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Methylene blue-induced phototoxicity: an unrecognized complication
R Porat1, S Gilbert, D Magilner
1Division of Neonatology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
Pediatrics
|May 1, 1996
Summary
Prenatal exposure to high doses of methylene blue can cause severe skin reactions, including blistering and peeling, when treated with phototherapy. This photosensitization is a newly identified risk for newborns.
Area of Science:
- Neonatal Medicine
- Dermatology
- Toxicology
Background:
- Methylene blue is used during pregnancy for various indications.
- Photosensitization is a known side effect of methylene blue, but not previously reported after prenatal exposure.
Observation:
- A preterm infant exposed prenatally to a toxic dose of methylene blue developed severe skin reactions after phototherapy.
- Skin redness, blistering, and desquamation occurred over 35% of the infant's body surface area.
Findings:
- The infant required exchange transfusions for methemoglobinemia, hemolytic anemia, and hyperbilirubinemia.
- Skin pathology confirmed bullae and desquamation, with complete re-epithelialization by 3 weeks of age.
Implications:
- This case highlights a previously unrecognized complication of prenatal methylene blue exposure.
- Pediatricians should be aware of methylene blue phototoxicity in neonates with high prenatal exposure.
- The severity may be linked to the high dose relative to the infant's size and gestational age.