Top 5 Iron Infusion Side Effects & How To Prevent Them

Top 5 Iron Infusion Side Effects & How To Prevent Them

By Dr Davin Lim, Procedural Dermatologist, Brisbane & Sydney

Top 5 Iron Infusion Side Effects & How To Prevent Them

Top 5 Iron Infusion Side Effects & How To Prevent Them

Iron infusions are the trending IV vitamin & mineral supplement. Over the past 5 years there has been exponential growth of over 450% with iron IV infusions. 

This write up will be focused on common side effects & how to solve them.

  1. Most severe side effect is iron infusion staining. Dermatologists are frequently consulted to provide laser iron stain removal. This article will concentrate on this side effect.
  2. Flushing, itch, & skin irritation can be seen in acute reactions. Often self limiting.
  3. Fishbane reaction: most commonly seen as chest discomfort, it is often self limiting. 
  4. Sore joints, sore muscles, self limiting.
  5. Metallic taste. Self limiting.

* Serious adverse reactions are seen in 3.8 cases per million infusions, however iron staining is seen in upto 1.6% of cases. This makes iron infusion stains the most common side effect of IV supplementation. 


How do we treat iron infusion stains?

Dermatologists are often called upon to treat iron infusion stains with lasers. Our dermatologists at Cutis Dermatology, Brisbane, have been involved in removing iron stains for over 15 years. We use the most technologically advanced pico lasers to help speed up resolution.

What are the factors for better outcomes when treating iron infusion stains?


  • Smaller area of staining: small areas do better than larger areas.
  • Lighter staining; as lasers need to work less.
  • Lighter skin type; lighter skin types are easier to treat because iron pigment is non-competitive.
  • Elbow joint effusion stains are easier to manage compared to wrist 
  • Superficial leakage of IV iron compared to deep leakage in the fat.


What factors are associated with a slower response to treatment?

  • Large area of staining.
  • Dense iron residue
  • Darker skin type.
  • More distal staining (wrist)
  • Iron deposits in the fat layer of skin.


What types of lasers can be used to treat iron infusion stains?


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. The last laser is used to drill 1.6 mm into the skin to cause epidermal extrusion of pigment via fractional methods. 


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


Why do we use picosecond lasers for iron staining?

Using special lasers we can maximize treatment outcomes & minimize side effects. Pico lasers such as Picoway & Picosure Pro use high energy lasers in a very short time frame. These lasers favor the photoacoustic balance over the photothermal. This reduces heat, in turn reducing the side effects of lasers.


How many laser sessions will it take to remove iron staining?

4 to 9 sessions are the average. It can take up to 9+ months for optimal results. The number of sessions can be roughly gauged with the predictable factors listed above. 

It follows a similar algorithm as tattoo pigment removal, namely the amount of iron present & most importantly, your immune system.  


Who pays for laser treatments?


Your cost for removal of the iron infusion stain can be determined with each of the following methods.

  1. You can send photographs (attention photo to Liz Bartley), she will consult our clinicians for a quote, & if required liaise with the iron infusion clinic, usually a hospital, day surgery or GP practice. 
  2. A real time consultation with our clinical team. Our dermatologist can write a letter of intent to your provider. 
  3. Provider to provider consultation– probably the best & fastest way to get your laser treatments underway. Ask the clinic who performed the iron infusion to contact our specialists at Cutis Dermatology. This will save you time & the consultation fee. 


How do I get started with treatment?


You don’t need to see a consultant dermatologist for assessment, as it is straightforward. You can either book an appointment with our senior nurses, send photos, or (if you really want to), book a consultation with a dermatologist. 


Are there any natural remedies to fade iron stains?

No. Creams & tablets won’t accelerate clearance as iron is in the deeper areas of skin. 

Arnica cream can accelerate bruising marks, but has not been proven to be effective for iron staining due to infusions.


How to prevent iron staining from infusions?

  1. Choose a more proximal site, namely the elbow joint not the wrists joint for infusion entry.
  2. Secure the IV line with tape AND an arm board.
  3. Test flush with saline to ensure the IV is in the vein & not in the surrounding tissue.
  4. Slowly infuse the IRON. Typically 2-4 hours. This reduces the chances of spillage.
  5. Frequent checks of the infusion site, usually every 10-30 minutes.
  6. Limiting the role of iron infusions to those who really need it. Iron infusion is a medical therapy, & not a ‘natural’ mineral infusion fad.


How to tell the difference between a bruise & an iron infusion stain?

Bruising is more common (about 25+% of IV cases), whilst iron infusion stains are less common; namly 1.6% of infusion. Bruises are purple & extend faster than iron stains, most importantly, bruises fade within a week or two, whilst iron infusion stains may either get darker or stay the same.


Are pico laser treatments painful?

A wee bit of discomfort is normal, however pico lasers cause less pain than nano lasers. We use a Zimmer cooler to ensure comfort levels. We also use numbing cream if required. 


How do we find out the level of iron staining in the skin?

In some cases we perform a tiny biopsy. This can sometimes be helpful in predicting the number of treatments required to remove the stain. Iron staining in the fat area is harder to remove, as it is out of reach, even using the most powerful pico lasers. 


Can I DIY iron stain removal?

You can, but it is less effective. If you are super keen, use microneedling in a vertical delivery- namely stamper not a roller. You do need to get to the dermal layer, hence it requires bleeding as the end point. In this setting, it hurts.

You can attempt microneedling every 3-5 weeks, aiming for 12 plus sessions. Risks of microneedling iron infusion stains include-

  • Bleeding
  • Scarring
  • Infection 

Why did iron staining occur?

The tube that feeds the infusion has dislodged from the vein, leading to spillage of iron to the surrounding tissue. The most common reasons include-

  1. Failure to secure the tube (tape, arm board)
  2. Failure of security tape (flexing or bending the arm)
  3. Too high infusion rate.
  4. Failure to respond quickly to the spillage of IV iron to the surrounding tissue.


What’s the summary of how dermatologists treat iron infusion stains?

Lasers provide the best option. Picosecond laser over older nano second tech. Stains around the elbow are easier to treat compared to the wrist joint. 

The number of sessions will vary depending on the area, & density of iron staining. 

Most often the hospital or clinic will pay for laser treatments, usually under insurance. To get started you can ask the clinic to send us a photo & request for a quote. 


Can I be allergic to iron infusions?

Yes, however this is very rarely seen nowadays as the formulation has changed. Anaphylaxis has been seen with iron-dextran infusions. Having resuscitation facilities is mandatory.

Other reported side effects include urticaria, rashes, flushing, & itch. Slowing down the infusion rate can reduce these unwanted effects.

Metallic taste and sore joints are common, however they are self limiting.

Fishbane reaction is a self limiting reaction consisting of chest pain & discomfort.

This is infrequently seen, however it must be differentiated from other causes of chest pain. Methods to reduce Fishbane reactions is to reduce the flow of iron. Most specialists will stop the treatment, then re-introduce infusion at a later time, usually a few minutes later. In most cases, restarting the infusion is uneventful. 


How would I prepare for an iron infusion? 

You can take all of your medications for the day. No fasting is required. Patients will be able to drive home following the infusion. In the super rare event of an unexpected reaction, you may be required to be observed a little bit longer. 


How long after my iron infusion will I start to feel better?

It can take up to 14 days before you start to notice a difference and feel better. Maximal improvement may take 6-12 weeks following the infusion.


Which is better: Iron infusion vs. iron injection?

Infusions deliver a dose of iron through the vein with an IV drip. Injections involve injecting iron into a muscle, usually the buttock. Infusions may take up to 4 hours,  injections deliver a whole dose immediately. 

Infusions tend to be less painful compared to injections. Injections can also cause intramuscular bleeding and orange discoloration. Because of these possible complications, doctors often favor iron infusions over iron injections as treatment for iron deficiency anemia.


How long does an iron infusion take?

2 to 4 hours. In some cases, the infusion may take a little longer, depending on the amount of iron your clinician thinks you need. A slow infusion rate reduces complications & mishaps, including iron staining. 

It may take several infusions to bring the body’s iron stores up. 


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