Iron Deficiency Anemia (Anaemia) And The Skin (For Professionals)

Iron Deficiency Anemia (Anaemia) And The Skin (For Professionals)

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Anemia is one of the most common health problems in the world today. This condition, where the blood has a lower than normal number of red blood cells, is due to a variety of causes, among which is the inadequate production of hemoglobin by the body, most commonly due to a deficiency of iron.

Anemia has three main causes: blood loss, lack of red blood cell production, or high rates of red blood cell destruction. These causes may be due to many diseases, conditions, or other factors. Anemia also can occur if your red blood cells don’t contain enough hemoglobin. Hemoglobin is an iron-rich protein that gives blood its red color. This protein helps red blood cells carry oxygen from the lungs to the rest of the body.

Anemia can have a lot of unpleasant complications. Some people who have anemia may have arrhythmias or problems with the rate or rhythm of the heartbeat. Anemia also can damage other organs in your body because your blood can’t get enough oxygen to them. It can also cause many other health problems, which are life-threatening.

But do you know that anemia can manifest itself in the skin? But how?

How the Skin Uses Iron

Before we go to the manifestations of anemia in the skin, let us first learn how the skin utilizes iron.

Our skin is composed of three layers: the epidermis, the dermis and the subcutis. The dermis is the layer of the skin which consists of numerous blood vessels.

Our skin is also comprised of two types of important skin fibers: collagen and elastin. Collagen fibers are the structural fibers of the skin. It is said that collagen fibers do not stretch very well. On the other hand, elastin fibers are the ones which make the skin resilient, smooth and supple. Elastin fibers also provide elastic recoil to blood vessel walls.

Iron is a physiologically essential nutritional element for all organs of the body. It plays critical roles in:

• electron transport and cellular respiration
• oxygen transport by hemoglobin
• cell proliferation
• and differentiation.

If there is not enough iron, the cells of the skin will fail to carry out its functions described above, which leads to:

• discoloration due to a decreased supply of oxygen in the skin and blood vessels
• poor skin cell growth leading to flaky, itchy skin
• poor hair cell growth which leads to diffuse hair loss.
• Nail growth would also be affected and growth of mucous membranes in the skin and tongue.

The growth and function of elastin fibers in the body is regulated by a lot of signal molecules in the body. The skin cells and the cells in the blood vessels must first synthesize and secrete numerous glycoproteins to form a framework upon which tropoelastins, the building blocks of elastin fibers, are properly assembled and are crosslinked together.

Furthermore, if the red blood cells are defective (as in hemolytic anemia), or in cases where there is increased iron absorption and multiple blood transfusions due to anemia of blood loss, iron accumulates in the skin tissues and the growth of elastic tissue becomes disrupted, and may lead to decreased elasticity of skin.

Knowing all these facts let us then tackle the changes in the skin brought about by anemia.

Skin Changes in Anemia:

• Pallor: Pallor or being pale is brought about by decreased oxygenation to the skin tissues, particularly in the dermis. You can detect pallor by placing a finger on your skin and pressing it for a minute. If the color comes back quickly after a minute, you do not have pallor; if your skin color is slow to return and appears white/ blanched, then you have a problem on the oxygenation and blood supply of your skin.

• Itching: Itching can result from dry, flaky and irritated skin due to damaged skin cells. These skin cells are damaged because they have poor nutrient supply and are not well oxygenated due to a decreased number of red blood cells and low hemoglobin levels.

• Diffuse hair loss (Diffuse Alopecia): Diffuse hair loss is due to poor nutrient supply and poor oxygen supply to the hair follicles. This causes poor growth of hair, making it brittle, dry and prone to hair fall.

• Koilonychia: Koilonychia is an abnormality in nail growth. It makes the nails appear flattened and have concavities with raised edges also called spoon nails. The depression in the nail is usually large enough to hold a drop of liquid. This results because of poor nail growth caused by a defective oxygen transport system and defective blood and nutrient supply due to anemia.

• Smooth Tongue: This is also known as glossitis in people with pernicious anemia. Glossitis is a condition in which the tongue is swollen and changes color. Finger-like projections on the surface of the tongue called papillae are lost, causing the tongue to appear smooth. This is caused by nutritional imbalances caused by anemia.

What to do:

If you suspect that you may have anemia, the first step is to go to your doctor. A complete blood count may be done and sometimes assessment of iron stores in the body. Your doctor may then prescribe you with iron supplements. Take iron as prescribed by your doctor to avoid possible problems related to iron overload, and do not mix iron with beverages such as coffee or tea because these drinks inhibits iron absorption. Get your vitamins eating vitamin C–rich foods with meals and taking 100 to 500 mg of vitamin C with your iron supplements to improve iron absorption.

Contributors

Dr Christophe Hsu – dermatologist. Geneva, Switzerland