Kratom: An Emerging Cause of Drug-Induced Hyperpigmentation

Mitragyna speciosa, a tree of the Rubiaceae family native to Southeast Asia, is the plant used in kratom products. Traditional use involves chewing fresh leaves or brewing them into tea, whereas modern products are marketed as loose powders, capsules, tablets, and other formulations. Kratom use has increased in recent years and is an underrecognized cause of hyperpigmentation, which is hypothesized to result from alkaloid-mediated activation of dopamine receptors, leading to melanocyte activation. Recognition of this uncommon adverse effect is increasingly important, as dermatologists should consider kratom use in patients presenting with unexplained photodistributed or drug-induced hyperpigmentation.