The Enigma of Exogeneous Cutaneous Hemosiderosis

A 24-year-old female, presented with a solitary well-defined grey- brown hyperpigmented patch measuring 5 × 4 cm on the volar aspect of the right forearm for 2 years [Figure 1a]. Dermoscopy revealed diffuse slate-grey pigmentation [Figure 1b]. On further inquiry, she recollected a history of parenteral iron infusion at the same site for iron deficiency anemia 2 years ago, prior to the development of the lesion. Skin biopsy revealed pandermal perieccrine and perineural hemosiderin deposition [Figure 1c], which was highlighted by Perls’ (Prussian blue) stain [Figure 1d]. A diagnosis of iatrogenic cutaneous hemosiderosis was made.Figure 1: (a) Clinical image depicts slate grey to blue green patch on right forearm; (b) dermoscopy depicts diffuse slate grey background with perifollicular accentuation [DermLite DL4, 10×, polarized mode]; (c) histopathology depicts periappendageal brown deposits [H ematoxylin and eosin 400×]; and (d) Perls Prussian blue highlights the hemosiderin deposits [100 ×]Iatrogenic cutaneous siderosis is a well-recognized dermatologic complication of 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 for patients.[1] In a review comprising seven articles, cutaneous hyperpigmentation secondary to intravenous iron infusion was most frequently noted on the arm or forearm and was consistently associated with treatment for iron deficiency anemia. Various quality-switched nanosecond and picosecond laser systems, with wavelengths ranging from 532 to 1064 nm, were employed for managing cutaneous siderosis. Treatment outcomes, assessed after an average of 5.4 sessions over 10.4 months, showed that more than half of the patients (54%) achieved complete pigment clearance.[2] Authors’ contributions We confirm that all authors have read and approved the manuscript for submission. All authors meet authorship criteria, and the manuscript represents honest work. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) The preparation of this manuscript was carried out entirely by the authors without the use of artificial intelligence technologies.