Hyperpigmentation in Megaloblastic Anemia

Lee, Seung Hun; Lee, Won Soo; Whang, Keum-Chan; Lee, Sun Ju; Chung, Jae Bock

doi:10.1111/j.1365-4362.1988.tb02407.x

Cited by 22 publications

(17 citation statements)

References 21 publications

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“…There are several causes of a vitamin B 12 deficiency, including fatty stool or malabsorption syndrome in adults, and an insufficiency of vitamin B 12 in maternal milk or malnutrition in infancy. Furthermore, as seen in our case, there have also been three reports of pigmentation due to a vitamin B 12 deficiency caused by postgastrectomy malabsorption 6,7,9 …”

supporting

confidence: 79%

“…There have been several reports regarding pigmentation due to a vitamin B 12 deficiency since Baker's report of 21 Indian cases in 1963. [1][2][3][4][5][6][7][8][9] Three similar cases have also been reported in Japan in the fields of neurology, 7 pediatrics 8 and dermatology. 9 Pigmentation due to a deficiency of vitamin B 12 can occur throughout the body, but it mostly occurs in the hands and feet, particular in the digit joint region, and sometimes in fingernails.…”

mentioning

confidence: 99%

“…Furthermore, as seen in our case, there have also been three reports of pigmentation due to a vitamin B 12 deficiency caused by postgastrectomy malabsorption. 6,7,9 The pathogenesis of pigmentation due to a vitamin B 12 deficiency is still unknown, however, Gillam and Cox hypothesized that a low level of reduced type glutathione, suppressing tyrosinase activity, in vitamin B 12 deficiency may induce a reduction in the melanogenesis of melanocytes in the epidermis. 2 In addition, it is also hypothesized that hydroxyl phenylalanine may also induce melanogenesis in B 12 deficiency.…”

mentioning

confidence: 99%

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Acral pigmentation caused by a vitamin B₁₂ deficiency

Komatsu

Mori

Takahashi

et al. 2008

The Journal of Dermatology

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supporting

confidence: 79%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Acral pigmentation caused by a vitamin B₁₂ deficiency

Komatsu

Mori

Takahashi

et al. 2008

The Journal of Dermatology

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“…427,428 Hemosiderin pigment was present around dermal capillaries and sweat glands in two cases of hyperpigmentation associated with hyperthyroidism. There is an increase in melanin in the lower layers of the epidermis and sometimes a small amount of pigment in the dermis.…”

Section: Histopathologymentioning

confidence: 99%

Disorders of pigmentation

Weedon

2010

Weedon's Skin Pathology

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“…It is observed in patients with megaloblastic, non-pernicious anaemia, mainly in those with dark-coloured skin (1)(2)(3).…”

Section: Sirmentioning

confidence: 99%

Skin Hyperpigmentation and Increased Angiogenesis Secondary to Vitamin B12 Deficiency in a Young Vegetarian Woman

Aroni¹,

Anagnostopoulou²,

Tsagroni³

et al. 2008

Acta Derm Venereol

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Acta Derm Venereol 88191 Letters to the Editor Sir, Reversible skin hyperpigmentation is one of the pigmentary changes associated with vitamin B12 deficiency. It is observed in patients with megaloblastic, non-pernicious anaemia, mainly in those with dark-coloured skin (1-3).We describe here a case of a 21-year-old Greek woman in whom hyperpigmentation (reddish-brown colour) was confined to the lateral surfaces of the legs. Increased angiogenesis was observed histologically in these areas. CASE REPORTA 21-year-old Caucasian female was referred to us because of gradually increasing hyperpigmentation on her legs, observed since she was 4 years old. The hyperpigmentation started from the inner thigh and had extended over the tibia over the past few years. She also reported developing concurrent "finger deformity".Her medical history included primary growth hormone deficiency, for which she had been treated with subcutaneous injections of growth hormone. She had been a vegetarian since she was 3 years old and did not consume any milk products.Physical examination revealed reticulated dark brown with reddish hue hyperpigmentation on both lateral surfaces of her legs (Figs 1a, 2A). Moreover, her fingers were in varying degrees of fixed flexion with impaired extension in all digits (Fig. 2B). The contractures were painless. No nail or tongue abnormalities were observed and neurological examination was normal.Routine investigations were within normal limits, with no changes in chronic B12 deficiency, except a low serum B12 concentration of 100 pg/ml (normal 160-900 pg/ml) and mild macrocytosis. Ht = 37.5%, Hb = 12.5 g/dl, MCV = 96 fl (normal = 78-95 fl), PLT = 250000, PT = 13.5 s, INR = 1, APTT = 35.6 s. Serum folate, Zn, ferritin, TIBC, T3, T4, TSH, DHEA, DHEA-S and ACTH were all within normal limits. The anti-intrinsic factor antibodies, anti-parietal cell antibodies, antimicrosomal thyroid and anti-thyrospherine antibodies, anti-gliadin and anti-tissue transglutaminase antibodies, anti-dsDNA, anti-ENA, RNP, anti-SM, SSA(Ro), SSB(Lo), antiJO1 and Ra-test were negative. Plain film radiological studies of her hands were normal, as was electromyography. The patient refused to undergo upper gastrointestinal endoscopy.Skin punch biopsies 4 mm in diameter were performed on her right crural and tibial areas. Microscopy showed increased numbers of basal cell layer melanocytes, as well as increased melanin granules in the basal layer and supral basal layer (Fontana stain). Multiple clusters of vessels CD34-positive (Fig. 3a,b) with a few lymphocytes and plasmacytes around them were observed in the dermis, as well as free melanin granules. Moreover, an increased number of fibroblasts and some giant cells were noted in the reticular dermis. Distortion of collagen fibres was found. Orcein (Shikata) staining revealed fragmented elastic fibres in the reticular dermis. There was an increased number of mast cells around the vessels. Vascular endothelial growth factor (VEGF) was weakly expressed by some endothelial and plasma cells. Pe...

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Hyperpigmentation in Megaloblastic Anemia

Cited by 22 publications

References 21 publications

Acral pigmentation caused by a vitamin B₁₂ deficiency

Acral pigmentation caused by a vitamin B₁₂ deficiency

Disorders of pigmentation

Skin Hyperpigmentation and Increased Angiogenesis Secondary to Vitamin B12 Deficiency in a Young Vegetarian Woman

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Hyperpigmentation in Megaloblastic Anemia

Cited by 22 publications

References 21 publications

Acral pigmentation caused by a vitamin B12 deficiency

Acral pigmentation caused by a vitamin B12 deficiency

Disorders of pigmentation

Skin Hyperpigmentation and Increased Angiogenesis Secondary to Vitamin B12 Deficiency in a Young Vegetarian Woman

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Acral pigmentation caused by a vitamin B₁₂ deficiency

Acral pigmentation caused by a vitamin B₁₂ deficiency