{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:27:04Z","timestamp":1772843224794,"version":"3.50.1"},"reference-count":39,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"publisher","award":["SUBK.C260.22.061"],"award-info":[{"award-number":["SUBK.C260.22.061"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>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 (&lt;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.<\/jats:p>","DOI":"10.3390\/nu17233743","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T08:44:28Z","timestamp":1764751468000},"page":"3743","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dysregulated Iron Homeostasis in Atopic Dermatitis: Linking Iron Deficiency to Clinical Severity and Quality of Life"],"prefix":"10.3390","volume":"17","author":[{"given":"Ma\u0142gorzata","family":"Ponikowska","sequence":"first","affiliation":[{"name":"Centre of General Dermatology and Oncodermatology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4944-5388","authenticated-orcid":false,"given":"Alina","family":"Jankowska-Konsur","sequence":"additional","affiliation":[{"name":"Centre of General Dermatology and Oncodermatology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7624-631X","authenticated-orcid":false,"given":"\u0141ukasz","family":"Lewandowski","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Immunochemistry, Faculty of Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S0140-6736(20)31286-1","article-title":"Atopic Dermatitis","volume":"396","author":"Langan","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1056\/NEJMra1401038","article-title":"Iron-Deficiency Anemia","volume":"372","author":"Camaschella","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4425","DOI":"10.1182\/blood-2011-01-258467","article-title":"Hepcidin and iron regulation, 10 years later","volume":"117","author":"Ganz","year":"2011","journal-title":"Blood"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Dutra, F.F., and Bozza, M.T. (2014). Heme on Innate Immunity and Inflammation. Front. Pharmacol., 5.","DOI":"10.3389\/fphar.2014.00115"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.cell.2010.06.028","article-title":"Two to Tango: Regulation of Mammalian Iron Metabolism","volume":"142","author":"Hentze","year":"2010","journal-title":"Cell"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1634\/theoncologist.2009-S1-22","article-title":"Iron Metabolism, Iron Deficiency, Thrombocytosis, and the Cardiorenal Anemia Syndrome","volume":"14","author":"Besarab","year":"2009","journal-title":"Oncologist"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1182\/blood-2018-06-856500","article-title":"Anemia of inflammation","volume":"133","author":"Weiss","year":"2019","journal-title":"Blood"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1093\/eurheartj\/ehs224","article-title":"Iron Deficiency and Heart Failure: Diagnostic Dilemmas and Therapeutic Perspectives","volume":"34","author":"Jankowska","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1159\/000243791","article-title":"The Role of Hepcidin in Iron Metabolism","volume":"122","author":"Nemeth","year":"2009","journal-title":"Acta Haematol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/MOG.0b013e32831ef1f7","article-title":"Iron Absorption and Metabolism","volume":"25","author":"Anderson","year":"2009","journal-title":"Curr. Opin. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3324\/haematol.2009.017046","article-title":"Pathogenesis and Treatment of Anemia in Inflammatory Bowel Disease","volume":"95","author":"Weiss","year":"2010","journal-title":"Haematologica"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.2337\/dc14-3082","article-title":"Mechanisms Linking Glucose Homeostasis and Iron Metabolism toward the Onset and Progression of Type 2 Diabetes","volume":"38","author":"McClain","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1002\/jcsm.12061","article-title":"Deranged Iron Status in Psoriasis: The Impact of Low Body Mass","volume":"6","author":"Ponikowska","year":"2015","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1159\/000505184","article-title":"Deranged Iron Status Evidenced by Iron Deficiency Characterizes Patients with Hidradenitis Suppurativa","volume":"236","author":"Ponikowska","year":"2020","journal-title":"Dermatology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"44","DOI":"10.2340\/00015555924447","article-title":"Diagnostic Features of Atopic Dermatitis","volume":"92","author":"Hanifin","year":"1980","journal-title":"Acta Derm. Venereol. Suppl."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/j.1365-2133.1994.tb08532.x","article-title":"The U.K. Working Party\u2019s Diagnostic Criteria for Atopic Dermatitis. III. Independent Hospital Validation","volume":"131","author":"Williams","year":"1994","journal-title":"Br. J. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/j.1365-2133.2007.08112.x","article-title":"Practical Issues on Interpretation of Scoring Atopic Dermatitis: The SCORAD Index, Objective SCORAD and the Three-Item Severity Score","volume":"157","author":"Oranje","year":"2007","journal-title":"Br. J. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1034\/j.1600-0625.2001.100102.x","article-title":"The Eczema Area and Severity Index (EASI): Assessment of Reliability in Atopic Dermatitis","volume":"10","author":"Hanifin","year":"2001","journal-title":"Exp. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1365-2230.1994.tb01167.x","article-title":"Dermatology Life Quality Index (DLQI)\u2014A Simple Practical Measure for Routine Clinical Use","volume":"19","author":"Finlay","year":"1994","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_21","unstructured":"World Health Organization (2011). Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity, World Health Organization. WHO\/NMH\/NHD\/MNM\/11.1."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1373\/clinchem.2009.140053","article-title":"Hepcidin in Human Iron Disorders: Diagnostic Implications","volume":"57","author":"Kroot","year":"2011","journal-title":"Clin. Chem."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2809","DOI":"10.1182\/blood-2015-12-639112","article-title":"Hepcidin in the Diagnosis of Iron Disorders","volume":"127","author":"Girelli","year":"2016","journal-title":"Blood"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1172\/JCI200420945","article-title":"IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin","volume":"113","author":"Nemeth","year":"2004","journal-title":"J. Clin. Investig."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Gozzelino, R., and Arosio, P. (2016). Iron Homeostasis in Health and Disease. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17010130"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1024\/0300-9831\/a000029","article-title":"Intestinal Iron Absorption: Regulation by Dietary & Systemic Factors","volume":"80","author":"Sharp","year":"2010","journal-title":"Int. J. Vitam. Nutr. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1161\/01.CIR.0000052939.59093.45","article-title":"Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice. A Statement for Healthcare Professionals from the Centers for Disease Control and Prevention and the American Heart Association","volume":"107","author":"Pearson","year":"2003","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v033.i01","article-title":"Regularization Paths for Generalized Linear Models via Coordinate Descent","volume":"33","author":"Friedman","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_29","first-page":"1","article-title":"Beta Regression in R","volume":"34","author":"Zeileis","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1093\/eurheartj\/ehq158","article-title":"Iron deficiency: An ominous sign in patients with systolic chronic heart failure","volume":"31","author":"Jankowska","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1111\/j.1365-2036.2006.03146.x","article-title":"Systematic Review: Managing Anemia in Crohn\u2019s Disease","volume":"24","author":"Kulnigg","year":"2006","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.cmet.2013.02.007","article-title":"Iron and diabetes risk","volume":"17","author":"Simcox","year":"2013","journal-title":"Cell Metab."},{"key":"ref_33","first-page":"1152","article-title":"Systemic Inflammation and Cardiovascular Risk in Atopic Dermatitis: Pathophysiologic and Clinical Perspectives","volume":"149","author":"Szegedi","year":"2022","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_34","unstructured":"Pietrzak, A., Grywalska, E., Bartosi\u0144ska, J., Chodorowska, G., and Krasowska, D. (2023). Immunometabolic Aspects of Atopic Dermatitis: The Missing Link between Systemic Inflammation and Cardiovascular Risk. Int. J. Mol. Sci., 24."},{"key":"ref_35","unstructured":"Batista, P., Gouveia, C., Carvalho, D., Sousa, S., Cunha, J.P., Monteiro, E.C., and Teixeira, M. (2022). Iron and Immune System: From Physiology to Pathology. Cells, 11."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1038\/s41577-025-01193-y","article-title":"Iron and the Immune System","volume":"25","author":"Frost","year":"2025","journal-title":"Nat. Rev. Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.cell.2016.12.034","article-title":"A Red Carpet for Iron Metabolism","volume":"168","author":"Muckenthaler","year":"2017","journal-title":"Cell"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1038\/nrc3495","article-title":"Iron and Cancer: More Ore to Be Mined","volume":"13","author":"Torti","year":"2013","journal-title":"Nat. Rev. Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1016\/S0140-6736(20)32339-4","article-title":"Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: A multicentre, double-blind, randomised, controlled trial","volume":"396","author":"Ponikowski","year":"2020","journal-title":"Lancet"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/23\/3743\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T08:48:57Z","timestamp":1764751737000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/23\/3743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":39,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["nu17233743"],"URL":"https:\/\/doi.org\/10.3390\/nu17233743","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]}}}