Cutaneous manifestations in Egyptian children with beta-thalassemia major: Relationship with serum ferritin, thyroid profile, and treatment modalities

Pediatr Dermatol. 2018 Sep;35(5):639-643. doi: 10.1111/pde.13570. Epub 2018 Jun 26.


Background: Cutaneous manifestations can be found in many patients with hematologic disorders, including thalassemia.

Methods: Patients with beta-thalassemia major attending the pediatric department of Fayoum University Hospital from April 2016 to October 2016 (n = 100) were compared with controls (n = 100). Both groups underwent detailed history evaluation, clinical examination, and laboratory investigations, including complete blood count, liver and kidney function, serum ferritin, and thyroid profile. A single dermatologist conducted a clinical dermatologic examination for all participants.

Results: Children with thalassemia had a greater prevalence of xerosis (72%), pruritus (52%), idiopathic guttate hypomelanosis (22%), urticaria (16%), ephelides (freckles; 13%), and scars (13%) than controls (P ≤ .001). We detected a significant relationship between serum ferritin and pruritus, xerosis, ephelides, idiopathic guttate hypomelanosis, urticaria, and age of patients with thalassemia (P < .05). Children without thyroid abnormalities were more likely to have xerosis, pruritus, idiopathic guttate hypomelanosis, urticaria, and ephelides (86%) than controls (P < .05). Although there was no significant difference in skin findings between patients who did and did not receive chelating agents (P > .05), a significant association was found between xerosis and the use of deferoxamine and deferiprone, whereas ephelides and urticaria were more common in patients receiving deferasirox.

Conclusion: Because cutaneous manifestations are common in Egyptian patients with beta thalassemia major, regular dermatologic follow-up is recommended for early management.

Keywords: cutaneous; ferritin; thalassemia; thyroid profile.

MeSH terms

  • Adolescent
  • Case-Control Studies
  • Chelating Agents / therapeutic use
  • Child
  • Child, Preschool
  • Egypt
  • Female
  • Ferritins / blood*
  • Humans
  • Infant
  • Male
  • Skin / pathology
  • Skin Diseases / epidemiology
  • Skin Diseases / etiology*
  • Thyroid Function Tests / methods
  • beta-Thalassemia / complications*


  • Chelating Agents
  • Ferritins