B12 Deficiency: Skin Hyperpigmentation

I just updated the list of symptoms of overt B12 deficiency on the VeganHealth.org page, Overt B12 Deficiency – Nerve Damage and Anemia.

I added one symptom, skin hyperpigmentation which is the darkening of the skin accompanied by even darker spots (1). The study is free to the public and you can see pictures (click here).

Interestingly, the discussion part of the paper points out that B12 deficiency interferes with the production of choline and choline-containing phospholipids. Perhaps this is why, or partially why, some vegans crave eggs (see To Quit or Not to Quit Veganism: Part Two), which are high in choline.

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1. Cherqaoui R, Husain M, Madduri S, Okolie P, Nunlee-Bland G, Williams J. A reversible cause of skin hyperpigmentation and postural hypotension. Case Rep Hematol. 2013;2013:680459. doi: 10.1155/2013/680459. Epub 2013 Jun 11. | link

2 Responses to “B12 Deficiency: Skin Hyperpigmentation”

  1. Dan Says:

    That is very interesting, thanks! I will keep that in my differential diagnosis when I am seeing hyperpigmentation in clinic. I’ve diagnosed alot of subclinical B12 deficiency but had never heard that skin hyperpigmentation was one of the symptoms (lemon coloring of grey hair is one I do know, however). I wonder if the mechanism has to do with adrenal failure and upregulation of POMC together with ACTH.

  2. Jack Norris RD Says:


    I wouldn’t necessarily call it “subclinical” as these two people were well into other deficiency symptoms. I don’t know how often it would show up or at what point in the deficiency state.

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