Palladium causes bizarre skin hyperpigmentation in long-term dihydrocodeinone "Braun" abusers.

Author(s) Arenbergerova, M.; Arenberger, P.; Gkalpakiotis, S.; Sticova, E.; Hulkova, H.; Trhlikova, O.; Sikora, J.
Journal J Eur Acad Dermatol Venereol
Date Published 2019 Sep 08

BACKGROUND: "Braun" is an illegal injectable dihydrocodeinone-enriched drug mixture of semi-synthetic opioids. It is prepared by palladium catalysed hydrogenation from codeine containing tablets.

OBJECTIVE: We aimed to characterize the dermatologic consequences of long-term abuse of "Braun".

METHODS: Skin biopsies of two long-term "Braun" abusers were evaluated histopathologically, immunohistochemically, and ultrastructurally. Palladium skin content was assessed by X-ray fluorescence spectrometry.

RESULTS: Both patients showed generalized diffuse dark blue-gray 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. XRF analysis confirmed elevated levels of palladium in the patient's skin in comparison to healthy controls.

CONCLUSION: Long-term abuse of palladium-contaminated dihydrocodeinone ("Braun") results in excessive accumulation of granular material in various dermal cell types and causes generalized diffuse skin hyperpigmentation. This article is protected by copyright. All rights reserved.

DOI 10.1111/jdv.15930
ISSN 1468-3083
Citation Arenbergerova M, Arenberger P, Gkalpakiotis S, Sticova E, Hulkova H, Trhlikova O, et al. Palladium causes bizarre skin hyperpigmentation in long-term dihydrocodeinone "Braun" abusers. J Eur Acad Dermatol Venereol. 2019.