Iron Infusion Stain Removal

Iron staining in darker skin types has the highest rate of side effects. This is due to the natural pigment in the upper layers of skin that competes for the laser energy. The incidence of post inflammatory pigmentation following laser ranges from 10 to 30%. 

You will need to carefully consider pigment removal if you have ethnic skin. The facts are as follows-

• Test patch recommended: cost $490
• Post laser pigment commonly seen. 
• Results are highly variable.
• Removal takes 30 to 70% longer than lighter skin types. 
• Resolution takes 18 to 36 months. 
• Side effects during this process are not uncommon. 

Chemical peels can be effective in treating pigmentation however for infusion stains, the pigment lies in the deeper parts of skin, out of reach by peels & most lasers. Special long wavelength, high powered pigment lasers are employed to treat deep pigment. 

No. IPL will result in a thermal burn of the skin, especially in darker skin types or if too high settings are used. A short pulse duration is required to remove tattoos & iron staining. Nano & pico lasers are employed for this job. 

If you have any of these factors, the speed of removal is slower-

• Distal staining, for example biceps & below. 
• Large areas respond slower
• Staining in darker skin types
• Iron staining that is of low contrast
• Staining that is deep or in the fat layer*

*Iron stains in the deeper layers, including the fat layer, are almost impossible to treat with lasers. Lasers can reach the lower dermal layers, but not the fat layer. For this form of iron staining, you will require time for your immune system to clear pigment naturally.

No ‘natural remedies’ are proven to remove iron staining. Additionally there are no scientific studies to improve clearance rate from your skin’s immune system. 

In theory, microneedling could potentially cause iron to migrate from affected areas. Treatments may trigger an inflammatory response, stimulating cells to move iron staining away, and could facilitate trans-epidermal migration of iron particles from the skin.

If you are still interested in considering microneedling, it is advisable to consult an aesthetician for a test patch. Treatments should be spaced 10-14 weeks apart, and a minimum of 6-8 sessions may be needed as a trial, with potentially 15 to 20 sessions for complete treatment. The needle depth has to penetrate to the level of the iron stain. This ranges from 1.3 mm to 2.5 mm. 

The key difference between silver and iron in terms of skin staining lies in the optical transmission of the particles. For silver ingestion, as seen in argyria, the particles reflect light, causing the skin to appear a dull gray. The level of silver staining is more superficial than that of iron staining, hence treatments are more predictable. 

Unlike iron infusion staining, silver particles can be immediately broken down, resulting in instant clearance. Although these particles are not quickly carried away by the immune system, they are reduced to very small particles with different optical properties. We published the electron microscopy research on this subject in 2018.

The exact mechanism behind this phenomenon isn’t fully understood, but it’s theoretically possible that macrophages or pigment-clearing cells perceive iron as cytotoxic. This might cause the immune system to avoid iron, as the cells don’t want to be damaged.

Repeated laser treatments could alter the biochemical structure of the iron residue, potentially allowing for more effective clearance over time. However, this process is not yet fully understood, unlike the removal of other heavy metals, such as silver, whose optical properties have been thoroughly studied and proven with electron microscopy.

Additionally the level of tattoos are higher up in the skin compared to iron staining. Red & black tattoos have preferential absorption in the main wavelengths, whilst the optimal absorption of iron stains is not within the commercially available wavelengths. To date the 755 & 1064 nm wavelengths have been traditionally used. 

We have 6 types of lasers to remove iron infusion stains. The first 5 involve exploding pigment (iron), with the resultant pigment taken up by your body’s immune system to clear iron particles. These lasers are first line, meaning they provide the best & most predictable results, acknowledging that in some cases, treatments are not successful. 

• Picoway: Picosecond laser by Candela; used in Brisbane
• Picosure Pro: Picosecond laser by Cynosure; used in Sydney
• Spectra Hollywood: Short PD, pigment laser by Lutronic used in Sydney
• Spectra: Longer PD pigment laser by Lutronic, used in Brisbane
• Pastelle: Longer PD laser made in Korea; used in Brisbane
• Erbium Joule Fraction: Drilling laser by Sciton; used in Brisbane.

Both have been reported in the literature. Some studies favor Q switching (older tech), whilst others favor picosecond lasers. We have used both, however prefer pico laser because they –

• Are better tolerated 
• Have less bruising
• Have less side effects
• May have better clearance rates

For Brisbane patients, book an appointment with Alison Webb at Cutis Dermatology. 

For NSW patients, please submit an application as we are taking selected cases. If you can not get into our clinic, Dr Adrian Lim in Sydney may have an appointment. 

Victoria patients, book a consultation at Laser Dermatology in Melbourne.