Use of Lasers for Iron-Induced Accidental Tattoos: Experience at a Tertiary Referral Center

Abstract

BACKGROUND Awareness of accidental tattoos after iron injections with paravenous leakage is low. No larger patient cohorts have been analyzed. The lesions are a burden to the patients. The only known treatment is laser therapy. OBJECTIVE To characterize the clinical appearance and development of iron-induced tattoos and to demonstrate safe and efficient removal with quality-switched (QS) and picosecond lasers. MATERIALS AND METHODS The authors conducted a retrospective systematic analysis on patients who presented at the Dermatology Department of the University Hospital of Zurich between Year 2008 and 2017 with accidental hyperpigmentations after iron injections. From 29 collected patients, 13 received laser treatment and were analyzed with reference to the lasers used, including wavelength, fluence, spot size, intervals, number of sessions, and overall success. The authors defined the latter as a complete removal or as patients' satisfaction. RESULTS The authors treated 13 patients and completed the treatment in 8 patients, with an average of 5.6 sessions. No complications occurred. CONCLUSION Spontaneous regression of iron-induced tattoos is possible within 1 to 2 years, but not guaranteed. Removal with QS ruby, Nd:YAG, and picosecond lasers can be achieved within a mean number of 5.6 sessions. Assuring a valid indication before intravenous iron administration is important.

A stain on iron therapy

“…One review assessed 29 patients who had reported accidental staining from iron infusions over a nineyear period. 13 Thirteen patients had laser therapy Box 3 Clinical features of iron extravasation [6][7][8][9][10][11][12][13]…”

“…12 Patients who experience iron extravasation resulting in staining may describe pain, swelling, and feelings of pressure or pricking at the infusion site. 13 Patients should therefore be told to notify staff of any of these symptoms ( Box 3 ). This is an important consideration for patients who do not understand English.…”

“…opical therapies, lymphatic drainage and massages have been tried without success. 9 , 13 The most evidence for successful reversal of iron staining is with laser therapy.…”

“…A rise in reports of iron staining 6 - 10 may correspond with the increasing use of intravenous iron in clinical practice. 6 - 13 …”

Successful Treatment of Iatrogenic Cutaneous Siderosis with Pigment Lasers: A Retrospective Study in 15 Consecutive Patients

“…To date, however, there are scant data in the literature about the possible and most efficient therapeutic options. Treatments with qualityswitched (QS) lasers are reported in a few cases with different wavelengths: 532, 755 and 1,064 nm (6,7,(9)(10)(11)(12). QS lasers, developed in the 1980s, are efficient in the removal of exogenous and endogenous pigments, such as tattoos, as well as epidermal and dermal melanin lesions.…”