Kratom as a novel cause of photodistributed hyperpigmentation

Abstract

A 54-year-old Caucasian man presented with slowly progressive, asymptomatic, hyperpigmented patches that developed on both of his arms over 18 months. On examination, the patient was found to have diffuse hyperpigmented patches on his arms and face in a photodistributed manner, with notable sparing of the knuckles on both hands (see Figs 1 to 4). In the decade preceding his presentation at our clinic, he was on various opiate pain medications for degenerative osteoarthritis. Over the last 4-5 years, to reduce his opioid use, he began weaning himself off of his prescription opiates and replacing them with the plant kratom (Mitragyna speciosa).

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