A Young Man with Generalized Pigmentation

  • Divya Sachdev
  • Piyush Kumar
  • Panchami Debbarman
Part of the Clinical Cases in Dermatology book series (CLIDADE)


A 30 years old, strictly vegetarian male presented with generalized weakness, weight loss, and gradually progressing cutaneous hyperpigmentation. On examination, pigmentation was more pronounced on sunexposed areas, flexural folds, and palmar creases along with mucosal involvement in the form of glossitis and pallor. Laboratory investigations revealed megaloblastic anaemia and low vitamin B12 level, thereby confirming the diagnosis of vitamin B12 deficiency. The treatment consisted of vitamin B12 supplementation. Vitamin B12 deficiency may occur due to malabsorption (due to pernicious anemia or gastric resection) and rarely, due to inadequate intake (almost exclusively in strict vegetarians). Cutaneous manifestations due to vitamin B12 deficiency manifest early and have diagnostic importance, thus allowing timely diagnosis and prevention of late neurological and other systemic complications.


Vitamin B12 Diffuse hyperpigmentation Glossitis Megaloblastic anemia Peripheral neuropathy Subacute combined degeneration of the spinal cord 


  1. 1.
    Hoffbrand AV. Megaloblastic anemias. In: Fauci AS, Braunwald E, Kasper DL, et al., editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw-Hill; 2008. p. 643–51.Google Scholar
  2. 2.
    Bernard M, Babior H, Franklin B. Megaloblastic anemias. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s principles of internal medicine. 16th ed. New York: McGraw-Hill; 2005. p. 601–7.Google Scholar
  3. 3.
    Agrawala RK, Sahoo SK, Choudhury AK, Mohanty BK, Baliarsinha AK. Pigmentation in vitamin B12 deficiency masquerading Addison’s pigmentation: a rare presentation. Indian J Endocrinol Metab. 2013;17(Suppl 1):S254–6.CrossRefGoogle Scholar
  4. 4.
    Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician. 2003;67(5):979–86.PubMedGoogle Scholar
  5. 5.
    Jithendriya M, Kumaran S, IB P. Addisonian pigmentation and vitamin B12 deficiency: a case series and review of the literature. Cutis. 2013;92:94–9.PubMedGoogle Scholar
  6. 6.
    Arora AK, Saini SS, De D, Handa S. Reticulate pigmentation associated with vitamin B12 deficiency. Indian Dermatol Online J. 2016;7(3):215–7.CrossRefGoogle Scholar
  7. 7.
    Wadia RS, Bandishti S, Kharche M. B12 and folate deficiency: incidence and clinical features. Neurol India. 2000;48:302.PubMedGoogle Scholar
  8. 8.
    Pruthi RK, Tefferi A. Pernicious anemia revisited. Mayo Clin Proc. 1994;69:144–50.CrossRefGoogle Scholar
  9. 9.
    Kannan R, Ng MJ. Cutaneous lesions and vitamin B12 deficiency: an often-forgotten link. Can Fam Physician. 2008;54(4):529–32.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Divya Sachdev
    • 1
  • Piyush Kumar
    • 2
  • Panchami Debbarman
    • 3
  1. 1.Consultant DermatologistRaipurIndia
  2. 2.Katihar Medical College and HospitalKatiharIndia
  3. 3.Consultant DermatologistMumbaiIndia

Personalised recommendations