A 42-year-old woman developed photosensitivity and rosacea in connection with a pregnancy 11 years

Fråga: A 42-year-old woman developed photosensitivity and rosacea in connection with a pregnancy 11 years ago. She is treated by UV-A. A second child was delivered 6 months ago and the child is at present breast-fed, and the mother wishes to continue with it. The doctor treating the patient´s dermatological problems now wants to institute Carotaben (betacaroten) 25 mg 2-3 x2. Can this treatment be safely started despite ongoing breast-feeding.

Sammanfattning: Direct information on the use of beta-carotene during lactation is lacking. High doses of this compound to the mother may result in amounts, to the nursing child, so high that an adverse effect cannot safely be excluded.

Svar: Beta-caroten is metabolically converted to vitamin A by the liver (1) although, for a subject without vitaminosis A deficiency, intake of beta-caroten has only a marginal effect on vitamin A blood-levels (2). Vitamin A is well-known as a teratogenic and toxic agent when overdosed (1) but this should have little relevance in the present case as already discussed. There are no reports in the literature on beta-carotene use neither during pregnancy nor lactation. In infants 7.5-15 mg/day of vitamin A for a month can cause toxicity (3). The biological activity of beta-carotene is about 1/6:th at that of vitamin A and therefore 45-90 mg of beta-carotene would, theoretically, be associated with an increased risk of toxicity if taken daily for a month. The proportion of the daily intake of beta-carotene that is excreted via the breast milk is not known (2). The doses which the questioner wants to use is 100-150 mg/day. It is reasonable to assume that the amount of the dose reaching the child does not exceed 1/3. Nevertheless, no direct information on the use of beta-carotene during lactation is available (2) and the maximum proportion of the dose, taken by the mother, which may reach the child may not be much smaller than the smallest reported toxic doses. It is therefore suggested that beta-carotene treatment during lactation be avoided.