Have you ever heard of an anemia rash or an Iron Deficiency Skin Rash? Yep, it’s a thing — you can certainly get an anemia skin rash or an iron deficiency skin rash! AND, itchiness triggered by low iron levels is also common.
I was so fascinated by this topic of anemia skin rashes that I wanted to dive deeper and help you understand just HOW important it is to get assessed for iron deficiency and anemia.
Unfortunately, iron deficiency anemia is one of the most common deficiencies that I uncover in clients whom I work with in my virtual practice.
If you’ve struggled in the past with iron (or have iron deficiency symptoms like hair loss or fatigue), this episode is a MUST for you!
Assessment of your iron levels is way more complicated than just looking at labs. I’m going through my process that I take every client through so that you get a better sense of what it’s like to have a comprehensive evaluation for skin symptoms of anemia.
Numbers on a paper only tell part of the story especially if you’re not feeling well and struggling with a low iron skin rash!
Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android
In this episode:
- Iron deficiency, anemia + does anemia cause itching?
- Anemia skin rash, low iron skin rash, and skin symptoms of iron deficiency
- Type of rash that can appear due to iron anemia
- How low iron impacts your thyroid (+ ultimately causes rashes on your skin)
- Which diets make you more susceptible to low iron skin rash
- Best labs to check for iron deficiency
- What I assess if I suspect iron deficiency
- Foods + supplements to help iron levels if you’re dealing with an iron deficiency rash
Quotes:
Clients often take for granted that their body will just make the nutrients it needs like iron. And that mindset unfortunately can get them into trouble.
Iron deficiency must be taken seriously and assessed from several different angles especially if symptoms are present.
Iron Deficiency Skin Rash (FULL TRANSCRIPT)
Welcome back to episode #163 of the Healthy Skin Show!
In today’s episode, I want to talk about a very important nutrient — specifically iron — and how a deficiency of it in your body can be a trigger for itchy, rashed skin.
As a clinical nutritionist, I assess every client for optimal nutrient levels because deficiencies of certain nutrients are alarmingly more common than you would think.
Especially if you’ve been struggling for some time with your health and your skin… and possibly tried elimination diets along the way.
While you might not think iron is important for your skin — think again!
Iron is incredibly important for your body’s overall health so having low stores can be a cause of anemia rashes.
If your iron is low, this can be a hidden reason you’re struggling with itchy, anemia skin symptoms and rashes (plus loads of other issues going on).
Can Anemia Cause Itching?
Can anemia cause itching? Absolutely. You’ve probably never considered iron as an important nutrient for your skin. Most people only think of it to help with moving oxygen around your body with the help of your red blood cells.
It’s not entirely clear why, but low iron can cause itchy skin. And it can also cause anemia rash.
The connection was first described back in the 1970s by C. F. H. Vickers and has been noted in other journals and research publications. So this is not a new phenomenon, but the research isn’t quite there to fully explain the exact relationship.(1,2,3)
Skin Iron Deficiency Anemia Symptoms
When you have an anemia skin rash, you might experience a strange rash that is made up of little splotches of dark red, purple, or brown which are actually indicative of pinpoint bleeds under the skin.
Because low iron status puts a huge strain on your body from a few different physiologic levels, ultimately your skin will suffer.
Remember, I’ve talked many times about how your skin is the lowest organ of the organ priority totem pole. If other systems are struggling, so will your skin! So that’s why you will notice iron deficiency symptoms on the skin.
Low Iron Skin Rash And Your Thyroid
One example of this has to do with your thyroid. I’ve talked in the past about the importance of appropriate thyroid hormone levels for healthy skin, and iron plays a role here too!
The enzyme that converts the inactive thyroid hormone, T4, to the active version, T3, is called Thyroid Peroxidase (TPO).
To function properly, the TPO enzyme requires iron. So low iron can reduce the amount of active free T3 available in your body that is necessary for healthy skin.
This is just one example of why iron is so important to properly assess.
Iron Deficiency Skin Rash Is More Common Than You Think
With all of the different diets to help your skin, it’s really easy to become overwhelmed. And my deeper concern after having worked with so many clients struggling with food fear is the consequence of low nutrient status.
Long-term elimination diets are a huge red flag triggering nutrient depletions because your diet increasingly becomes restrictive. Less diversity of food equals less diversity of nutrients (and thus can have harmful ramifications on the diversity of your gut microbiome).
Additionally, it’s well-documented that vegan and plant-based diets also can leave you deficient in iron (and possibly battling a low iron rash!) no matter how much spinach and beans you eat. There are two different forms of iron – heme and non-heme. Iron found in plant foods is predominantly the non-heme version which is poorly absorbed. I recommend anyone following these diets to get labs run annually to ensure their iron levels are sufficient.
If you take away just ONE thing from this episode, it’s that your body doesn’t make iron. Clients often take for granted that the body will just make the nutrients it needs, but that notion couldn’t be farther from the truth. While there are some nutrients your body makes (like niacin under the right circumstances), iron isn’t one of them.
Iron must be absorbed from food or supplemental sources.
Best Tests To Check For Iron If You Have An Iron Deficiency Rash
If you want to stay on top of your health game, I highly recommend that you get certain labs run every year. This is especially true if you struggle with Celiac disease, IBD, or autoimmunity!
I have a great lab testing resource for you HERE that I recommend clients request from their doctor.
But if we’re just talking about iron, then you want to focus on the following:
- Complete Blood Count (CBC)
- Full Iron Panel (includes serum iron, TIBC, Iron saturation)
- Ferritin
Within the CBC panel, I specifically assess your red blood cells (RBCs) for any sign of unusual size.
Values such as MCV, MCH, MCHC, and RDW tell us a story about the look of your RBCs and the amount of hemoglobin they contain.
A word of caution – hemoglobin (found on a Complete Blood Count panel) should NEVER be used as the sole determinator of iron stores. The reason is that hemoglobin drops AFTER other iron markers, leaving you with a delayed and false sense that your iron is fine (even though you may have symptoms of iron deficiency anemia). Therefore, a full iron panel and ferritin provide a more current perspective of your iron status.
Skin Symptoms Of Anemia And Hemoglobin
And as already mentioned, another marker that’s important to assess when you’re dealing with a potential anemia rash is hemoglobin. Hemoglobin requires iron and acts sort of like a magnet for oxygen and carbon dioxide.
When your RBCs pass through your lungs, the hemoglobin grabs a molecule of oxygen that’s been inhaled and travels with it through your body. The oxygen is released in peripheral tissue and that’s when your RBC grabs onto a CO2 molecule. When it makes its way back around to the lungs, the CO2 is released (and ultimately exhaled) so you can grab another oxygen molecule.
If you don’t have enough iron, it’s hard to make adequate hemoglobin. As a personal example, when my dad became ill, he needed blood transfusions when his hemoglobin dropped below 7.
It’s also important to know that if you have a genetic condition called Thalassemia, you will likely have trouble producing enough hemoglobin.(4)
Generally speaking, if you can’t make enough hemoglobin because of low iron status, you’ll start to experience symptoms of iron deficiency anemia (and suboptimal oxygenation levels).
A full iron panel helps you better understand what your body has to work with and how that may be creating your anemia skin symptoms.
And ferritin helps from two perspectives.
First, ferritin is the storage form of iron — so it basically tells you how much you have in reserve.
Second, it’s also a marker of inflammation if your level is high (above 100 ng/mL).
Assessing For Iron Deficiency Skin Rash
Unfortunately, iron deficiency rash in women is often blamed on a heavy menstrual cycle when that’s not always the case.
I’ve worked with many clients who struggled with low iron for a long time only to be told that it was their “normal” or their periods must be too heavy (when neither was true).
Iron deficiency must be taken seriously and assessed from a few different angles because of the long-term health implications of low iron stores. Labs are very important and the basis for how serious (or even severe) the situation is.
Your diet must be assessed since iron is absorbed from the food you eat. Lower levels of iron can result due to:
- Low stomach acid (Test yours with these at-home directions!)
- Vegan or plant-based diets (which focus on non-heme sources that are less absorbable)
- Poor or impaired absorption especially if a digestive disease like Celiac disease or Inflammatory Bowel Disease is present
Blood loss is another area of assessment that includes:
- Monthly menstrual flow that is heavy or going on for longer than normal (3-8 days)
- Occult or hidden blood in your stool indicative of bleeding in the GI tract
Toxic environmental exposure to lead must be assessed in:
- Food
- Drinking water (ie. tap water levels)
- Paint + glass artistry
Anemia Rashes And Gut Health
Gut microbiome dysbiosis can also drive iron levels lower since some gut bugs will literally steal iron from your diet and supplements so that you can’t absorb it. These bugs become stronger as a result and can make dysbiosis worse. That’s why I’m careful to assess the gut microbiome before just recommending an iron supplement if you’re struggling with anemia skin symptoms.(5)
Plus hidden parasitic infections in the GI tract can also steal iron from food and supplements as well.
Iron Deficiency Symptoms To Look For
Because of the long-term health consequences (even beyond your skin) of iron deficiency anemia, it’s crucial to get an accurate assessment.
And assessing potential symptoms of iron deficiency anemia:(6,7,8,9)
- Grey or pale complexion
- Paleness that lingers after pressing on your fingernails
- Feeling cold
- Chronic fatigue
- Feeling dizzy
- Heart palpitations, irregular heartbeat, arrhythmia
- Hair loss
- Headaches
- Bleeding gums or nose bleeds
- Weakness
- Restless legs
- Cracks in the corners of your mouth
- Difficulty catching your breath with exertion (like trouble going upstairs)
- Desire to eat non-food items like chew on ice (called Pica)
- Itchy skin
- Tiny petechiae on the skin sometimes referred to as aplastic anemia rash (small dark red, brown, or purple spots due to bleeding under the skin that can also be suggestive of aplastic anemia and other nutrient deficiencies)
Sources Of Iron (If Your Levels Are Suboptimal)
If you have a low iron rash and you discover or know that your iron levels are subpar, it’s important to start by assessing how serious the deficiency is.
This is especially important before starting supplementation!
So, if your blood markers are low and you have symptoms of iron anemia despite a diet with appropriate amounts of iron and no evidence of inappropriate blood loss, I’d recommend getting a referral to a gastroenterologist.
Severe iron deficiency is not the time to take a “wait and see” approach since it ultimately compromises so many systems.
Especially if you can’t absorb iron, taking a supplement may end up being a waste of time. And I know that may not be the news you’re hoping for if you're dealing with a low iron rash — keep reading for more information about supplements.
Also, for example, if your hemoglobin is at 7.1, you might require medical intervention (via IV infusions) to bring your levels back up to a healthier spot.
When appropriate, diet interventions that can be helpful include:
- Blackstrap molasses
- Red meat + organ meats
- Shellfish
- Cooking food in cast iron pans
- Freshly squeezed citrus juice (lemon, lime) overtop of meat just before eating
Can Iron Supplements Help With Anemia Rashes?
Sometimes supplementation may be appropriate if you have a low iron rash, however, the form of iron matters because certain forms can increase constipation (which is not ideal for someone already constipated).
Iron glycinate supplements may be a better option, but again, should be taken based on the recommendation of your practitioner after reviewing your labs and the other factors I already discussed.
If you take thyroid medication, leave 3 to 4 hours between your thyroid medication and the iron supplement so that the iron doesn’t interfere with your thyroid medication. (10)
And one funny thing about iron supplementation is that it tends to be more effective when taken every other day. Iron increases a substance in your body called hepcidin which regulates iron absorption. When hepcidin is increased, it reduces iron absorption for about 24 hours. (11)
Getting To The Bottom Of Anemia And Itching
When you have an iron deficiency and you suspect it’s causing your skin rash, it’s tempting to go straight for a bottle of iron supplements and hope for the best.
But in my experience, a nutrient deficiency can be the symptom of something even deeper…and usually, there’s more than one thing going on in your body that’s causing your skin to flare up.
That’s where my Skin Rash Root Cause Finder comes in.
It’s a completely free, easy-to-use guide that allows you to explore all of the potential triggers of your skin rash. And then finally get to work fixing them — so your rashes can be a thing of the past.
So whether you know low iron is causing some issues, or you’re still trying to figure out what’s going on so you can stop the itch, the Skin Rash Root Cause Finder is your ideal tool.
Download it here and let’s do some digging!
Low Iron Rash Final Thoughts
I hope this episode clarifies for you why getting assessed for nutrient status (especially iron) is so critical!
If you’ve got questions or comments, leave your thoughts below. I’d love to hear your thoughts on iron deficiency and skin rash!
And if you know anyone who’s dealing with low iron, anemia rash, or has weird itchiness they can’t figure out, share this episode with them!
Thank you so much for turning in and I look forward to seeing you in the next episode!
REFERENCES
- https://jamanetwork.com/journals/jama/article-abstract/352253
- https://www.researchgate.net/publication/328534606_Iron-deficiency_and_pruritus_a_possible_explanation_of_their_relationship
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464269/
- https://www.medicalnewstoday.com/articles/319050
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315993/
- https://www.verywellhealth.com/fixing-low-iron-thyroid-3232716
- https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia
- https://www.healthline.com/health/anemia-rash#diagnosis
- https://www.medicalnewstoday.com/articles/319488
- https://www.verywellhealth.com/fixing-low-iron-thyroid-3232716
- https://ashpublications.org/blood/article/126/17/1981/34441/Oral-iron-supplements-increase-hepcidin-and
Thank you! This is quite enlightening.
OMG! do you have an office where you see patients? I have systemic lupus and a rash that no one can tell me what it is
Hi Monique, I do not have a physical office nor do I have experience with Lupus. Also, I’m not a doctor so I can’t diagnose anything. You would definitely need to see a doctor to get a clear diagnosis. Without any details, it’s difficult for me to know what to even direct you to ask for testing-wise.
Thanks for taking the time to describe this in full detail. I have been suffering from iron deficiency for so long now and no one has ever taken the time to go into such insightful depth.
This was very helpful. While iron deficiency is being addressed but an itchy rash remains, do any topical preparations or oral meds (e.g. antihistamines) provide temporary relief, or is it likely to persist until the anemia is resolved? The only short term relief I have found is through icing the affected area, avoiding scratching, and avoiding getting the area wet.
They may or may not help. It would depend on what your doctor recommends and what you are able to try on your own. There are some herbs like stinging nettles in supplement form that can be helpful.