Spontaneous Resolution of Extensive Haemosiderin Skin Staining Following Iron Infusion During Pregnancy

Intravenous iron is increasingly used in pregnancy for the treatment of iron deficiency anaemia due to its efficacy and rapid haematologic response. Cutaneous haemosiderin staining secondary to iron extravasation is a rare but distressing complication that is frequently described as persistent or permanent. Although therapeutic interventions have been reported and rare spontaneous cases may exist in the broader dermatologic literature, we found no well-documented reports demonstrating spontaneous improvement or complete resolution without treatment, particularly with long-term follow-up and photographic confirmation. We present the case of a nulliparous woman in her 20s who developed extensive haemosiderin staining of the right upper arm following peripheral intravenous iron polymaltose infusion at 22 weeks of gestation. Discolouration progressed over one month and was associated with intermittent discomfort. Laser therapy was recommended by the dermatology team for cosmetic management; however, the patient elected for expectant management. No therapeutic intervention was undertaken. Gradual fading became apparent approximately nine months after the extravasation event, with complete resolution confirmed at 39 months during assessment in a subsequent pregnancy. Although the interval between these reviews was extended, the patient reported steady improvement without any interim treatment. To our knowledge, this case provides the first clearly documented longitudinal evidence of complete spontaneous resolution of extensive iron staining, supported by long-term photographic follow-up. This conclusion is based on a literature search conducted via PubMed and MEDLINE, which revealed no previously reported cases of spontaneous resolution without intervention. Recognition that natural resolution may occur could support a shift toward expectant first-line management and offer reassurance, particularly for patients who may not have access to expensive dermatologic treatments.