By Gary M. White, MD

Deficiency of vitamin B12 may rarely cause skin changes including atrophic glossitis.


The pigmentary changes of vitamin B12 deficiency have included brown or brownish-black hyperpigmentation predominantly affecting hands and feet (especially the knuckles, periungual skin, and palmar creases) and oral mucosa. Occasionally, hyperpigmentation is accentuated on the pressure points such as elbows, malleoli, and knees. Diffuse reticulated hyperpigmentation has been described. Nail changes and premature graying have also been reported.

The tongue becomes red, smooth, and atrophic through loss of the spongiform papillae. Only partial or complete involvement may occur. These areas may be tender and eating or the sense of taste may be impaired.


Reticulate pigmentation associated with vitamin B12 deficiency. Indian Dermatol Online J 2016;7:215-7

A 28-year-old man presented with localized hyperpigmentation of the palmar and dorsal aspects of both hands of two months duration. The patient had low serum B12 levels and megaloblastic anaemia and a gastric biopsy showed chronic gastritis. The patient’s symptoms resolved with vitamin B12 supplementation. Sultan Qaboos Univ Med J. 2015 Aug; 15(3): e420–e423.


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