Bengü Nisa AKAY, Seçil VURAL, Nihal KUNDAKÇI, Hilayda Karakök GÜNGÖR

Dar Bant UVB ve PUVA Tedavilerinin Serum Folat Seviyeleri Üzerine Etkileri

Amaç: Dar bant UVB (DBUVB) özellikle gebe kadınlarda güvenilirlik profili yüksek olduğu için tercih edilen bir dermatolojik tedavi yöntemidir.Önceki çalışmalar fotodegredasyon ile kanda folat seviyelerinde düşüş olabileceğini öne sürmüştür. Çalışmamızda hastalarımızda folat düzeylerindefototerapi ile ilişkili bir düşme olup olmadığını araştırdık.Gereç ve Yöntem: Deri ve zührevi hastalıkları anabilim dalına başvurup psoralen ve ultraviyole A (PUVA) veya DBUVB tedavilerinden birini alan vefolik asit düzeyleri takip edilen hastalar retrospektif olarak değerlendirildi.Bulgular: Hastaların hiçbirinde klinik laboratuvar referans değerinin altında folik asit düzeyi saptanmadı. DBUVB tedavisi öncesi bakılan serum folatseviyeleri ortalama 9,30 (±3,22 SD) 18. seans kontrolde gönderilen folat seviyesi ise ortalama 7,26 (±4,82 SD), 36. seanstaki seviyeleri ise ortalama8,69 (±3,6 SD) olarak tespit edildi. PUVA tedavisi alanlarda ise tedavi öncesi folat değerleri 9,16 (±3,76 SD), 18. seans sonrası 6,76 (±4,89 SD), ve 36.seans sonrası 9,41 (±3,79 SD), olarak ölçülmüştür. Tekrarlanan ölçümler arasındaki farklılıklar her iki grupta da istatistiksel olarak anlamlı bulunmadı(p>0,05).Sonuç: DBUVB ve PUVA tedavileri Fitzpatrick deri tipi genellikle III ve IV olan toplumumuzdaki hastalarda kan folik asit seviyeleri açısından güvenligörünmektedir.

The Effect of Narrow Band UVB and PUVA Treatment on Serum Folate Levels

Objectives: Narrow band UVB (NBUVB) treatment is a preferred dermatological treatment modality especially in pregnant women because of high safety profile. Previous studies have shown photodegradation may decrease folate levels in blood. In this study we aim to investigate if phototherapy causes low folic acid levels in our patients. Materials and Methods: Patients applying to dermatology unit and receiving either psoralen plus UVA or NBUVB treatment with regular folic acid level check-ups were analysed retrospectively. Results: In none of the patients folic acid levels lower than reference levels were detected. Mean serum folate values in baseline were 9.30 (±3.22 SD). The mean value after 18 treatment sessions was 7.26 (±4.82 SD), and after 36 sessions was 8.69 (±3.6 SD). In PUVA group baseline mean folate level was 9.16 (±3.76 SD), followed by 6.76 (±4.89 SD) after 18 sessions and 9.41 (±3.79 SD) after 36 sessions. Repeated measure in time were not statistically significant in both groups (p>0.05). Conclusion: NBUVB and PUVA treatments appear to be safe in regards to blood folic acid levels in our population where Fitzpatrick skin type III and IV is more common.

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1. Bangsgaard N, Rorbye C, Skov L. Treating Psoriasis During Pregnancy: Safety and Efficacy of Treatments. Am J Clin Dermatol. 2015;16:389-398.
2. Zhu JL, Hjollund NH, Andersen AM, et al. Occupational exposure to pesticides and pregnancy outcomes in gardeners and farmers: a study within the Danish National Birth Cohort. J Occup Environ Med. 2006;48:347-352.
3. Murase JE, Koo JY, Berger TG. Narrowband ultraviolet B phototherapy influences serum folate levels in patients with vitiligo. Journal of the American Academy of Dermatology. 2010;62:710-711.
4. Borradale D, Isenring E, Hacker E, et al. Exposure to solar ultraviolet radiation is associated with a decreased folate status in women of childbearing age. Journal of photochemistry and photobiology B, Biology. 2014;131:90-95.
5. El-Saie LT, Rabie AR, Kamel MI, et al. Effect of narrowband ultraviolet B phototherapy on serum folic acid levels in patients with psoriasis. Lasers Med Sci. 2011;26:481-485.
6. Czeizel AE, Dudás I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med. 1992;327:1832-1835.
7. Giovannucci E. Epidemiologic studies of folate and colorectal neoplasia: a review. J Nutr. 2002;132:2350S-2355S.
8. Gisondi P, Fantuzzi F, Malerba M, et al. Folic acid in general medicine and dermatology. J Dermatolog Treat. 2007;18:138-146.
9. Wiwanitkit V. Narrowband ultraviolet B phototherapy and serum folic acid level. Lasers Med Sci. 2012;27:685.
10. Lucock M. Folic acid: nutritional biochemistry, molecular biology, and role in disease processes. Mol Genet Metab. 2000;71:121-138.
11. https://cot.food.gov.uk/sites/default/files/vitmin2003.pdf. (Last Accessed: 06.08.2019)
12. Branda RF, Eaton JW. Skin color and nutrient photolysis: an evolutionary hypothesis. Science. 1978;201:625-626.
13. Off MK, Steindal AE, Porojnicu AC, et al. Ultraviolet photodegradation of folic acid. Journal of photochemistry and photobiology B, Biology. 2005;80:47-55
14. Steindal AH, Juzeniene A, Johnsson A, et al. Photodegradation of 5-methyltetrahydrofolate: biophysical aspects. Photochem Photobiol. 2006;82:1651-1655.
15. Akhtar MJ, Khan MA, Ahmad I. Photodegradation of folic acid in aqueous solution. J Pharm Biomed Anal. 1999;19:269-275.
16. Gambichler T, Bader A, Sauermann K, et al. Serum folate levels after UVA exposure: a two-group parallel randomised controlled trial. BMC Dermatol. 2001;1:8.
17. Cicarma E, Mork C, Porojnicu AC, et al. Influence of narrowband UVB phototherapy on vitamin D and folate status. Experimental dermatology. 2010;19:e67-72.
18. Juzeniene A, Stokke KT, Thune P, et al. Pilot study of folate status in healthy volunteers and in patients with psoriasis before and after UV exposure. Journal of photochemistry and photobiology B, Biology. 2010;101:111-116.
19. Rose RF, Batchelor RJ, Turner D, et al. Narrowband ultraviolet B phototherapy does not influence serum and red cell folate levels in patients with psoriasis. J American Academy Dermatology. 2009;61:259-262.
20. Park KK, Murase JE. Narrowband UV-B phototherapy during pregnancy and folic acid depletion. Archives of dermatology. 2012;148:132-133.
21. Béani JC, Jeanmougin M. [Narrow-band UVB therapy in psoriasis vulgaris: good practice guideline and recommendations of the French Society of Photodermatology]. Annales de dermatologie et de venereologie. 2010;137:21-31.
22. Lapunzina P. Ultraviolet light-related neural tube defects? Am J Med Genet. 1996;67:106.