Kratom-associated hyperpigmentation in an elderly male: a case report

Kratom, derived from the leaves of Mitragyna speciosa tree, is a psychoactive herbal extract known for its opioid-like effects and stimulant properties. Kratom has long been used in SE Asia for various medical purposes. It has recently become popular in the United States, and despite its promotion as a legal botanical product, regulatory agencies have flagged kratom as a substance of concern regarding its safety and potential adverse effects. Kratom’s pharmacology, involving mitragynine and 7-hydroxymitragynine, contributes to its diverse effects ranging from stimulant to opioid-like responses. This drug is currently available online and at local convenience stores, and its use is increasing. The drug is known to induce skin hyperpigmentation, among other more serious side effects. Here, we present a case report of a 71-year-old male patient with notable sun-exposed hyperpigmentation attributed to chronic kratom use for back pain management. Histopathologic examination confirmed drug-induced hyperpigmentation. While hyperpigmentation associated with kratom use is an emerging concern, it underscores the importance of considering substance-induced pigmentation in the differential diagnosis. Treatment options for drug-induced hyperpigmentation remain limited, emphasizing the significance of prevention through discontinuation of the offending agent and sun protection measures. This case underscores the need for a comprehensive approach to evaluate and manage hyperpigmentation, including a thorough medication history. As Kratom continues to gain popularity, clinicians must remain vigilant for its potential cutaneous manifestations to ensure timely diagnosis and management.