Dysregulated Iron Homeostasis in Atopic Dermatitis: Linking Iron Deficiency to Clinical Severity and Quality of Life.

BACKGROUND: Disturbed iron metabolism has been described in chronic diseases with pro-inflammatory/immune activation. This study aimed to characterize iron status in patients with atopic dermatitis (AD) and to examine its relationship with disease severity and quality of life. METHODS: We prospectively enrolled 86 adult patients with moderate-to-severe AD. Clinical assessments included the Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), and the Dermatology Life Quality Index (DLQI). Blood samples were collected for hematologic parameters and iron-related biomarkers, including serum iron, ferritin, transferrin, transferrin saturation (Tsat), soluble transferrin receptor (sTfR), and hepcidin. Associations between iron markers and clinical outcomes were evaluated using beta regression models with variable selection and stability analyses. RESULTS: Abnormalities in circulating iron biomarkers indicating iron deficiency were prevalent in patients with AD: 45% of patients had low Tsat (<20%), 37% low ferritin, and 26% reduced serum iron, despite largely normal hemoglobin. Patients with pro-inflammatory activation (as evidenced by elevated high-sensitivity C-reactive protein (hsCRP) above 5 mg/L) displayed a pattern characterized by lower iron, Tsat and higher sTfR levels. In multivariable analyses, lower serum iron remained associated with worse DLQI scores, while higher transferrin was associated with greater disease severity (EASI, SCORAD). CONCLUSIONS: Iron deficiency without anemia was a common feature of moderate-to-severe AD and was associated with higher clinical burden. Dysregulated systemic iron homeostasis was associated with impaired quality of life and increased disease severity.