{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:28:54Z","timestamp":1788276534641,"version":"build-2803163510"},"reference-count":14,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"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:p>\n                    Kratom (\n                    <jats:italic>Mitragyna speciosa<\/jats:italic>\n                    ) is a plant\u2010derived supplement increasingly used in the United States for chronic pain and mood elevation due to its opioid\u2010like 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\u2010year\u2010old Soldier taking kratom for lower back pain presented with asymptomatic blue\u2010gray pigmentation involving his face, neck, and dorsal hands. Biopsy revealed pigment\u2010laden 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\u2010like. Scanning electron microscopy with energy\u2010dispersive X\u2010ray analysis (SEM\u2010EDXA) demonstrated sulfur\u2010containing material, consistent with phaeomelanin and\/or a drug metabolite melanin\u2010like complex. This case expands the clinicopathologic understanding of kratom\u2010associated dermatoses and illustrates the utility of SEM\u2010EDXA in identifying exogenous or drug\u2010induced pigmentation.\n                  <\/jats:p>","DOI":"10.1111\/cup.70126","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T09:05:37Z","timestamp":1778490337000},"page":"925-929","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Photodistributed Hyperpigmentation in a Chronic Kratom User: Histologic and Elemental Characterization"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4868-5609","authenticated-orcid":false,"given":"Aubrey Nicole","family":"Montebello","sequence":"first","affiliation":[{"name":"SAUSHEC Wilford Hall Ambulatory Surgical Center  Lackland Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6425-2456","authenticated-orcid":false,"given":"Michael R.","family":"Lewin\u2010Smith","sequence":"additional","affiliation":[{"name":"Environmental Laboratory Services, Joint Pathology Center  Silver Spring Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8457-2395","authenticated-orcid":false,"given":"Liesl","family":"Grenier","sequence":"additional","affiliation":[{"name":"Walter Reed National Military Medical Center  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5358-5557","authenticated-orcid":false,"given":"Stacy L.","family":"Strausborger","sequence":"additional","affiliation":[{"name":"Environmental Microscopy Laboratory, Environmental Laboratory Services Joint Pathology Center  Silver Spring Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5063-0476","authenticated-orcid":false,"given":"Michael","family":"Royer","sequence":"additional","affiliation":[{"name":"Dermatopathology The Joint Pathology Center  Silver Spring Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/968786"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2022.07.033"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.79804"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.64550\/joid.s60n3136"},{"issue":"15","key":"e_1_2_8_6_1","first-page":"1","article-title":"Photodistributed Hyperpigmentation in a Chronic Kratom User","volume":"2","author":"Suleman S.","year":"2023","journal-title":"International Clinical and Medical Case 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