{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:54:53Z","timestamp":1791284093673,"version":"4.1.0"},"reference-count":13,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T00:00:00Z","timestamp":1570665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T00:00:00Z","timestamp":1570665600000},"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":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\u2018Braun\u2019 is an illegal injectable dihydrocodeinone\u2010enriched drug mixture of semi\u2010synthetic opioids. It is prepared by palladium\u2010catalysed hydrogenation from codeine\u2010containing tablets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to characterize the dermatologic consequences of long\u2010term abuse of \u2018Braun\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Skin biopsies of two long\u2010term \u2018Braun\u2019 abusers were evaluated histopathologically, immunohistochemically and ultrastructurally. Palladium skin content was assessed by X\u2010ray fluorescence (XRF) spectrometry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both patients showed generalized diffuse dark blue\u2013grey hyperpigmentation of the skin. In both, an abnormal population of cells containing intracytoplasmic brownish granular material was identified in the papillary dermis by light microscopy. Electron microscopy revealed a dense and minimally structured material that predominantly accumulated in macrophages, fibroblasts and vascular endothelial cells.\n                      <jats:styled-content style=\"fixed-case\">XRF<\/jats:styled-content>\n                      analysis confirmed elevated levels of palladium in the patient's skin in comparison to healthy controls.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Long\u2010term abuse of palladium\u2010contaminated dihydrocodeinone (\u2018Braun\u2019) results in excessive accumulation of granular material in various dermal cell types and causes generalized diffuse skin hyperpigmentation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdv.15930","type":"journal-article","created":{"date-parts":[[2019,9,8]],"date-time":"2019-09-08T09:35:02Z","timestamp":1567935302000},"page":"188-191","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Palladium causes bizarre skin hyperpigmentation in long\u2010term dihydrocodeinone \u2018Braun\u2019 abusers"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7919-9619","authenticated-orcid":false,"given":"M.","family":"Arenbergerova","sequence":"first","affiliation":[{"name":"Department of Dermatovenereology Third Faculty of Medicine Charles University, and University Hospital Kralovske Vinohrady Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Arenberger","sequence":"additional","affiliation":[{"name":"Department of Dermatovenereology Third Faculty of Medicine Charles University, and University Hospital Kralovske Vinohrady Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Gkalpakiotis","sequence":"additional","affiliation":[{"name":"Department of Dermatovenereology Third Faculty of Medicine Charles University, and University Hospital Kralovske Vinohrady Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Sticova","sequence":"additional","affiliation":[{"name":"Department of Pathology Third Faculty of Medicine Charles University, and University Hospital Kralovske Vinohrady Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Hulkova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine Research Unit for Rare Diseases First Faculty of Medicine General University Hospital Prague Czech Republic"},{"name":"Institute of Pathology First Faculty of Medicine General University Hospital Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Trhlikova","sequence":"additional","affiliation":[{"name":"Institute of Macromolecular Chemistry Academy of Sciences of the Czech Republic Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Sikora","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine Research Unit for Rare Diseases First Faculty of Medicine General University Hospital Prague Czech Republic"},{"name":"Institute of Pathology First Faculty of Medicine General University Hospital Prague Czech 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