To the Editor,
Pica refers to an abnormal appetite for non-edible substances usually occurring in children with developmental disability or brain injury. However, it can also occur during adulthood, as it is associated with iron deficiency. Pica requires medical attention in case of severe eating behaviour that can be potentially harmful. Here we present a case of craving for Johnson’s® baby talcum powder in a patient with iron deficiency anaemia.
A 41-year-old woman was referred to our outpatient clinic by her general practitioner because of severe iron deficiency anaemia. She was supposed to take iron tablets because of anaemia caused by frequent epistaxis due to hereditary haemorrhagic telangiectasia. Unfortunately, she had discontinued taking her iron supplementation without a specific reason eight months previously. Laboratory results revealed severe iron deficiency anaemia (haemoglobin 5.9 g/dl, mean corpuscular volume 62 fl). During the consultation, the patient told us that she consumed one bottle of Johnson’s® baby powder daily. She also told us that her behaviour had subsequently been picked up by her daughter. Fortunately, after four weeks of iron supplementation, our patient felt no more craving and completely stopped the consumption of Johnson’s baby powder. Her general practitioner was informed and immediately intervened pertaining to her daughter, in whom iron deficiency was excluded.
To our best knowledge this is the first described pica syndrome of talcum powder craving associated with severe iron deficiency. Pica occurs in up to 45% of non-pregnant iron deficient adults and most often presents with a craving for ice, which is called pagophagia, but substances such as rubber and toothpicks have been reported as well. This craving generally rapidly reverses within a few weeks with iron repletion. The mechanism leading to this syndrome is unknown.1 Pica for Johnson’s® baby powder might be a potentially harmful for a patient’s health, because it contains hydroxylated magnesium silicate and zinc oxide minerals that inhibit iron absorption, which might worsen the iron deficiency. Furthermore, when consuming the powder straight from its bottle it is likely that, besides aspiration, amounts of the powder will be inhaled, which might cause acute respiratory problems (e.g. bronchoconstriction, chemical pneumonia). Chronic lung damage could be due to granulomatous or interstitial lung disease or pulmonary talcosis, which might over time lead to pulmonary fibrosis.2,3 In a case of severe iron deficiency it is important to ask about unusual cravings in order to detect pica, especially since potentially harmful substances may be consumed. Furthermore, clinicians should be aware of the possibility that such behaviour may be copied by relatives as well.