'Ferritin face' claims sweep social media: iron deficiency cannot be diagnosed from the face, experts say

Dark circles under the eyes, grey or pale skin, cracked lips and hair loss — influencers on TikTok call these signs 'ferritin face' and claim they indicate low iron stores. Experts, however, say iron deficiency cannot be diagnosed from the face, and that these symptoms can have many other causes.

Iron is not made in the body; it comes from food. Ferritin is the protein that stores iron in the body, particularly in the liver, and releases it in a controlled manner. Measuring ferritin levels through a blood test can give a snapshot of the body's iron reserves, although experts warn those levels are not always a reliable guide.

According to guidelines from the National Institute for Health and Care Excellence, blood ferritin levels of less than 30 micrograms per litre indicate an iron deficiency. Sue Pavord, professor of practice in medical haematology at Oxford University hospitals, said a level below 50 might also be a pointer to iron deficiency.

The symptoms influencers describe — dark circles under the eyes, grey skin, cracked lips and hair loss — can be caused by a variety of factors, including genetics, stress and dehydration. But experts say low iron stores can have an effect. 'Iron is needed for every single cell of the body. So if you are iron deficient, you will be very fatigued, have brain fog, your skin will look dull and saggy, you'll look pale and tired,' Pavord said.

'While we can't diagnose iron deficiency from the face, it might be a suggestion that there is iron deficiency,' Pavord said. Prof Toby Richards of the University of East London and the Iron Clinic added that such changes were particularly pronounced in people with very low iron stores. 'They tend to be the really sick patients,' he said.

'Periods and pregnancies are the most common [causes],' Pavord said, but others include not getting enough iron, either from dietary choices or because of poor absorption, as can occur with coeliac disease. Low ferritin levels can also arise from blood loss linked to gastrointestinal problems such as gastritis or polyps. 'We also sometimes see it in athletes because of the high demand for iron on their bodies,' she added.

Richards said those at high risk of low ferritin — such as people who have heavy periods, are pregnant or have had children, or are vegetarian or vegan — should ask for a blood test, and that it should include a full blood count, a ferritin level check, and tests for B12 and folate levels. 'This is a proper disease, and to put it into perspective, it's the leading cause of disability in women of reproductive ability,' he said.

Pavord also said those concerned about their ferritin levels should ask for a blood test, adding that it was important to understand the cause of the deficiency. Older people suspecting iron deficiency would need a proper clinical assessment and investigations to look for a source of bleeding from the bowel, she said.

Pavord said it is possible to buy iron tablets over the counter at a pharmacy. 'Taking iron tablets without confirming iron deficiency is not really going to do you any harm, particularly if you're a young woman, because you're losing a lot of iron with periods,' she said. But Richards noted many products do not contain the appropriate dose: if someone is iron deficient, they need a full treatment dose and then repeat blood results in three months' time; what is marketed is normally the lower-dose supplement, he said.

Pavord was positive about the increase in awareness. 'We need to stop normalising iron deficiency,' she said. 'Many women are just exhausted trying to cope with their periods, cope with their pregnancies, cope with their young children and their busy jobs, and we need to stop normalising fatigue.' Richards agreed: 'Anything that raises the plight of women in this area is a good thing.'

However, Dr Asiya Maula, a GP from the private firm The Health Suite, was cautious. 'The risk with social media trends is that people may see themselves in a list of symptoms and assume they have a deficiency without checking whether that is actually the cause,' she said.