Case of the Month

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Dermatologic condition involving peri-anal region

A 39-year-old woman presents for the treatment of “increasing darkness on her backside.”

Peri-anal dyschromia secondary to coffee bean pigment

A 39-year-old woman came into the office complaining of increasing peri-anal darkening over the past several years. She said the darkening had increased to the point where she was becoming self-conscious during intimate situations. She was at the clinic to determine the cause and discuss potential anal bleaching. The darkness can be seen in the photograph (along with the site where the biopsy was performed at about 10:00).

I asked the patient if she had any idea what was causing the discoloration. After a brief period of silence, she told me “There is one thing, but I don’t want to talk about it.” I told her I wanted to help her, but it was difficult without more information. She then told me “I have been giving myself a coffee enema, every day, for the past 6 years.” Not being familiar with this practice I asked her why she did that. She looked at me with a combination of disdain and confusion and said: “To avoid brain fog, of course.” I was completely unfamiliar with "coffee enemas" and decided to investigate and searched “coffee enema” on Amazon and to my surprise, over 700 products, including full coffee enema KITS, appeared! I then googled the term “coffee enema,” and over 1 million pages came up!

Here is an excerpt from one of the webpages on the topic:

A coffee enema is a type of colon cleanse used in alternative medicine. During the procedure, a mixture of brewed, caffeinated coffee and water is inserted into the colon through the rectum. Coffee enemas may have originated from German physicians searching for a cancer treatment in the early 1900s.

In her case, I was unsure if the discoloration was some type of post-inflammatory hyperpigmentation or a different process. A biopsy was performed and, above, is a series of 3 photomicrographs from that biopsy, with dermatopathologic commentary from Erick Jacobsen, MD:

“The histopathology demonstrated dyschromia both in the epidermis and the dermis. The stratum corneum showed staining with exogenous pigment, and in the superficial dermis there were prominent pigmented melanophages. The findings were consistent with on-going staining of the tissue with superimposed post-inflammatory pigmentary alteration.”

Anyway, at follow-up, I discussed with her the biopsy results and that the darkening, indeed, was consistent with microscopic coffee bean particles/dust in the upper layer of skin. I told her that if she was still concerned with becoming embarrassed in intimate situations, she could offer a verified explanation. If that was not acceptable, she could avoid ‘brain fog” by simply drinking the coffee, instead.

The discoloration should fade over a couple of months, as new skin replaces the stained skin. She kindly said “thank you ” and I have not seen her since.

This was a new situation for me, but because of the demonstrated popularity of "coffee enemas," it might be a situation that other doctors have encountered. If you have not seen this clinically, this case may be beneficial to you if the situation ever presents itself.