Identifying Gingival Pigmentation Patterns and Skin Color and Its Co-relation With Serum Ferritin Levels in Thalassemic Patients

Abstract

Background: Patients with β-thalassemia major (β-TM), a genetic issue due to hemoglobin (Hb) synthesis disorder, require life-long erythrocyte transfusion. The purpose of this study is to evaluate and compare gingival pigmentation and skin color with serum ferritin levels of patients with β-TM, using the Dummett's oral pigmentation index (DOPI) and Fitzpatrick skin scale, respectively. Methods: A total of 100 patients were monitored at a thalassemia care center. Each patient's gingival pigmentation and skin color were matched with DOPI and the skin scale under natural light. Serum ferritin levels, the interval of blood transfusions, and iron chelation medications were studied. A gingival pigmentation score and skin color type were compared with the serum ferritin. Results: A significant correlation was found between age, serum ferritin, pigmentation score, and skin color, which means as serum ferritin level increases, gingival pigmentation score increases, and skin color darkens. Conclusion: This study evaluated the correlation between gingival pigmentation and skin color with serum ferritin levels and established gingival pigmentation as a sign of iron deposition in β-TM patients. This is the simplest and least invasive method for evaluating serum ferritin level parameters in β-TM patients.

Management of gingival hyperpigmentation induced by increased ferritin level in aHbS‐β+thalassemia patient using diode laser

“…Gajjar and his colleagues studied the association of ferritin levels and gingival and skin pigmentation degree in beta thalassemia patients. They had concluded that gingival hyperpigmentation and skin color changes had been seen among older multi‐transfused patients, also had noticed a significant relation between ferritin levels and gingival pigmentations and skin color changes 10 …”

“…They had concluded that gingival hyperpigmentation and skin color changes had been seen among older multi-transfused patients, also had noticed a significant relation between ferritin levels and gingival pigmentations and skin color changes. 10 Although good amounts of data are available regarding the diagnosis and management of sickle cell disease, however, there is a lack in the literature concerning management of this rare phenotype. Antibiotic prophylaxis was recommended for this patient.…”

“…7,8 Many studies had shown that ferritin levels and pigmentations of skin and gingiva are correlated especially in thalassemia patients or those who undergo blood transfusion regularly. 9,10 In addition, it was found that iron deposition can enhance melanin production, which will lead to hyperpigmentation. 11 Due to the rarity of sickle cell β + thalassemia genotype, oral and maxillofacial manifestations are not well described; in addition, there is a lack in the literature regarding dental considerations when treating such patients.…”

“…All these factors can cause increased iron levels primarily in the form of ferritin including ineffective erythropoiesis, excessive gastrointestinal iron absorption due to hemolysis, and frequent red blood cells transfusion 7,8 . Many studies had shown that ferritin levels and pigmentations of skin and gingiva are correlated especially in thalassemia patients or those who undergo blood transfusion regularly 9,10 . In addition, it was found that iron deposition can enhance melanin production, which will lead to hyperpigmentation 11 …”

“… 7 , 8 Many studies had shown that ferritin levels and pigmentations of skin and gingiva are correlated especially in thalassemia patients or those who undergo blood transfusion regularly. 9 , 10 In addition, it was found that iron deposition can enhance melanin production, which will lead to hyperpigmentation. 11 …”