Novel Histopathologic Features of Diffuse Blue-Gray Hyperpigmentation Associated With Kratom Use: A Case Report and Literature Review.
Rita Kamoua, Kristen Paradine, Craig A Rohan et al.
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Case in brief
A 38-year-old woman with Hashimoto’s thyroiditis and a seizure disorder developed progressive blue-gray hyperpigmentation, first on the nose and later involving the face, neck, chest, upper back, and arms. It had been treated as melasma without improvement. Biopsy showed basal-layer hyperpigmentation and dermal melanophages; Fontana-Masson staining revealed black melanin granules alongside distinct red-brown intracytoplasmic pigment, supporting drug-associated deposition. Medication review did not identify commonly implicated drugs. Further history revealed kratom tea use for approximately 18 months, discontinued around the time of presentation.
What made this case unusual
The biopsy showed a distinctive admixture of black melanin granules and red-brown intracytoplasmic pigment in association with kratom exposure, adding a histopathologic feature to the description of kratom-associated hyperpigmentation.
Diagnostic / clinical pearl
For atypical or treatment-resistant hyperpigmentation, review exposures comprehensively, including herbal products; biopsy and special stains may help distinguish drug-associated pigment deposition from other causes.