First Documented Case: Kratom Tea Use Linked to Spreading Blue-Gray Skin Pigmentation

Why it matters

This unusual skin disorder was initially misdiagnosed as melasma for years — and clinicians should add kratom to their list of drugs that can cause drug-induced pigmentation, particularly as its use rises and patients often forget to disclose supplement use.

The big picture

Drug-induced hyperpigmentation accounts for 10–20% of acquired pigmentary disorders. While kratom is increasingly used in the U.S. for pain, mood, and opioid withdrawal, its cutaneous side effects have been almost completely overlooked in the medical literature — leaving clinicians unprepared to recognize this presentation.

Key findings

• A 38-year-old woman developed blue-gray skin pigmentation starting on her nose, spreading to face, neck, chest, back, and arms over 3 years
• The condition was initially treated as melasma without improvement
• Skin biopsy showed characteristic drug-induced pigmentation with distinct red-brown intracytoplasmic pigment
• Patient had used kratom tea for approximately 18 months and stopped before the clinical presentation
• A comprehensive medication review excluded all other commonly implicated drugs

What they say

"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-associated hyperpigmentation that expand the current understanding of drug-induced cutaneous changes," the authors wrote.

Bottom line

**Kratom tea can cause persistent blue-gray skin discoloration that mimics melasma — clinicians should ask about kratom use when evaluating any unexplained skin pigmentation disorder.**