Epidermal changes in vitamin B 12 deficiency

Gilliam, J. N.

doi:10.1001/archderm.107.2.231

Cited by 8 publications

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“…Unlike previously reported cases [10, 11], there were no malabsorption syndromes, nor was there malnutrition or any other gastrointestinal causes. The patient revealed a 2-year history of N 2 O abuse upon further evaluation.…”

Section: Discussioncontrasting

confidence: 80%

“…Hyperpigmentation of the skin with megaloblastic anemia associated with vitamin B12 deficiency was first observed by Cook in 1944 [9, 10, 11]. Pigmentation due to vitamin B12 deficiency can occur at any location on the body, but it occurs most commonly on the hands and feet, particularly in the interphalangeal joints, and sometimes in the fingernails and toenails.…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis of hyperpigmentation of the skin associated with vitamin B12 deficiency remains unclear. Gilliam and Cox [11] postulated that vitamin B12 deficiency leads to lower intracellular levels of reduced-type glutathione, which has a tyrosinase-inhibiting effect, and that once this effect declines, the epidermal melanocytes are stimulated to produce melanin. Moreover, the decreased reduced-type glutathione concentration retards mitosis and reduces DNA synthesis, causing dermal atrophy and hyperpigmentation.…”

Section: Discussionmentioning

confidence: 99%

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Recreational Nitrous Oxide Abuse-Induced Vitamin B12 Deficiency in a Patient Presenting with Hyperpigmentation of the Skin

Chiang¹,

Hung

Wang

et al. 2013

Case Rep Dermatol

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Vitamin B12 deficiency causes skin hyperpigmentation, subacute combined degeneration of the spinal cord, and megaloblastic anemia. Although vitamin B12 deficiency rarely occurs in well-nourished, healthy, young people, nitrous oxide (N₂O) intoxication is an important cause of vitamin B12 deficiency in this cohort. N₂O, a colorless gas used as an anesthetic since the late 19th century because of its euphoric and analgesic qualities, is now used as a recreational drug and is available via the Internet and at clubs. Here, we describe the case of a 29-year-old woman presenting with skin hyperpigmentation as her only initial symptom after N₂O abuse for approximately 2 years. N₂O intoxication-induced vitamin B12 deficiency was diagnosed based on the skin pigmentation that had manifested over the dorsa of her fingers, toes, and trunk, coupled with myeloneuropathy of the posterior and lateral columns, a low serum vitamin B12 level, an elevated serum homocysteine level, and the N₂O exposure revealed while establishing the patient's history. Symptoms improved significantly with vitamin B12 treatment. We recommend that dermatologists consider N₂O intoxication-induced vitamin B12 deficiency as a potential cause of skin hyperpigmentation and myeloneuropathy of the posterior and lateral columns in young, otherwise healthy patients. Failure to recognize this presentation may result in inappropriate treatment, thus affecting patients' clinical outcomes.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Recreational Nitrous Oxide Abuse-Induced Vitamin B12 Deficiency in a Patient Presenting with Hyperpigmentation of the Skin

Chiang¹,

Hung

Wang

et al. 2013

Case Rep Dermatol

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“…The epidermal melanocytes are then stimulated to produce melanin as the tyrosinase inhibiting effect of GSH has been diminished. 6 Vitamin B 12 deficiency was first described by Cook and later by Baker et al 7 A serum B 12 above 300 pg/ml is interpreted as normal. Patients with B 12 levels between 200 and 300 pg/ml are considered borderline, and further enzymatic testing may be helpful in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Generalized pigmentation with nutritional deficiency

Naskar¹,

Kharkar²

2019

Int J Res Dermatol

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Vitamin B12 deficiency is one of the most underdiagnosed causes of hyperpigmentation. It is known to cause Addisonian pigmentation. We describe a case where a patient presented with hyperpigmentation on the aesthetically significant areas of the body for which he presented to the clinic. Diagnosis was confirmed on histopathology and serum vitamin B12 levels. The hyperpigmentation reversed significantly on treatment.

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“…Infants with marginal cobalamin status may have neurological symptoms without any hematological abnormalities (Honzik et al 2010;Monsen et al 2003). Brownish black hyperpigmentation affecting dorsal fingers and toes and medial thighs, arms, and axilla have been reported in children with severe cobalamin deficiency (Baker et al 1963;Gilliam and Cox 1973;Sabatino et al 1998;Simsek et al 2004). The hyperpigmentation, mostly reported in darker-pigmented children, usually resolves completely within 2-12 weeks of treatment (Heath and Sidbury 2006).…”

Section: Symptoms Of Cobalamin Deficiency In Infants and Older Childrenmentioning

confidence: 99%

Cobalamin status in children

Bjørke‐Monsen

Ueland

2010

J of Inher Metab Disea

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Cobalamin and the metabolic markers methylmalonic acid and total homocysteine undergo marked changes during childhood. In breastfed infants a metabolic profile indicative of cobalamin deficiency is common. Symptoms of cobalamin deficiency in children differ with age, presenting a continuum from subtle developmental delay to life-threatening clinical conditions. The symptoms may be difficult to detect, particularly in infants, and there tends to be a diagnostic delay of several months in this age group. Several reports show that even moderate deficiency in children may be harmful, and long-term consequences of neurological deterioration may persist after cobalamin deficiency has been treated. Given the crucial role of cobalamin for normal growth and development, possible widespread infantile deficiency needs attention. Cobalamin deficiency should be considered a differential diagnosis in children with subtle symptoms, and strategies to prevent cobalamin deficiency in mothers and children should be addressed.

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Epidermal changes in vitamin B 12 deficiency

Cited by 8 publications

References 0 publications

Recreational Nitrous Oxide Abuse-Induced Vitamin B12 Deficiency in a Patient Presenting with Hyperpigmentation of the Skin

Recreational Nitrous Oxide Abuse-Induced Vitamin B12 Deficiency in a Patient Presenting with Hyperpigmentation of the Skin

Generalized pigmentation with nutritional deficiency

Cobalamin status in children

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