Citation Information :
Deuri A, Mazumder AM, Sarma AK, Kausar N, Chandran JJ. Rare Mucocutaneous (Dermatological) Manifestations of Vitamin B12 Deficiency: A Case Series. Bengal Physician Journal 2023; 10 (2):59-68.
Vitamin B12 deficiency is widespread in developing countries, especially in Africa, India, South and Central America. It affects 1–2% of the general population and 10–15% of older adults and hospitalized patients. The evaluation includes a detailed history of associated conditions and symptoms; an examination for gastrointestinal, dermatological, neurological, and other findings, and laboratory testing, including complete blood count (CBC) and vitamin B12 and folate levels. The prevalence of vitamin B12 deficiency is higher in vegans. Less commonly mucocutaneous presentations usually Addisonian-like hyperpigmentation over knuckles palms, and soles, diffuse/symmetric or a few scattered macules can occur. The hypothesis regarding pathophysiology behind these includes the decrease in the reduced form of glutathione increasing the activity of tyrosinase; second defective melanin transfer between melanocytes and keratinocytes and finally disturbed melanin distribution due to megaloblastic changes in keratinocytes.
Here we present a case series of eleven patients ages varying from 22 years to 71 years, who presented with a history of multiple blood transfusions with rare findings of mucocutaneous hyperpigmentation, very prominent in the hard and soft palate, tongue, buccal mucosa and accentuated hyperpigmentation in upper limb and lower limb, all over face. Few cases also presented with whole-body pigmentation. They all presented high mean corpuscular volume (MCV) (>120) with severe anemia with hypersegmented neutrophils, normal cortisol, and very low serum vitamin B12. All related investigations were done. They have previously tried treatment with oral vitamin B12 supplements, but they didn't respond. Now they were treated with intramuscular vitamin B12 and all patients started to respond with clinical and lab oratorical values. There were also improvements in hyperpigmentation also.
Amada, Kazuhiro. Chapter 9 - Cobalt: Its Role in Health and Disease. In: Astrid Sigel, Helmut Sigel, Roland KO Sigel (Eds). Interrelations between Essential Metal Ions and Human Diseases. Met Ions Life Sci 2013;13:295–320. DOI: 10.1007/978-94- 007-7500-8_9.
Bail HW, Russell RM. “Vitamin B12 deficiency in the elderly”. Annual Review of Nutrition 1999;19:357–377. DOI: https://doi.org/10.1146/annurev.nutr.19.1.357.
Kannan R, Ng MJM. Cutaneous lesions and vitamin B12 deficiency: An often-forgotten link. Can Fam Physician 2008;54(4):529–532. PMID: 18413300.
Baker SJ, Ignatius M, Johnson S, et al. Hyperpigmentation of skin. A sign of vitamin-B12 deficiency. Br Med J 1963;1(5347):1713–1715. DOI: 10.1136/bmj.1.5347.1713.
Cherqaoui R, Husain M, Madduri S, et al. A reversible cause of skin hyperpigmentation and postural hypotension. Case Rep Hematol 2013;2013:680459. DOI: 10.1155/2013/680459.
Sen K, Sinhamahapatra P, Lalhmachhuana J, et al. A study of clinical profile of vitamin B 12 deficiency with special reference to dermatologic manifestations in a tertiary care hospital in sub- Himalayan Bengal. Indian J Dermatol 2015;60(4):419. DOI: 10.4103/0019-5154.160506.
Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr 2009;89:693S-696S. DOI: 10.3945/ajcn.2008.26947A.
Antony AC. Vegetarianism and vitamin B-12 (cobalamin) deficiency. Am J Clin Nutr 2003;78(1):3–6. DOI: 10.1093/ajcn/78.1.3.
Antony AC. Prevalence of cobalamin (vitamin B12) and folate deficiency in India audi altera partem. Am J Clin Nutr 2001;74(2): 157–159. DOI: 10.1093/ajcn/74.2.157.
Jithendriya M, Kumaran S, P IB. Addisonian pigmentation and vitamin B12 deficiency: A case series and review of the literature. Cutis 2013;92(2):94–99. PMID: 24087784.
Aaron S, Kumar S, Vijayan J, et al. Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency–related neurological syndromes. Neurol India 2005;53(1):55–58. DOI: 10.4103/0028-3886.15057.
Hasan SH, Samad R, Das JC, et al. Hyperpigmentation with vitamin B12 deficiency in an adolescent girl. J Bangladesh Coll Phys Surg 2021;39(1):62–67. DOI: 10.3329/jbcps.v39i1.50461.
Rzepka Z, Respondek M, Rok J, et al. Vitamin B12 deficiency induces imbalance in melanocytes homeostasis – A cellular basis of hypocobalaminemia pigmentary manifestations. Int J Mol Sci 2018; 19(9):2845. DOI: 10.3390/ijms19092845.
Jangda A, Voloshyna D, Ramesh K, et al. Hyperpigmentation as a primary symptom of vitamin B12 deficiency: A case report. Cureus 2022;14(9):e29008. DOI: 10.7759/cureus.29008.
Aroni K, Anagnostopoulou K, Tsagroni E, et al. Skin hyperpigmentation and increased angiogenesis is secondary to vitamin B12 deficiency in a young vegetarian woman. Acta Derm Venereol 2008;88(2):191–192. DOI: 10.2340/00015555-0377.