Higher Serum Ferritin Levels Correlate with an Increased Risk of Cutaneous Morbidity in Adult Patients with β-Thalassemia: A Single-Center Retrospective Study

Iron Load Toxicity in Medicine: From Molecular and Cellular Aspects to Clinical Implications

Iron is essential for all organisms and cells. Diseases of iron imbalance affect billions of patients, including those with iron overload and other forms of iron toxicity. Excess iron load is an adverse prognostic factor for all diseases and can cause serious organ damage and fatalities following chronic red blood cell transfusions in patients of many conditions, including hemoglobinopathies, myelodyspasia, and hematopoietic stem cell transplantation. Similar toxicity of excess body iron load but at a slower rate of disease progression is found in idiopathic haemochromatosis patients. Excess iron deposition in different regions of the brain with suspected toxicity has been identified by MRI T2* and similar methods in many neurodegenerative diseases, including Alzheimer's disease and Parkinson's disease. Based on its role as the major biological catalyst of free radical reactions and the Fenton reaction, iron has also been implicated in all diseases associated with free radical pathology and tissue damage. Furthermore, the recent discovery of ferroptosis, which is a cell death program based on free radical generation by iron and cell membrane lipid oxidation, sparked thousands of investigations and the association of iron with cardiac, kidney, liver, and many other diseases, including cancer and infections. The toxicity implications of iron in a labile, non-protein bound form and its complexes with dietary molecules such as vitamin C and drugs such as doxorubicin and other xenobiotic molecules in relation to carcinogenesis and other forms of toxicity are also discussed. In each case and form of iron toxicity, the mechanistic insights, diagnostic criteria, and molecular interactions are essential for the design of new and effective therapeutic interventions and of future targeted therapeutic strategies. In particular, this approach has been successful for the treatment of most iron loading conditions and especially for the transition of thalassemia from a fatal to a chronic disease due to new therapeutic protocols resulting in the complete elimination of iron overload and of iron toxicity.

Necrobiosis Lipoidica in a Patient with β-Thalassemia Major: A Case Report and Review of the Literature

Necrobiosis lipoidica (NL) is a rare granulomatous disease that predominantly affects middle-aged women and is often associated with diabetes mellitus (DM), rheumatoid arthritis (RA) and other metabolic disorders. Thalassemias are the most common hereditary hemoglobin (Hb) disorders worldwide. A few studies investigated dermatologic problems that coexist with β-thalassemia major (β-TM). The most common skin disorders in patients with β-TM are xerosis, urticaria, pseudoxanthoma, hyperpigmentation, leg ulcers and small-vessel vasculitis. Necrobiosis lipoidica has only been occasionally reported in patients with β-TM. Herein, we present a female with β-TM and NL. Furthermore, a brief review of the literature was performed.

Skin Disorders in Egyptian Children with β-Thalassemia Major

BACKGROUND

Thalassemia major is one of the common genetic disorders in Egypt. Skin disorders are usually neglected and frequently underdiagnosed among these patients.

OBJECTIVE

This work aimed to study the frequency and pattern of skin manifestations in Egyptian children with β-thalassemia.

METHODS

Fifty-four β-thalassemia major patients being followed at the Hematology Clinic of Beni-Suef University Hospital were selected to participate in this study. All patients underwent detailed history evaluation, clinical examination and laboratory investigations, including complete blood count and serum ferritin. All patients were examined by a dermatologist to record any skin disorders.

RESULTS

Pruritus (37%), scars (33.3%), hyperpigmentation (31.5%) and xerosis (22.2%) were the most common findings. We found significant relations between serum ferritin and the occurrence of scars, hyperpigmentation, xerosis and ephelides (p <0.05). Also, significant associations between use of deferoxamine and scars (p=0.004), hyperpigmentation (p=0.004), xerosis (p=0.03) and ephelides (p=0.042) were found.

CONCLUSION

Skin disorders are frequent in Egyptian children with thalassemia major. Careful skin examination is required to provide early diagnosis.