Palladium causes bizarre skin hyperpigmentation in long‐term dihydrocodeinone ‘Braun’ abusers

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 S...

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Bibliographic Details
Published in:Journal of the European Academy of Dermatology and Venereology 2020-01, Vol.34 (1), p.188-191
Main Authors: Arenbergerova, M., Arenberger, P., Gkalpakiotis, S., Sticova, E., Hulkova, H., Trhlikova, O., Sikora, J.
Format: Article
Language:English
Subjects:
Female
Humans
Hydrocodone - adverse effects
Hyperpigmentation - chemically induced
Hyperpigmentation - metabolism
Hyperpigmentation - pathology
Illicit Drugs - adverse effects
Male
Middle Aged
Narcotic-Related Disorders - complications
Narcotics - adverse effects
Palladium - adverse effects
Palladium - metabolism
Spectrometry, Fluorescence
Synthetic Drugs - adverse effects
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Summary: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 (XRF) spectrometry. Results Both patients showed generalized diffuse dark blue–grey 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.
ISSN:0926-9959
1468-3083
DOI:10.1111/jdv.15930