Sharma Ajay N, Golbari Nicole M, Grushchak Solomiya, Andrade Adriana Ribas, Zachary Christopher B
Department of Dermatology, University of California, Irvine, Irvine, California, USA.
Gastroenterology Clinical and Experimental Laboratory, University of Sao Paulo, Sao Paulo, Brazil.
Lasers Surg Med. 2024 Sep;56(7):625-631. doi: 10.1002/lsm.23825. Epub 2024 Jul 15.
Iatrogenic cutaneous siderosis is a well-recognized dermatologic complication after parenteral iron infusion. The condition manifests as discrete, hyperpigmented patches near the site of injection. Most cases do not resolve spontaneously, leading to significant aesthetic and psychological distress to patients. A recent case of iatrogenic cutaneous siderosis at our institution prompted a systematic review of the efficacy of energy-based devices previously reported in the treatment of this condition.
PubMed and Cochrane databases were searched for all peer-reviewed articles published using the following search terms: "iron OR heme OR hemosiderosis OR siderosis" and "hyperpigmentation OR staining OR tattoo." Articles reporting on energy-based devices in the treatment of iron-induced hyperpigmentation were included.
A total of seven articles and 54 total patients were included in this review. All patients, including the patient treated at our institution, were female, with an average age of 44 years. Hyperpigmentation was most commonly associated with intravenous iron infusion (48/54, 89%), on the arm or forearm (44/54, 81%), and used for the treatment of underlying iron deficiency anemia (54/54, 100%). The application of six different nanosecond or picosecond quality-switched laser systems was reported in the treatment of cutaneous siderosis, with wavelengths ranging from 532 to 1064 nm. Spot sizes varied between 2 and 7 mm, with energy fluences spanning 0.5-40 J/cm depending on both the device and spot size. Outcomes were measured after an average of 5.4 laser treatments and 10.4 months, with over half of all reported patients experiencing complete clearance (27/50, 54%). Our patient received treatment in three test areas with picosecond alexandrite 785 nm, nanosecond Nd:YAG 532 nm, and picosecond Nd:YAG 532 nm devices. The nanosecond Nd:YAG 532 nm treated area demonstrated the greatest improvement, and the entire arm was subsequently treated with this device.
Despite the often intractable nature of iatrogenic cutaneous siderosis, laser surgery is a reasonable and safe treatment modality for patients seeking cosmetic improvement of this dyschromia. Dermatologists should be aware of this entity and the efficacy of the energy-based devices currently in our armamentarium. A combination approach may need to be utilized with different wavelengths and pulsed widths to target iron pigment in both dermal and subcutaneous layers.
医源性皮肤铁色素沉着症是静脉输注铁剂后一种公认的皮肤并发症。该病表现为注射部位附近散在的色素沉着斑。大多数病例不会自行消退，给患者带来严重的美观和心理困扰。我院近期发生的一例医源性皮肤铁色素沉着症病例促使我们对先前报道的基于能量的设备治疗该病的疗效进行系统评价。
在PubMed和Cochrane数据库中检索所有使用以下检索词发表的同行评议文章：“铁或血红素或血色素沉着症或铁色素沉着症”和“色素沉着过度或染色或纹身”。纳入报道基于能量的设备治疗铁诱导色素沉着过度的文章。
本综述共纳入7篇文章和54例患者。所有患者，包括我院治疗的患者，均为女性，平均年龄44岁。色素沉着过度最常与静脉输注铁剂有关（48/54，89%），位于手臂或前臂（44/54，81%），用于治疗潜在的缺铁性贫血（54/54，100%）。据报道，应用6种不同的纳秒或皮秒调Q激光系统治疗皮肤铁色素沉着症，波长范围为532至1064nm。光斑大小在2至7mm之间变化，能量密度根据设备和光斑大小在0.5-40J/cm之间。平均经过5.4次激光治疗和10.4个月后测量结果，超过一半的报道患者色素沉着完全清除（27/50，54%）。我院患者在三个测试区域分别接受了785nm皮秒翠绿宝石激光、532nm纳秒Nd:YAG激光和532nm皮秒Nd:YAG激光治疗。532nm纳秒Nd:YAG激光治疗区域改善最为明显，随后整个手臂均采用该设备进行治疗。
尽管医源性皮肤铁色素沉着症通常难以治疗，但对于寻求改善这种色素异常的患者来说，激光手术是一种合理且安全的治疗方式。皮肤科医生应了解这种疾病以及我们现有设备中基于能量的设备的疗效。可能需要采用不同波长和脉冲宽度的联合方法来靶向真皮和皮下层中的铁色素。
