From the Guidelines
Abnormal ferritin levels with associated formication should be managed by addressing the underlying iron disorder, and the most recent evidence suggests that iron repletion is needed to improve quality of life and decrease the risk of complications related to anemia. For low ferritin (iron deficiency), the American Gastroenterological Association (AGA) guideline recommends using a ferritin cut-off value of 45 mg/dL in individuals with anemia 1. The management of iron deficiency anemia involves oral iron supplementation, and according to the AGA guideline, oral iron supplementation usually is initiated first, but often is tolerated poorly because of side effects such as nausea, abdominal pain, and constipation 1. Some key points to consider in the management of abnormal ferritin levels with associated formication include:
- Iron repletion is needed to improve quality of life and decrease the risk of complications related to anemia
- Oral iron supplementation usually is initiated first, but often is tolerated poorly because of side effects
- IV iron may be given initially in some patients with severe ID or conditions in which oral iron may not be well absorbed
- For the formication (sensation of insects crawling on skin), symptomatic treatment includes topical antihistamines, moisturizers, and oral antihistamines
- Regular monitoring of ferritin levels every 3 months during initial treatment is essential to guide therapy adjustments The most recent and highest quality study, the AGA clinical practice update on management of iron deficiency anemia, provides the best guidance for managing abnormal ferritin levels with associated formication 1. In terms of specific treatment recommendations, oral iron supplementation with ferrous sulfate 325 mg 1-3 times daily between meals is recommended, with vitamin C 250 mg to enhance absorption, and for the formication, symptomatic treatment includes topical antihistamines like diphenhydramine cream, moisturizers, and oral antihistamines such as hydroxyzine 25 mg three times daily. It is also important to note that gabapentin starting at 300 mg daily and gradually increasing to 300 mg three times daily may help with neuropathic sensations, and addressing the underlying iron abnormality often improves formication symptoms, as iron plays a crucial role in neurological function and skin health 1.
From the Research
Abnormal Ferritin Levels and Formication
Abnormal ferritin levels can be associated with various conditions, including iron deficiency anemia, iron overload, and inflammatory diseases. Formication, a crawling sensation on the skin, can be a symptom of iron deficiency anemia or other conditions.
Causes of Abnormal Ferritin Levels
- Iron deficiency anemia: Low ferritin levels indicate iron deficiency, which can cause formication 2
- Iron overload: Elevated ferritin levels can indicate iron overload, which can be caused by conditions such as hemochromatosis or transfusional iron overload 3
- Inflammatory diseases: Ferritin is an acute-phase protein, and its levels can be elevated in inflammatory diseases such as rheumatoid arthritis or infections 4, 5
Management of Abnormal Ferritin Levels
- Iron deficiency anemia: Treatment with oral iron supplements can help increase ferritin levels and alleviate symptoms such as formication 6
- Iron overload: Treatment depends on the underlying cause, but may include phlebotomy or chelation therapy to reduce iron levels 3
- Inflammatory diseases: Treatment of the underlying disease can help reduce ferritin levels and alleviate symptoms 4, 5
Diagnostic Tests
- Serum ferritin measurement: This is the first laboratory test recommended in the evaluation of microcytosis, which can be a sign of iron deficiency anemia or other conditions 2
- Complete blood count: This test can help diagnose iron deficiency anemia or other conditions that may be causing formication 2