From the Guidelines
Yes, iron deficiency can cause pruritus (itching). According to the British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis 1, iron replacement is recommended for patients with generalized pruritus due to iron deficiency. The exact mechanism of how iron deficiency leads to itching is not fully understood, but it may be related to decreased oxygen delivery to tissues, altered mast cell function, or changes in nerve sensitivity when iron levels are low.
Key Points to Consider
- Patients with unexplained chronic itching, especially if accompanied by other symptoms like fatigue, weakness, pale skin, or brittle nails, should be evaluated for iron deficiency.
- Treatment involves iron supplementation, typically with oral ferrous sulfate 325mg taken 1-3 times daily between meals with vitamin C to enhance absorption.
- Side effects may include constipation and stomach upset.
- Alternative formulations like ferrous gluconate or iron infusions may be considered for those who cannot tolerate oral supplements.
- The pruritus typically improves as iron levels normalize, though this may take several weeks to months of consistent supplementation.
Addressing Underlying Causes
Addressing the underlying cause of iron deficiency, such as blood loss or poor absorption, is also essential for long-term resolution. This may involve dietary changes, such as increasing iron intake through red meat, seafood, and fortified cereals, or addressing underlying conditions that may be contributing to iron deficiency, such as celiac disease or heavy menstrual bleeding.
Recent Evidence
A recent study on iron deficiency in athletes highlights the importance of regular blood screening to identify iron deficiency, especially in female athletes who are at higher risk due to menstrual blood loss 1. Another study on the management of ulcerative colitis emphasizes the need to consider iron deficiency and anemia of chronic disease when evaluating anemia in patients with inflammatory bowel disease 1. However, the most relevant and recent guideline for the management of generalized pruritus due to iron deficiency is from the British Association of Dermatologists 1.
Recommendation
Iron supplementation is recommended for patients with generalized pruritus due to iron deficiency, as stated in the British Association of Dermatologists' guidelines 1. This recommendation is based on the strength of evidence and the potential benefits of iron supplementation in improving pruritus and overall quality of life.
From the Research
Iron Deficiency and Itching
- Iron deficiency is a common condition that can cause various symptoms, including fatigue, exercise intolerance, and difficulty concentrating 2, 3, 4.
- However, there is no direct evidence in the provided studies that links low iron levels to itching (pruritus) as a specific symptom.
- The studies mention various nonhematological manifestations of iron deficiency, such as fatigue, reduced physiological endurance, difficulty in regulating temperature, and decreased cognitive performance 3, but itching is not explicitly mentioned.
- Iron deficiency can cause skin-related symptoms like hair loss 5, but pruritus is not listed as a common symptom of iron deficiency in the provided evidence.
Diagnosis and Treatment of Iron Deficiency
- Iron deficiency is diagnosed by low serum ferritin levels or transferrin saturation 2, 4.
- Oral iron therapy is the first line of treatment for most cases of iron deficiency 2, 4, 5.
- Intravenous iron is indicated for patients with oral iron intolerance, poor absorption, or certain chronic inflammatory conditions 2, 4.