Epidermal Changes in Vitamin B12 Deficiency

Gilliam, James N.

doi:10.1001/archderm.1973.01620170043012

Cited by 47 publications

(11 citation statements)

References 40 publications

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“…Histological findings from hyperpigmented skin in patients with pernicious anaemia vary. Some authors report an increased number of melanophages/melanin in the dermis as in our case (Figs 2c,d), 2,3,5 whereas others note an increased number of melanocytes 4 . The rapid resolution of pigmentation with B12, the macular character, back involvement, the follicular accentuation in the axillae, and the finding of melanophages in the dermis on histology did not support a diagnosis in our patient of acanthosis nigricans, where there is normally little increase in melanin.…”

contrasting

confidence: 62%

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Pigmentary changes in pernicious anaemia: an important but under-recognized phenomenon

Sherley-Dale¹,

Goulding²,

Leithead

et al. 2011

Clinical and Experimental Dermatology

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contrasting

confidence: 62%

“…Dermatological conditions such as vitiligo and poliosis are associated with pernicious anaemia. Skin hyperpigmentation is very infrequently encountered; it was recorded first in 1908 1 and rarely reported since 2–5 . Our patient’s skin hyperpigmentation was noted a year before referral, and others have noted a similar prodrome 2,4,5 .…”

supporting

confidence: 56%

Pigmentary changes in pernicious anaemia: an important but under-recognized phenomenon

Sherley-Dale¹,

Goulding²,

Leithead

et al. 2011

Clinical and Experimental Dermatology

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“…B12 deficiency leads to a decrease in intracellular glutathione levels, which normally inhibit tyrosinase activity, thus increasing melanogenesis. 5 Alternatively, B12-mediated interruptions in melanin transfer between melanocytes and keratinocytes result in pigment incontinence and atypical pigmentation patterns, typically involving buccal and palmar creases. 6 Diffuse skin hyperpigmentation has been seen in patients with B12 deficiencies, though rarely reported.…”

Section: Discussionmentioning

confidence: 99%

Reversible acral and mucosal hyperpigmentation in a patient with B12 deficiency secondary to polyglandular autoimmune syndrome type II

Asokan

Wheatley

Lullo

et al. 2020

SAGE Open Medical Case Reports

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Reversible cutaneous hyperpigmentation often occurs in the setting of nutritional deficiencies and protein energy malnourishment, with atypical presentations arising from autoimmune disease. Here, we present a 52-year-old female with hypertension, type 1 diabetes, and Hashimoto’s thyroiditis, under the diagnosis of polyglandular autoimmune syndrome type II, referred for evaluation of asymptomatic hyperpigmentation of the palms, soles, hard palate, and tongue for 6 months. The patient underwent a significant work-up, including esophagogastroduodenoscopy, which revealed hypertrophic gastropathy as well as evidence of acquired B12 deficiency secondary to pernicious anemia. The patient was initiated on B12 supplementation, with eventual resolution of mucocutaneous findings.

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“…There are an increased number of melanocytes in the basal layer with numerous melanophores in the papillary dermis and increased melanin in the dermis and epidermis. 11 Reversible premature greying of hairs is usually associated with cutaneous hyperpigmentation. 12 Generalized acquired cutaneous hyperpigmentation is a challenging problem.…”

Section: Pathophysiology Of Hyperpigmentationmentioning

confidence: 99%

A case report on hyperpigmentation in vitamin B12 deficiency

Verma

Vijayavarman

2019

Int J Res Med Sci

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Cobalamin (Vitamin B12) is a water-soluble vitamin. Cobalamin is synthesized only by microorganisms. The only source of vitamin B12 for humans is food of animal origin. Hyperpigmentation of skin has been reported only rarely as the presenting manifestation of vitamin B12 deficiency. We report a patient who had hyperpigmentation as her presenting medical complaint and in whom Vitamin B12 deficiency was the cause. A 36-year-old female presented with generalised weakness and progressive and asymptomatic hyperpigmentation of hand and feet for 5 months. She is vegetarian by diet. On examination, hyperpigmentation was present over dorsal aspect of metacarpophalangeal, proximal and distal interphalangeal joints. Hyperpigmentation were present over dorsum of the foot and over the joints. The tongue was depaillated, and hyperpigmentation was present. Her serum level of vitamin B12 was diminished (83pg/ml). Megaloblastic anemia presents with protean manifestations. The association between vitamin B12 deficiency and hyperpigmentation, although unusual, has been described. Cutaneous manifestations associated with B12 deficiency include characteristic mucocutaneous hyperpigmentation (most common), vitiligo, angular cheilitis, and hair-nail changes. It mainly affects knuckle pads and oral mucosa. It is an under-recognized sign of megaloblastic anemia and should always be looked for in the setting of pallor. Hyperpigmentation could be the earliest manifestation of vitamin B12 deficiency before anemia sets in. It is worthwhile to consider the possibility of vitamin B12 or folate deficiency in a patient with unexplained pigmentary changes. Early detection and adequate treatment will prevent anemia and various neurological manifestations.

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Epidermal Changes in Vitamin B12 Deficiency

Cited by 47 publications

References 40 publications

Pigmentary changes in pernicious anaemia: an important but under-recognized phenomenon

Pigmentary changes in pernicious anaemia: an important but under-recognized phenomenon

Reversible acral and mucosal hyperpigmentation in a patient with B12 deficiency secondary to polyglandular autoimmune syndrome type II

A case report on hyperpigmentation in vitamin B12 deficiency

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