We read with interest Zeichner ’s1 case report of acne vulgaris during pregnancy treated successfully with narrowband UV-B (NB-UV-B) therapy. Generally, UV-B is considered a safe form of psoriasis therapy during pregnancy, and this may apply to acne treatment as well. However, it is of utmost importance not to overlook the photodegradation of folic acid associated with light therapy.
Folic acid deficiency is associated with the development of neural tube defects, which complicate 1 in every 1000 pregnancies and can be detected early in the second trimester. There is new evidence in patients with psoriasis that high cumulative NB-UV-B doses cause a proportionate decrease in serum folic acid levels ( ≥118.16 J/cm2 in 36 treatments).2 Previous studies found insignificant decreases in serum folic acid; however, these studies had smaller numbers of treatments and had lower total cumulative doses (6.9 J/cm2 in 9-15 sessions in 19 patients; 2.3 J/cm2 in 18-20 treatments in 35 patients).2 Furthermore, a more recent pilot study found that patients' folic acid levels decreased after broadband UV-B therapy (110-220 mJ/cm2 in 7-22 treatments).3 In addition, there was a case report in Buenos Aires of 3 unrelated patients who had sunbed exposure in early pregnancy; their infants all developed neural tube defects, which may have resulted from folic acid depletion.4
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The Rational Clinical Examination
Make the Diagnosis: Early Pregnancy
The Rational Clinical Examination
Original Article: Is This Patient Pregnant?
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