Higher Serum Ferritin Levels Correlate With An Increased Risk Of Cutaneous Morbidity In Adult Patients With Beta-Thalassemia: A Single-Center Retrospective Study

Disturbed iron homeostasis characterizes beta-thalassemia and increases its morbidity. Our aim was to retrospectively associate beta-thalassemia disease characteristics with treatment requiring skin conditions. The files of adult beta-thalassemia (including sickle beta-thalassemia) patients were screened over a 10-year period for treatment-requiring skin disease episodes and their correlation with hematologic diagnoses and epidemiological and serological characteristics. Seventy-eight patients were identified, and 7 (9%) developed at least one relevant episode including cutaneous small-vessel vasculitis (CSVV), urticaria, and leg ulcers. Average ferritin serum level correlated significantly with development of a dermatosis (2,034 +/- 799 mu g/l in cases vs. 920 +/- 907 mu g/l in the overall population; p = 0.001, ANOVA). This difference relied exclusively on the high ferritin levels observed in patients with 'generalized' dermatoses (urticaria and CSVV: 3,860 +/- 1,220 mu g/l) as opposed to values within the normal range in the case of 'localized' ones (leg ulcers: 662 +/- 167 mu g/l). The employed iron chelation treatment influenced ferritin levels (p = 0.002, Kruskal-Wallis test) since chelation with a single agent seems to increase the risk of a skin disease (p = 0.013, likelihood ratio method). Conclusively, serum ferritin can be evaluated as risk factor for generalized dermatoses, but not for leg ulcers, in patients with the beta-thalassemia genotype. This risk can be efficiently controlled with adequate chelation. (c) 2015 S. Karger AG, Basel