Kratom Use Linked to Recalcitrant Photo-Distributed Skin Hyperpigmentation

Why it matters

Kratom-induced hyperpigmentation is an underrecognized dermatologic side effect that may be mistaken for other skin conditions, requiring clinicians to ask about kratom use when evaluating photo-distributed skin discoloration.

The big picture

As kratom use expands to over 2 million Americans, dermatologists and primary care providers must include kratom in their differential when evaluating unexplained photo-distributed skin changes — the exact mechanism remains unknown and warrants further investigation.

Key findings

• • A 32-year-old male developed recalcitrant gray-to-blue-brown hyperpigmented patches on sun-exposed areas (face, ears, neck) after one year of kratom use
• • Multiple treatments including hydroquinone, kojic acid, niacinamide, and tranexamic acid failed to resolve the hyperpigmentation
• • The case adds to a growing literature of 4+ documented cases with similar presentations
• • Proposed mechanisms include mitragynine stimulating melanocyte activity via mu-opioid receptor agonism or D2 receptor antagonism triggering alpha-melanocyte-stimulating hormone production

What they say

Single case report with literature review of existing kratom hyperpigmentation cases; published in JAAD Case Reports 2025 (University of Missouri and Florida State University).

Bottom line

Kratom can cause photo-distributed skin hyperpigmentation that resists standard treatments; clinicians should ask about kratom use in patients with unexplained skin discoloration.