532 nm Q-switched Laser Therapy for Iron Extravasation-Induced Skin Pigmentation: A Case Report and Literature Review

Cutaneous siderosis represents a challenging dermatological condition characterized by iron deposition within the skin, resulting in persistent brownish hyperpigmentation that can significantly impact a patient's quality of life. While this condition can arise from various etiologies, intravenous iron infusions remain a common cause due to extravasation and subsequent iron deposition in cutaneous tissues. This case report explores the efficacy of Q-switched 532 nm Nd:YAG laser treatment for cutaneous siderosis, a wavelength selected after demonstrating its superiority over 694 nm ruby and 1064 nm Nd:YAG lasers through direct comparative testing. A 26-year-old woman developed extensive brownish hyperpigmentation following a ferric carboxymaltose infusion. She experienced immediate burning, swelling, and subsequent discoloration extending from her elbow to her wrist. Diagnosis of cutaneous siderosis was confirmed through clinical evaluation. Treatment involved four sessions of Q-switched Nd:YAG laser therapy at a 532 nm wavelength, based on the previous comparative findings. Treatment parameters ranged from 0.6 J/cm² to 1.0 J/cm² fluence with a 4 mm spot size. Clinical outcomes were assessed using a systematic approach with digital photographs and the Global Aesthetic Improvement Scale (GAIS). Gradual pigment reduction was observed throughout the treatment course, with complete resolution of hyperpigmentation achieved two years after the first treatment session. Q-switched Nd:YAG laser therapy at 532 nm is an effective treatment for cutaneous siderosis resulting from iron infusion extravasation. This case demonstrates the potential for successful removal of iron-induced skin pigmentation with minimal adverse effects, offering a viable solution for patients experiencing this complication.