Iron Deficiency and Skin Manifestations

Primary Manifestation: Pruritus Without Rash

• The British Association of Dermatologists specifically lists "disorders of iron metabolism" as a cause of generalized pruritus without rash, which can lead to secondary skin changes from scratching in patients with underlying systemic disease 1, 2
• Iron deficiency anemia is a common cause of generalized pruritus in patients, with iron replacement therapy leading to complete cessation of pruritus in many cases, as recommended by the British Association of Dermatologists 1, 3

Clinical Approach

• The British Journal of Dermatology recommends checking full blood count and ferritin levels in all patients with chronic generalized pruritus, even without visible rash, to diagnose iron deficiency 1, 3
• Ferritin is an acute-phase protein and may be falsely elevated despite iron deficiency, so serum iron and total iron binding capacity should be checked if ferritin appears "normal" but iron deficiency is suspected, according to the British Journal of Dermatology 1, 3

Important Caveats

• Iron overload can also cause generalized pruritus, so both deficiency and excess should be considered in the differential diagnosis, as stated by the British Journal of Dermatology 1, 3
• The British Association of Dermatologists recommends inquiring about diet, potential blood loss sources, and gastrointestinal symptoms in all cases, and considering testing for tissue transglutaminase antibodies if iron deficiency is unexplained 1, 2, 3