Many people with eczema report a link between low iron levels and eczema outbreaks, but it’s not clear whether eczema is actually linked to anemia — low levels of healthy red blood cells.

“I remember when I took iron, my skin got the clearest I’ve had it since I started having hand eczema,” one myEczemaTeam member said.

Another member said, “I’m wondering if the low iron is causing the eczema to be so bad, like with my other symptoms.”

Read on to find out more about a possible link between iron-deficiency anemia — the most common type of anemia — and eczema.

What Is Anemia?

Anemia occurs when your body doesn’t produce enough red blood cells or your red blood cells don’t function properly. Red blood cells contain a protein called hemoglobin, which carries oxygen from the lungs to the rest of the body. If you don’t have enough red blood cells and hemoglobin to carry oxygen to all your body parts, you may experience the symptoms of anemia.

Common symptoms include feeling weak, tired, and dizzy and hearing a pounding or “whooshing” noise. Other common anemia symptoms also include a fast or irregular heartbeat, headache, and cold skin. People experiencing anemia may notice that their skin looks paler than usual or has a yellow cast to it.

A rash is one of the less common symptoms of anemia, but it can occur. Two types of anemia — iron-deficiency anemia and aplastic anemia — can cause a rash that may be confused with eczema.

Iron-Deficiency Anemia Rash

Iron-deficiency anemia is the most common type of anemia and affects 13 percent of people worldwide. Your body needs iron to create new blood cells, so if your iron levels aren’t sufficiently high, you won’t have enough blood cells. Not getting enough iron in your diet can cause iron deficiency. Gastrointestinal diseases, like colitis and Crohn’s disease, can make absorbing iron difficult. Blood loss through, for example, menstruation, surgery, and physical trauma also can cause iron-deficiency anemia.

Iron-deficiency anemia rash can cause itchy skin. When you scratch, the skin becomes bumpy, painful, and inflamed. Researchers don’t know why iron-deficiency anemia causes a rash, but it could be related to skin thinning.

Iron-deficiency anemia is usually treated with dietary changes and iron supplements. Foods that can help include:

• Meat such as beef, ham, lamb, and liver
• Poultry including chicken, turkey, and duck — particularly dark meat
• Seafood including shrimp, anchovies, sardines, tuna, and oysters
• Vegetables like spinach, string beans, broccoli, and kale
• Legumes including lima beans, peas, pinto beans, lentils, and black-eyed peas
• Grain-based foods enriched with iron, such as breads, pasta, and cereal
• Fruits including strawberries, dates, prunes, and dried apricots and peaches

Most multivitamins don’t have enough iron to treat anemia. Oral iron supplements can be purchased over the counter or prescribed by a health care provider — but you should speak with your doctor before starting on iron supplements and take care to follow their guidance closely.

Severe cases of anemia can be treated with intravenous iron — that is, iron administered into a vein through a catheter.

Aplastic Anemia Rash

Aplastic anemia is a condition that affects the bone marrow, the spongy substance in your bones that creates blood cells. In aplastic anemia, a person’s bone marrow doesn’t create enough blood cells, and it’s often a result of a person’s immune system attacking their bone marrow. However, this condition is very rare — between 1 and 6 out of every 1 million people develop it each year, according to Cleveland Clinic.

Aplastic anemia rash appears as patches of small red or purple dots, called petechiae. Petechiae can be unsightly but they usually don’t itch or hurt. These rashes occur because the bone marrow is having trouble producing blood cells called platelets, which help blood clot. Without enough platelets, small blood vessels in the skin burst open and bleed, creating little dots of blood.

Aplastic anemia is treated with medication to stop damage to bone marrow and to help create new, healthy blood cells. It’s also treated with blood transfusions and blood and bone marrow transplants.

Anemia and Eczema — Is There a Link?

Whether it’s associated with iron-deficiency anemia or aplastic anemia, anemia rash is not a form of eczema. However, anemia might be associated with eczema.

One study of almost 850,000 children found an association between iron-deficiency anemia and atopic diseases (inflammatory skin conditions) like atopic dermatitis (the most common form of eczema). Similarly, another study of almost 237,000 children with any type of eczema were more likely to have anemia and that a history of both eczema and asthma was associated with higher odds of anemia.

Finally, a study of almost 1.5 million people in the South Korean medical system, including adults, found that iron-deficiency anemia and anemia were more common in people with atopic disease. Additionally, they found that the more atopic diseases people had, the higher the prevalence of anemia.

There are several reasons why anemia might be associated with eczema:

• Restrictive diets to prevent eczema outbreaks could limit iron intake.
• Genetic factors could play a part.
• Iron deficiency can affect the immune system in ways that could encourage eczema outbreaks.

According to one study in Allergo Journal International, iron deficiency stifles the development of certain immune cells but still allows those associated with allergic reactions to develop. In addition, iron deficiency affects cells called mast cells, which are responsible for reactions to allergens. Iron-containing proteins can keep the activation of these mast cells from developing.

Keeping Yourself Healthy

Eczema itself is a risk factor for iron-deficiency anemia because as an autoimmune condition, it can cause the body to produce lower levels of red blood cells. Therefore, taking care to reduce your risk of iron-deficiency anemia is important, as it may also reduce your risk of eczema outbreaks. Talking to your health care provider if you’re experiencing any of the symptoms of iron-deficiency anemia can help improve both conditions. They may recommend adding more iron to your diet or starting a ferrous sulfate (iron) supplement.

Some MyEczemaTeam members have found that improving their iron intake improves their eczema symptoms. “I started taking iron supplements,” one member said. “Hey presto! My eczema improved. I now take iron twice a week or when the itching increases.”

Importantly, talk with your doctor before starting an iron supplement, or any other type. If they recommend one, be sure to follow their guidance. Iron supplements should be taken on an empty stomach. Bear in mind that iron supplements can cause side effects, including constipation, heartburn, stomach cramps, nausea, diarrhea, and dark stool (poop). Getting more iron than your body requires can lead to serious health problems. Iron tablets also can interfere with the effectiveness of other medications, including tetracycline, penicillin, ciprofloxacin, and drugs used for Parkinson's disease and seizures.

Talk With Others Who Understand

On MyEczemaTeam, the social network for people with eczema and their loved ones, more than 49,000 members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Have you experienced anemia? Did treating it help your eczema outbreaks? Share your experience in the comments below, or start a conversation by posting on your Activities page.