana, Sbruzzi.	2017	Brazil	Lasers in Medical Science
E^†18³³	Laserterapia em úlcera por pressão: avaliação pelas Pressure Ulcer Scale for Healing e Nursing Outcomes Classification	Palagi, Severo, Menegon, Lucena.	2015	Brazil	Revista da Escola de Enfermagem da USP
E^†19³⁴	Improving the ability to eliminate wounds and pressure ulcers	Kuffler.	2015	^USA§	Wound Repair and Regeneration
E^†20³⁵	Photobiomodulation in promoting wound healing: a review	Kuffler.	2015	^USA§	Regenerative Medicine
E^†21³⁶	Low-Level laser therapy along with intravascular laser in deep pressure ulcer resistant to conventional therapies	Kazemikhoo, Rahbar, Akrami.	2015	Iran	Journal of Skin and Stem Cell
E^†22³⁷	Nonpharmacologic Interventions to heal pressure ulcers in older patients: an overview of systematic reviews (The SENATOR^††-ONTOP^‡‡ series)	Pharm, Lozano-Montoya, Abraha, Cherubini, Soiza, O’Mahony, et al.	2015	Italy	Journal of the American Medical Directors Association
E^†23³⁸	Low-level laser therapy as an antimicrobial and antibiofilm technology and its relevance to wound healing	Percival, Francolini, Donelli.	2015	United Kingdom	Future Microbiology
E^†24³⁹	Closure of chronic non healing ankle ulcer with low level laser therapy in a patient presenting with thalassemia intermedia: Case report	Dixit, Agrawal, Sharma, Singh.	2014	India	Indian Journal of Plastic Surgery

Id*	Objectives	Type of study	Population or articles included (n^†)	Specifications on FBM^‡ and/or PDT^§, and frequency of application	Main findings on FBM^‡ and PDT^§ in LP^\|\|
E^¶1¹⁶	To Report on adjuvant laser therapy in a patient with LP^\|\| after COVID-19**	Case report	(n^†=1)	LLLT^†† with wavelengths of 660 and 808 nm^‡‡, and 1 J^§§ red laser and 1 J^§§ infrared laser.	The results of the healing of the lesions showed healing by second intention and four clinical indicators: evolution of tissue repair with the presence of epithelialization tissue from the 6th and 7th days of application, completely covered granulation, reduced lesion size, and absence of exudate, only transudate.
E^¶2¹⁷	To summarize the role of physical therapies as complementary treatments in wound healing.	Narrative review	-		In LP^\|\|, red light increases healing with better results when compared to LED^\|\|\|\| 805 nm^‡‡.
E^¶3¹⁸	To summarize the applications of FBM^‡ in the field of wound healing and specify the current results in the parameters used for treatment.	Narrative review	-	LLLT^†† applied seven times.	Results suggest that a specific wavelength of 658 nm^‡‡, which falls within the range of red light, may be more effective in treating LP^\|\|.
E^¶4¹⁹	To evaluate the efficacy of MBF^‡, ultrasound and high-frequency electrophysical agents in the healing of pressure injuries in adults and the elderly.	Systematic review	(n^†=12)		MBF^‡ showed similar efficacy to other technologies indicated in other studies in the healing of pressure injuries. FBM^‡ with a red wavelength (660 nm^‡‡) in stages 2 and 3 of pressure injuries effectively promoted healing compared to standard treatment. It was observed that the use of MBF^‡ accelerates tissue repair in pressure injuries.
E^¶5²⁰	To investigate the safety and efficacy of PDT^§ treatment using methylene blue on lesions that showed signs of inflammation indicative of infection.	Case report	(n^†=3)	-PDT^§ with methylene blue at a concentration of 10 mg/mL^¶¶ and LED source^\|\|\|\| (660 nm^‡‡). PDT^§ applied once a week for three years.	The size reduction observed was extremely significant, going from 26.2 cm* in length and 9.5 cm* in width (248.9 cm^2†††) to 5.2 cm* by 4.0 cm* (20.8 cm^2†††). The infection aspects of the lesion also decreased over the course of the treatment, with the formation of adhered but friable granulation tissue, medium serosanguinolent drainage and a slight odor.
E^¶6²¹	To report the experiences of a specialist nurse in the management of a clinical case of an elderly patient with LP^\|\| stage 3, who underwent low-intensity laser therapy.	Experience report	(n^†=1)	LLLT^†† with red (660 nm^‡‡) and infrared (808 nm^‡‡) wavelengths with 1 J^§§§/cm²^†† red and infrared laser. LLLT^†† applied every 48 hours for two months.	On the 5th application of the laser, there was a significant improvement in secretion and perilesional erythema. The lesion healed completely after two months of laser therapy and dressings.
E^¶7²²	To determine how physiotherapists deal with patients with paraplegia and sacral pressure injuries, as well as the effectiveness of laser therapy in treating large and severe pressure injuries.	Case report	(n^†=1)	-LLLT^†† with GaAlAs^‡‡‡ light, a continuous, non-contact (non-pulsating) beam at a wavelength of 658 nm^‡‡ of infrared laser. LLLT^†† applied five times a week, between 8 and 15 minutes of irradiation, for one month.	The treatment of pressure lesions with laser therapy at a wavelength of 658 nm^‡‡ appeared to be successful.
E^¶8²³	To evaluate the efficacy of a prototype LED phototherapy device^\|\|\|\| in participants with pressure injuries.	Randomized, placebo-controlled interventional trial	(n^†=15)	LLLT^†† with LED^\|\|\|\| with a wavelength of 630 nm^‡‡ (red) and 940 nm^‡‡ (infrared), a dose of 6 J^§§§/cm^2††† (group I) and 8 J^§§§/cm^2††† (group II). LLLT^†† was applied three times a week for eight weeks, totaling 24 sessions for each participant.	The area of the LP^\|\| showed a statistically significant reduction (p<0.001) over the 24 sessions in all treatment groups. The groups receiving LED phototherapy^\|\|\|\| (I and II) showed greater healing compared to group III (placebo). The healing rate was higher in group II, ranging from 94.5% to 98.7% at the 24th session.
E^¶9²⁴	To analyse the etiology of non-healing injuries and different treatments for injury management.	Narrative review	-		Wavelengths of 633-904 nm^‡‡ cause the fastest healing of LP^\|\|. LLLT^†† irradiation also induces healing due to its antibacterial effect. Although 650 nm^‡‡ is more effective, the bacterial load decreases under treatment with wavelengths of 830 and 904 nm^‡‡, but increases under the wavelength of 670 nm^‡‡.
E^¶10²⁵	To evaluate the usefulness of SSIT^§§§ as a prognostic tool in the treatment of LP^\|\| stages III and IV, with hydrocolloid/hydrogel dressings plus 20 exposures to LLLT^††, compared to hydrocolloid dressings alone, in a group of long-term bedridden patients.	Randomized comparative study	(n^†=43)	LLLT^†† with a wavelength of 808 nm^‡‡. Group I: LP^\|\| treated with specialized dressings and laser therapy (five times a week for four weeks); Group II: LP^\|\| treated with specialized dressings without laser therapy.	In the study, three variants of LP^\|\| healing were observed: pure healing with minimal granulation; healing with hypergranulation; and non-healing. Analysis of the thermographic patterns related to SSIT^§§§ revealed their dependence on the course of healing. The percentage of successful healing of LP^\|\| reached 79.2% in group I compared to 73.7% in group II (p<0.05). The dominant healing variant in Group I was pure healing with minimal granulation, while in Group II the variants pure healing with minimal granulation and healing with hypergranulation were present with equal frequency.
E^¶11²⁶	To conduct a systematic review evaluating the efficacy of MBF^‡ in the form of LLLT^†† in the treatment of pressure injuries in adults and the elderly.	Systematic review	(n^†=5)		FBM^‡ at infrared wavelength showed efficacy in pressure injury healing, similar to the standard care presented in the different studies. FBM^‡ (658 nm^‡‡) was effective in promoting healing when compared to standard treatment.
E^¶12²⁷	To provide background and examine evidence for the therapeutic application of light energy treatments for wound healing.	Narrative review	-		The 658 nm^‡‡ laser treatment was more effective (70% closure, p< 0.05) in promoting LP^\|\| closure. In contrast, the 808 and 940 nm^‡‡ laser treatments (31% and 30% closure, respectively) did not appear to significantly improve healing rates compared to the placebo group (28% closure).
E^¶13²⁸	To study the effectiveness of laser therapy in the healing process of pressure injuries.	Systematic review	(n^†=11)		It should be noted that doses of 4 J^§§/cm^2††† with a wavelength of 658 nm^‡‡ were the most effective in treating pressure injuries.
E^¶14²⁹	To evaluate the effect of laser irradiation at different wavelengths on the expression of growth factors and selected inflammatory mediators in specific phases of the wound healing process. The study included patients diagnosed with chronic lesions of LP^\|\|-related etiology (II, III, IV).	Randomized clinical trial	(n^†=67)	LLLT^†† with GaAlAs^‡‡‡ light. Group A - 940 nm^‡‡; Group C - 658 nm‡^‡; Group B - 808 nm^‡‡; Group D - simulated therapy. Treated with LLLT^†† and analyzed once a day, five days a week for one month.	For group C (658 nm^‡‡), the change in TNF-α^\|\|\|\|\|\| concentration was more intense (reduction of approximately 75%), while the changes in other groups were not so obvious (reduction of approximately 50%). It seems that the successful effect of wound healing after irradiation at wavelengths of 658 nm^‡‡ is associated with an anti-inflammatory effect, as well as the stimulation of phenomena such as angiogenesis, proliferation or tissue remodeling during the wound closure process.
E^¶15³⁰	To present a case report of LP^\|\| in the calcaneus region in a diabetic patient treated with a combination of FBM^‡, laser therapy and the application of a cellulose membrane.	Case report	(n^†=1)	LLLT^†† with a 660 nm^‡‡ laser (visible red) in a punctual and continuous manner; and PDT^§ (plate of 30 LEDs^\|\|\|\| with a wavelength of 450±10 nm^‡‡ visible blue for 12 minutes with an irradiance of 30 mW^¶¶¶/cm^2†††) and a 1.5% curcumin photosensitive agent.	Healing of the LP^\|\| occurred after 30 days of treatment after observation of total epithelialization of the lesion.
E^¶16³¹	To compare the action of HeNe**** and AsGa^†††† lasers on the healing process of LP^\|\| and to develop a study with preventive measures as treatment.	Case report	(n^†=3)	Case I - LLLT^†† with HeNe** laser; Cases II and III - LLLT^†† with AsG^a laser^††††. Case I - a total of 52 sessions of LLLT^†† with HeNe**; Cases II and III - 22 to 46 sessions of LLLT^†† with AsGa^††††.	Patient 1 - at the end of the applications, there was a 100% reduction in the lesion and the user reported a substantial improvement in their quality of life. Patient 2 - complete healing of the lesion in 22 sessions. Patient 3 - there was a reduction in the depth of the lesion to 0.5 cm***, with the height and width remaining the same. There was little improvement in the healing of the pressure sore, but a small improvement in the appearance of the sore.
E^¶17³²	To evaluate the effects of LLLT^†† on LP^\|\| in humans by means of a systematic review of randomized studies.	Systematic review	(n^†=4)	-	Significant results were observed when using LLLT^†† with a wavelength of 658 nm^‡‡, and no evidence was found for using wavelengths above that for the treatment of LP^\|\|.
E^¶18³³	To describe the healing process of pressure injuries in critically ill patients treated with conventional dressing therapy plus low-intensity laser therapy, as assessed by PUSH^‡‡‡‡ and by the NOC^§§§§ injury healing outcome: second intention.	Case report	(n^†=1)	LLLT^†† with the AlGaInP^\|\|\|\|\|\|\|\| laser, wavelength 660 nm^‡‡. LLLT^†† applied once a day, three times a week, for a period of five consecutive weeks, totaling 15 applications.	The lesion shrank from 7 cm* in length to 1.5 cm* and from 6 cm* in width to 1.1 cm*, when comparing the first and 15th day of assessment. The epithelial tissue remained in ascendancy, with a significant reduction in the amount of serosanguinous secretion and the absence of a foul odor. However, erythema and maceration perilesional worsening, probably due to diaper diuresis, which increased perineal moisture.
E^¶19³⁴	To summarize and critically evaluate the evidence from Systematic Reviews on non-pharmacological interventions to treat pressure injuries in elderly patients.	Narrative review	n^†=110	-	LLLT^†† and LED illumination^\|\|\|\| are used on various types of lesions including healing of non-healing lesions such as diabetic foot lesions, pressure lesions, venous lesions and post-chemotherapy against radiation lesions. In comparative studies, exposure of chronic non-healing pressure injuries that do not respond to standard medical care to wavelengths in the range of 635 and 810 nm^‡‡ results in their faster healing.
E^¶20³⁵	To analyse research related to the induction of pressure injury healing, gene activation and pain elimination by the application of photobiomodulation and its mechanisms of action.	Narrative review	-	-	People with LP^\|\| grade II undergoing 12 weeks of monochromatic pulse FBM^‡ show a reduction in lesion size of 80 versus 50% for patients in the control group, and irradiation with 660 and 880 nm^‡‡ reduces the initial lesion area by 13 times versus control subjects.
E^¶21³⁶	To describe the treatment of chronic pressure injury in patients with spinal cord injury using LLLT^††	Case report	(n^†=1)	LLLT^†† with a wavelength of 980 nm^‡‡ continuous 6 J^§§/cm^2†† for the margins and 655 nm^‡‡, continuous 1.8 J^§§/cm^2†† for the lesion bed together with intravascular laser therapy. LLLT^†† was applied every other day for 12 sessions and then twice a week for a total of 24 sessions.	After two sessions of laser therapy, the perfusion of the lesion improved and after the 12th session the diameter of the lesion had reduced to 3×5 cm^2†† with a depth of 1 cm***. After 24 sessions of LLLT^†† and zetaplasty surgery, the lesion healed completely.
E^¶22³⁷	To summarize and critically evaluate the evidence from systematic reviews of primary studies on non-pharmacological interventions to treat LP^\|\| in elderly patients.	Systematic review	(n^†=45)	-	The level of evidence is very low or insufficient to support the use of adjuvant therapy (ultrasound, negative pressure, laser, electromagnetic, light, shockwave, hydrotherapy, radiofrequency or vibration therapy) to increase the healing rates of LP^\|\| in elderly patients.
E^¶23³⁸	To identify the literature that reports only LLLT^††, without photodynamic agents, as an antimicrobial/antibiofilm technology and to determine its effects on lesion healing.	Narrative review	-	-	Patients with LP^\|\| treated with infrared light (956 nm^‡‡) and red light (637 nm^‡‡) had a 49% higher healing rate compared to controls. The time taken for the lesion to close by 50% and 90% was significantly reduced. After 5 weeks of treatment, the average lesion area decreased to 10%, while controls took 9 weeks to achieve this result. Few clinical trials have defined a standard protocol for eradicating LLLT^†† infection. From the available pilot studies, exposing the patient to light of 870 nm^‡‡/930 nm^‡‡ and energy doses of more than 100 J^§§/cm^2††† seems to be an effective therapeutic approach.
E^¶24³⁹	To verify the effect of LLLT^†† in the form of LED^\|\|\|\| on a chronic non-healing lesion lasting 6 months in an 18-year-old male patient suffering from thalassemia.	Case report	(n^†=1)	LLLT^†† in the form of LED^\|\|\|\|. LLLT^†† with a dosage of 17.3 J^§§/cm^2††† for 8 minutes for 2 weeks followed by a proliferative dosage of 8.65-4.33 J^§§/cm^2†† for 4 minutes from week 3 to week 6.	On the 6th week of application, the lesion closed.

[TFN1] *PubMed/MEDLINE = United States National Library of Medicine/Medical Literature Analysis and Retrieval System Online; ^†LLLT = Low-level light therapy; ^‡CINAHL = Cumulative Index to Nursing and Allied Health Literature; ^§LILACS = Literatura Latino-Americana e do Caribe em Ciências da Saúde; ^||BDENF = Base de Dados em Enfermagem; ¶SciELO = Scientific Electronic Library Online

Photobiomodulation and photodynamic therapy in the treatment of pressure injuries: a scoping review^*

Highlights:

Photobiomodulation and photodynamic therapy in the treatment of pressure injuries: a scoping review*

Highlights:

Photobiomodulation and photodynamic therapy in the treatment of pressure injuries: a scoping review^*