Skin Iron Deposition Characterises Lipodermatosclerosis and Leg Ulcer

Caggiati, Alberto; Rosi, C.; Casini, Arianna; Cirenza, Mirko; Petrozza, Vincenzo; Acconcia, Maria Cristina; Zamboni, Paolo

doi:10.1016/j.ejvs.2010.08.015

Cited by 59 publications

(53 citation statements)

References 27 publications

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“…Macrophage iron can be further increased during inflammation by virtue of increased systemic or local hepcidin expression, which leads to reduction in ferroportin, an iron eﬄux protein, resulting in intracellular iron accumulation. Individuals may also be predisposed to CVD disease through a genetic inability to counteract the skin iron overload (Caggiati et al, 2010). Studies have shown that common hemochromatosis gene mutations such as the C282Y mutation significantly increase the risk of ulcer in CVD by almost seven times (Zamboni et al, 2005).…”

Section: Deleterious Effects Of Local Cutaneous Iron Depositionmentioning

confidence: 99%

The role of iron in the skin and cutaneous wound healing

2014

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In this review article we discuss current knowledge about iron in the skin and the cutaneous wound healing process. Iron plays a key role in both oxidative stress and photo-induced skin damage. The main causes of oxidative stress in the skin include reactive oxygen species (ROS) generated in the skin by ultraviolet (UVA) 320–400 nm portion of the UVA spectrum and biologically available iron. We also discuss the relationships between iron deficiency, anemia and cutaneous wound healing. Studies looking at this fall into two distinct groups. Early studies investigated the effect of anemia on wound healing using a variety of experimental methodology to establish anemia or iron deficiency and focused on wound-strength rather than effect on macroscopic healing or re-epithelialization. More recent animal studies have investigated novel treatments aimed at correcting the effects of systemic iron deficiency and localized iron overload. Iron overload is associated with local cutaneous iron deposition, which has numerous deleterious effects in chronic venous disease and hereditary hemochromatosis. Iron plays a key role in chronic ulceration and conditions such as rheumatoid arthritis (RA) and Lupus Erythematosus are associated with both anemia of chronic disease and dysregulation of local cutaneous iron hemostasis. Iron is a potential therapeutic target in the skin by application of topical iron chelators and novel pharmacological agents, and in delayed cutaneous wound healing by treatment of iron deficiency or underlying systemic inflammation.

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Section: Deleterious Effects Of Local Cutaneous Iron Depositionmentioning

confidence: 99%

The role of iron in the skin and cutaneous wound healing

2014

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“…4,5 Common clinical findings in chronic lipodermatosclerosis include hyperpigmentation, small white-scarred areas ("atrophie blanche"), localized skin induration, small ulcerations, and erythematous plaques in patients who have chronic venous insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Severity Stratification by Compression Ultrasound Examination in Lipodermatosclerosis and Diabetic Dermopathy Patients: a Report of Three Cases

Podoleanu

Dobrovăț

Stolnicu

et al. 2017

Journal of Interdisciplinary Medicine

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Lipodermatosclerosis and diabetic dermopathy are low-risk skin lesions with many similar clinical features, except for venous abnormalities such as chronic venous insufficiency, but are rarely a reason for referring the patient to vascular ultrasound examination. We present 3 serial cases in which the compression ultrasound examination (CUS) of the venous circulation of the affected limbs was of utmost importance in the severity stratification. Asymptomatic deep venous thrombosis (DVT) was found in the first two cases, while in the third case the CUS excluded any type of vascular involvement, leading to a definite diagnosis of diabetic dermopathy. Lipodermatosclerosis may be associated with asymptomatic DVT due to chronic venous insufficiency, and early referral to CUS positively impacts further patient management.

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“…However, our present observation does not support an association of local leg skin damage with a systemic iron overload, as determined by serum ferritin levels. Probably in these latter cases vast amounts of metabolically active excess iron deposits in the organism are bound peripherally in the tissues in the form of hemosiderin [37], e.g. locally in the dermis of the legs.…”

Section: Discussionmentioning

confidence: 99%

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

Skandalis

Vlachos²,

Pliakou³

et al. 2015

Acta Haematol

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Disturbed iron homeostasis characterizes β-thalassemia and increases its morbidity. Our aim was to retrospectively associate β-thalassemia disease characteristics with treatment-requiring skin conditions. The files of adult β-thalassemia (including sickle β-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 μg/l in cases vs. 920 ± 907 μg/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 μg/l) as opposed to values within the normal range in the case of ‘localized' ones (leg ulcers: 662 ± 167 μg/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 β-thalassemia genotype. This risk can be efficiently controlled with adequate chelation.

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Skin Iron Deposition Characterises Lipodermatosclerosis and Leg Ulcer

Cited by 59 publications

References 27 publications

The role of iron in the skin and cutaneous wound healing

The role of iron in the skin and cutaneous wound healing

Severity Stratification by Compression Ultrasound Examination in Lipodermatosclerosis and Diabetic Dermopathy Patients: a Report of Three Cases

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

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