Work

Photodistributed Hyperpigmentation in a Chronic Kratom User: Histologic and Elemental Characterization

Year: 2026

Type: article

Abstract: Kratom (Mitragyna speciosa) is a plant-derived supplement increasingly used in the United States for chronic pain and mood elevation due to its opioid-like effects. While systemic side effects have been described, cutaneous manifestations have rarely been reported. We report a case of striking photodistributed dyspigmentation in a chronic kratom user, with a detailed description of the histologic and elemental analysis findings. A 37-year-old Soldier taking kratom for lower back pain presented with asymptomatic blue-gray pigmentation involving his face, neck, and dorsal hands. Biopsy revealed pigment-laden macrophages within the superficial dermis, a mild perivascular and periadnexal lymphohistiocytic infiltrate, and a slightly thickened basement membrane. Special stains confirmed the pigmented particles as melanin-like. Scanning electron microscopy with energy-dispersive X-ray analysis (SEM-EDXA) demonstrated sulfur-containing material, consistent with phaeomelanin and/or a drug metabolite melanin-like complex. This case expands the clinicopathologic understanding of kratom-associated dermatoses and illustrates the utility of SEM-EDXA in identifying exogenous or drug-induced pigmentation.

Source: Journal of Cutaneous Pathology

DOI: 10.1111/cup.70126

Authors: Aubrey Nicole Montebello, Michael R. Lewin‐Smith, Liesl Grenier, Stacy L. Strausborger, Michael Royer

Institutions: Wilford Hall Ambulatory Surgical Center, San Antonio Uniformed Services Health Education Consortium, Joint Pathology Center, Walter Reed National Military Medical Center

Language: English

Topic: melanin and skin pigmentation

Subfield: Cell Biology

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: green

OpenAlex ID: W7160875570