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Comparative Study of Serum Zinc Concentration In Ranjbar et al. BMC Oral Health (2020) 20:296 https://doi.org/10.1186/s12903-020-01277-2 RESEARCH ARTICLE Open Access Comparative study of serum zinc concentration in recurrent herpes labialis patients and healthy individuals Zahra Ranjbar1, Maryam Zahed1* , Mohammad Ali Ranjbar2 and Zahra Shirmardan3 Abstract Background: Recurrent herpes labialis (RHL) is a common recurrent infective vesiculoulcerative disease. Topical and systemic administration of Zinc compounds has been indicated to have preventive and therapeutic efects. The pur- pose of this study was to evaluate the serum level of zinc in the patients with RHL and healthy individuals and also to investigate the correlation of this level with various parameters of the patient and disease course. Methods: This cross-sectional study was performed on 43 patients with a history of recurrent herpers labialis and 42 subjects without any previous experience of the lesion. Blood samples were taken, and serum zinc level was meas- ured using colorimetry (spectrophotometry) method. Chi-Square test was used to compare the qualitative relation- ships, and for comparing the quantitative relationships, independent T-test was used. To observe the relationshipof quantitative factors including serum zinc level, the number of relapses, and recovery rates, correlation test was taken. Results: The results show that, serum zinc level has no signifcant diference between healthy subjects and the patients (p > 0.05). Also, zinc level was not related to age and sex factors and frequency of relapse (p > 0.05). However surprisingly, there was a signifcant relationship between zinc level and recovery period in the RHL patients. The lower the serum zinc level, the higher the duration of recovery (p 0.009). = Conclusion: The results of this study indicate that, zinc defciency can be considered as a risk factor for increasing the duration of herpes labialis lesions. Therefore, the evaluation of serum zinc level in the subjects with RHL and subse- quent administration of zinc are recommended in these kind of patients. Keywords: Herpes labialis, Zinc, Serum Background after fuid or skin contact with contaminated individuals Herpes simplex virus type 1 (HSV-1), as a member of [1, 2]. In most of the cases, the virus tends to remain in the herpes virus family, is the etiologic factor of a vari- the sensory ganglions or skin epithelium after the initial ety of diseases such as primary gingivostomatitis, recur- infection [3]. Factors such as sunlight, shock, stress, fever, rent herpes labialis, and recurrent intraoral herpetic and hormonal changes can trigger the reactivation of the lesions. Accordingly, it generally afects the upper parts virus causing a secondary or recurrent lesion like herpes of the human body, and the primary infection appears labialis [1, 2]. Herpes labialis primarily appears as an itchy erythema and is followed within few minutes or hours by a group *Correspondence: [email protected]; [email protected] of small vesicles with clear fuid in the skin area around 1 Oral and Dental Disease Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University the oral cavity, lips, nose or the oral mucosa. Te vesicles of Medical Sciences, Shiraz, Iran erupt and turn into multiple small superfcial ulcerations Full list of author information is available at the end of the article that eventually merge forming a painful ulcer covered by © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Ranjbar et al. BMC Oral Health (2020) 20:296 Page 2 of 7 a crust in following days. Tis lesion can be very irritating school in 2018. Te sample size was chosen according to and disabling due to its pain and unappealing appearance previous studies [22]. Te study was approved by the eth- [4, 5]. ical committee of Shiraz University of Medical Sciences. Drugs such as acyclovir and valacyclovir and also less (IR.SUMS.REC.1397.449). common medications such as cytarabine and vidara- All subjects were over the age of 18 years old. Te cases bine, are used in the treatment of viral herpes infections with the history of recurrent lesions were asked to visit [6, 7]. Acyclovir is widely used as a systemic agent or an oral and maxillofacial medicine specialist in less than with topical application due to the severity of infection, 48 h after the onset of a new lesion. Terefore, all patients and it is considered as the chosen treatment for herpes were precisely diagnosed as having recurrent herpetic labialis infections [6]. Nevertheless, nausea, dizziness, lesions. All the subjects were evaluated by a single exam- headaches, mental changes, neurotoxicity and kidney iner. A control group consisted of healthy subjects who disorders are the well-known side efects of this drug [8]. were without any history of similar oro-facial and geni- Nowadays, new treatments such as micro–nano flopo- tal lesions during their life. Tis group was randomly dia-like Zinc oxide (ZnO) structures, cinnamon extract selected from the subjects who attended the same clinic or prepared 3-O-sulfonated sugars are introduced to for routine dental checkup. Tey were matched in age treat herpes simplex infections with fewer side efects and gender compared to the case group. Exclusion crite- [9–11]. ria for both groups were pregnancy, a history of systemic Zinc is an essential feature for the natural function of and immunological diseases afecting the activity of the cells and organs of the body [12–14]. Te local use of zinc immune system, and the use of drugs or any supple- promotes the production of epithelial cells and endothe- ments. Furthermore, the subjects who experienced less lium of the vessels. In addition, the use of zinc com- than 3 recurrences in the past year or who had no clear pounds is found to enhance the local defense system [15] memory of the number of relapses or exact duration of Zinc has the capacity to stimulate cellular immunity. their last lesion were excluded from the patient group. T-lymphocytes involved in cellular immunity are consid- At the beginning of the study, an informed consent ered to be important in protecting against viral, fungal, form was obtained from all the subjects. A form contain- and protozoic infections, as well as malignant and auto- ing biographical information including age, gender, his- immune diseases [16, 17]. Zinc appears to increase the tory of any certain disease, medications and supplements, number of the efecter and helper T-cells. On the other the rate of relapse of the lesions in the past year, and the hand, Zinc defciency has been shown to reduce host duration of recovery period of the last experienced lesion immunity by reducing circulating T-cells and decreasing was obtained. Lesion improvement was considered when the phagocytic activity of macrophages, which can gener- patient had no detectable lesion and no pain or other sen- ally afect cell-mediated immunity [18, 19]. sory changes like tingling existed. All blood samples were Te topical use of zinc solutions for the treatment taken in the morning whilst fasting. Te used method for and prevention of herpes simplex infections has long measuring zinc levels was colorimetry (spectrophotom- been established [17, 20, 21]. Furthermore, saliva zinc etry). In this method, zinc forms a red chelate complex defciency has been investigated as well as its role in with 2-(5-Brom-2_pyridylazo)-5-(N-propyl-N-sulfopro- the recurrence of this viral infection [22]. It has been pylamino). shown that, salivary zinc is signifcantly lower among the Te results were statistically analyzed using SPSS soft- patients sufering from the recurrent herpes labialis com- ware version 18. Chi-Square test was used to compare the pared to healthy individuals [22]. qualitative factors. To compare the quantitative relation- Due to the fact that, serum zinc concentration is cur- ships, independent T-test was used. In addition, a Corre- rently known as the best and most widely used biomarker lation test was taken, to observe the relationship between of zinc status in populations [23], we decided to check quantitative factors as follows: serum zinc level, number this marker in the herpes labialis patients to further of relapses, and lesion improvement. To evaluate the suf- evaluate the efect of this element in the prevention and fciency of sample size, power analyses were done after treatment of this recurrent lesion. analyzing data. For this purpose, efect sizes (ES) were calculated and where the ES was medium to large, power Methods was computed. Tis cross-sectional study was performed on 85 subjects including 43 patients with the history of recurrent her- Results pes labialis (RHL) and 42 healthy individuals without Of the participants in the study, 67 were women (78%) any history of the disease, who were referred to the Oral and 18 were men (22%).
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