Iron infusion stain removal

Iron infusion stains are the result of iron infusions gone wrong. The most common cause is intravenous infusions of iron replacement therapy. Staining occurs when there is a leakage of iron into the skin. Iron stains can be long lasting. Pico lasers can improve iron staining in some, but not all cases. 

Key Points

  • Iron staining can occur with infusions & less commonly with IM injections
  • Pico laser is the best treatment option for iron staining
  • It often takes between 9 to 20 months for lasers to be effective
  • Treatments are spaced between 6 to10 weeks apart
  • It takes between 4 to 10 sessions for good results
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Iron infusion stain removal at a glance

Best outcomes: 6-20 months
Procedure time: 10-20 minutes
Duration of results: Permanent
Back to work: NA
Recovery: NA
Anaesthetic: Gas, skin cooling
Your specialist: Nurse, dermatologist
How much: $

Our results speak for themselves

FAQs

How can we treat iron infusion stains?

Lasers offer the best chances of accelerating iron stain removal. Lasers work by accelerating the clearance of iron salts from the skin by changing the size & molecular properties of metals. This enables faster clearance by your immune system.

What is the best laser for iron stains?

The best laser is the pico laser. This special laser has a very short pulse duration that shatters pigment, including iron stains. The two best laser systems are the Picoway & the Picosure Pro. These two pico lasers have the highest available power, & the shortest possible pulse duration. The Enlighten (Cutera) has a much longer pulse duration, & in theory, is not as good as Picoway or Picosure.

 

Nano lasers including Spectra, C6, Pastele, RevLite & others are not as efficient as pico lasers. 

How long does it take to remove iron staining?

On average, between 9 to 20+ months. Read more to understand the marked variability between patients, as the time to clearance depends on your immune system, location of staining, density of iron, skin colour & total surface area. It also depends on the laser system used, & the settings.  

 

On average, between 4-10 sessions are required to make a difference. One treatment will have little impact on iron staining. Not all cases are successful. In some cases, results from iron staining are permanent. 

Is laser treatment painful & how long does it take?

Laser pigment removal is well tolerated. We use cooling devices & in some cases numbing cream prior to treatment. It takes between 2-6 minutes for the procedure, depending on the area, extent & density of iron staining. 

What is the biggest factor determining success of treatment?

The biggest factor that determines the speed & success of clearance, is YOUR immune system. Lasers work by optimising the molecular presentation of particles so that your immune system can effectively clear them.  

 

The second most important factor is the depth of pigment. In some cases, iron reaches the fat layer, out of reach of even the most powerful lasers. 

Can we guarantee that lasers will work?

Nope. Unlike laser resurfacing, vascular laser or even lasers for heavy metal ingestion such as silver, laser treatment of iron is not predictable. We will do our very best to help speed up resolution, however the result (& speed) depends on your immune system. 

 

Rest assured that we employ the best & most technologically advanced laser systems (Picoway, Picosure Pro), high energy, short PD 1064 Nd yag in both full bream & fractional. You will be consenting that laser treatment is not a guarantee, but it is the best option we currently have. 

Can we provide a medicolegal report regarding our findings?

Yes. Our senior consultants can provide a legal report based upon clinical findings. A fee applies for these services. 

 

 

  • Consultation fee (dermatologist) $270 
  • Medico-legal reporting fee $900 +GST

 

If you would like treatment with no consulting fee, book an appointment with our nurses. Nurses do not provide medico-legal services.

Can creams be effective?

No. This is because iron is in the deeper layers of skin, out of reach from all creams. Even super strong chemical peels are ineffective. 

Can microneedling be effective?

In theory microneedling can cause iron to migrate from the sites. Treatments can evoke an inflammatory reaction that can stimulate cells to carry iron staining away from the affected areas. Additionally, microneedling can cause trans epidermal migration of iron particles from the skin. 

 

We do not offer microneedling for two reasons-

 

 

  1. The chance of this working effectively is slim- less than 10%.
  2. The costs to the patient do not warrant a trial. Microneedling costs upwards of $700 per session, factor in 10-15 sessions & the costs add up. 

 

If you would like to consider microneedling, you should contact an aesthetician to conduct a test patch. Treatment should be spaced 10-14 weeks apart. It may require at least 5-8 sessions as a trial, & upwards of 15 to 20 sessions for treatment.

What sites are commonly involved in accidental iron staining of the skin?

Iron staining or infusion accidents are mainly on the arms, around the elbow joint. Hence extravasation affects the upper arm, elbow area & forearm. The most common cause is flexion of the elbow, leading to dislodgement of the cannula. 

Infusion staining of the legs & buttocks are less common, as IM iron infusions are rarely performed.

Why is iron density & time till infusion is stopped important?

Much like removing ink tattoos from the skin, the actual amount of iron in the skin plays a significant role in how quickly your stain improves. High density iron means much slower clearance. 

If your infusion accident was not picked up early, chances are you have a much higher load of iron in the tissue. The time taken till fading & the number of sessions will increase. 

Products

Medik8 Physical Sunscreen SPF50+
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Dermaceutic All Things Pigment 21 Day Kit
$154.00

The best laser for removing iron infusions stains is the pico laser. This special laser has a very short pulse duration that shatters pigment, including iron stains.

What are other factors that determine the speed of resolution?

Apart from one’s individual immune response, other factors that contribute to speed of iron infusion clearance include-

 

 

  • The extent of staining: large areas respond much slower compared to small ones
  • The location: lower the staining on the arm, the slower the response
  • The density of iron: dark iron stains = more iron particles 
  • Patient skin type: darker your skin, the more sessions required

The type of lasers used: Picoway is the best, followed by Picosure Pro, whilst longer PD pico lasers such as Enlighten by Cutera may not give the ideal end point

Why are tattoos easier to fade & remove compared to stains?

We don’t fully understand this phenomenon, however it is theoretically possible that the macrophages or cells that clear up pigment, view iron as cytotoxic. This means that your immune system stays well clear of iron as cells don’t want to die. 

 

With repeated laser treatments, the biochemical structure of iron residue may change, allowing for more clearance in time. We still don’t fully understand this process (unlike removing other heavy metals where the optical properties of silver have been proven with electron microscopy). 

Why did skin staining occur?

It is complex & goes something like this-

 

 

  • Consent prior to iron infusion: if you were consented for iron infusion, the hospital may not pay for treatments. Some hospitals do.

 

 

  • No consent: this is a grey area. Most practitioners will pay for treatments, or at least a trial of treatments. 

As a guide, the costs are as follows- small area treatment; palm size – $480. Medium area treatment; hand size $ 630. Large area; greater than hand size $790. Treatment is with the very latest Picoway or Picosure laser systems.

Who pays for treatments if iron staining was secondary to a medical procedure?

It is complex & goes something like this-

 

 

  • Consent prior to iron infusion: if you were consented for iron infusion, the hospital may not pay for treatments. Some hospitals do.

 

 

  • No consent: this is a grey area. Most practitioners will pay for treatments, or at least a trial of treatments. 

As a guide, the costs are as follows- small area treatment; palm size – $480. Medium area treatment; hand size $ 630. Large area; greater than hand size $790. Treatment is with the very latest Picoway or Picosure laser systems. 

What is skin biopsy & when is it useful?

A skin biopsy can help determine the depth of iron staining. Unlike tattoos which occupy the dermal layer of skin, iron staining has been shown to affect the fat layer. If this is so, lasers may not work as iron is too deep. 

We may elect to take a tiny (2 mm) biopsy to ascertain depth prior to laser. It is still unclear if depth of pigment is related to prognosis.

Who should I book in with for treatments?

Book a free consultation with our laser nurses. They have extensive experience in the management of iron staining. They will examine & document your stains prior to discussion treatment options. 

 

You can also book in with our consultant dermatologists. An extra fee is charged if you require a detailed medico legal report.

 

Nurse consultation: Free. Redeemable with treatments.

Dermatologists: $270 consultation fee + extra for detailed medicolegal report.

How common is iron infusion staining?

Very. Our practice sees approximately 50-80 cases annually, with an increase in the incidence every year. Half our cases come from public or private hospitals, & the other half from the community. The incidence is rising because more people are getting iron infusions.

Iron infusion side effects such as skin staining occur in approximately 1% of cases (range of 0.68 to 1.3% in clinical trials).

What steps can be taken to reduce the incidence of iron staining following infusions?

Given the marked increase in iron infusions with resulting skin staining (it is a probability game), steps should be taken to minimise the numbers. This includes-

 

 

  • Ensuring an appropriate indication for iron infusion
  • Patients should be consented & informed of this possible side effect
  • Consent should be obtained to discuss that iron stain removal may not be possible. Side effects may be permanent.
  • Ensure the correct injection site and administration technique is used
  • Signs of iron extravasation should be monitored carefully during the infusion process

What is the difference between iron staining and silver staining or agyria?

The fundamental difference between these metals is the optical transmission of particles. For silver ingestion or agyria, the particles reflect light. The skin is dull grey. Unlike iron infusion staining, we can instantly break down the particles of silver, resulting in immediate clearance. These particles are not immediately carried away by the immune system, however they are broken down into very small particles that have different optical properties. Our dermatologists have published their electron microscopy work in 2018. 

What is the difference between iron staining and silver staining or agyria?

The fundamental difference between these metals is the optical transmission of particles. For silver ingestion or agyria, the particles reflect light. The skin is dull grey. Unlike iron infusion staining, we can instantly break down the particles of silver, resulting in immediate clearance. These particles are not immediately carried away by the immune system, however they are broken down into very small particles that have different optical properties. Our dermatologists have published their electron microscopy work in 2018. 

Who to see if you are interstate?

If you are interstate & suffer from iron staining, you can get a referral to see our colleagues in NSW & Victoria. Their practice has seen many cases of iron infusion staining and will guide you. 

 

Victoria: Assoc Prof Phil Bekhor. 

NSW: Dr Adrian Lim.

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