{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:53:30Z","timestamp":1788317610212,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Cutan Pathol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Drug\u2010induced hyperpigmentation accounts for 10%\u201320% of acquired pigmentary disorders and can be misdiagnosed for other causes such as melasma, post inflammatory changes, or heavy metal deposition. Kratom (\n                      <jats:italic>Mitragyna speciosa<\/jats:italic>\n                      ), a Southeast Asian plant with an opioid\u2010like profile, has been increasingly used in the United States for several conditions such as pain, mood disorders, and opioid withdrawal. While neuropsychiatric and liver toxicity adverse effects are documented, hyperpigmentation, and skin changes remain poorly recognized.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We describe a 38\u2010year\u2010old female with a history of Hashimoto's thyroiditis and seizure disorder who developed a progressive blue\u2010gray hyperpigmentation over 3\u2009years. The hyperpigmentation was initially confined to the nose and subsequently spread to the face, neck, chest, upper back, and arms. It was initially diagnosed and treated as melasma without improvement. Skin biopsies revealed basal layer hyperpigmentation and dermal melanophages. Fontana\u2010Masson staining demonstrated an admixture of black melanin granules and distinct red\u2010brown intracytoplasmic pigment, consistent with Kratom\u2010associated drug deposition. These findings were consistent with drug\u2010induced hyperpigmentation. A comprehensive medication review history excluded commonly implicated drugs. Upon further questioning, the patient disclosed prior use of kratom tea for approximately 18\u2009months, which was discontinued around the time of the clinical presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the importance of thorough exposure history, including herbal supplements, in the workup of atypical hyperpigmentation and highlights novel histopathological features of Kratom\u2010associated hyperpigmentation that expand the current understanding of drug\u2010induced cutaneous changes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cup.70055","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T23:31:04Z","timestamp":1767915064000},"page":"887-892","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Novel Histopathologic Features of Diffuse Blue\u2010Gray Hyperpigmentation Associated With Kratom Use: A Case Report and Literature Review"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1766-2943","authenticated-orcid":false,"given":"Rita","family":"Kamoua","sequence":"first","affiliation":[{"name":"Wright State University Boonshoft School of Medicine  Fairborn Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5531-5743","authenticated-orcid":false,"given":"Kristen","family":"Paradine","sequence":"additional","affiliation":[{"name":"Wright State University Boonshoft School of Medicine  Fairborn Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4268-4311","authenticated-orcid":false,"given":"Craig A.","family":"Rohan","sequence":"additional","affiliation":[{"name":"Wright State University Boonshoft School of Medicine  Fairborn Ohio USA"},{"name":"Department of Dermatology Wright State University Boonshoft School of Medicine  Fairborn Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"McDaniel","sequence":"additional","affiliation":[{"name":"Dermatopathology Laboratory, Forefront Dermatology  De Pere Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Perkins","sequence":"additional","affiliation":[{"name":"Dermatopathology Laboratory, Forefront Dermatology  De Pere Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.2165\/00128071\u2010200102040\u201000006"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2019.04.180212"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40429\u2010023\u201000476\u20105"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1403140"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropharm.2017.08.026"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/11782218221095873"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.53401"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2022.07.033"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.16650"},{"issue":"1","key":"e_1_2_11_11_1","first-page":"1","article-title":"Photodistributed Hyperpigmentation in a Chronic Kratom User","volume":"2","author":"Suleman S.","year":"2023","journal-title":"International Clinical Medicine Case Reports Journal"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.64550\/joid.s60n3136"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.12788\/cutis.1100"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.79804"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2025.02.017"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/jdpa.0000000000000056"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.70019"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40257\u2010018\u20100393\u20102"},{"issue":"3","key":"e_1_2_11_19_1","first-page":"21","article-title":"A Study of Kratom Eaters in Thailand","volume":"27","author":"Suwanlert S.","year":"1975","journal-title":"Bulletin on 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