Paper
Pigmentation of fingertips and nails in vitamin B12 deficiency
Published Jul 1, 1977 · C. Ridley
British Journal of Dermatology
21
Citations
0
Influential Citations
Abstract
A white woman aged 76, previously in good health, was admitted complaining of swelling of the ankles, loss of weight and loss of appetite, all for about a month. She was found to be faintly icteric and clinically anaemic, with oedema, a raised jugular venous pressure and an enlarged smooth liver. Pigmentation, reticulate and brownish, was noted on the finger pulps and nails. There were no pigmentary abnormalities elsewhere. The haemoglobin was 42 g/dL (42 g/ioo ml) and the marrow showed megaloblastic erythropoiesis. The diagnosis of Addisonian pernicious anaemia, with lack of absorption of vitamin B12 because of lack of intrinsic factor, was confirmed by a Schilling test. Parts I and II, the ratio of 24 h urinary excretion of '̂̂ Co to that of ''^Co being i to to (normal greater than 2). Histological examination (Fontana stain) of a pigmented area of the finger pulp demonstrated increased melanin in the dermis and epidermis. Therapy was begun with Vitamin B12 iooo/(g intramuscularly weekly. There was a reticulocyte response of up to 24-8"^ and the haemoglobin rapidly rose, reaching 84 g/dL within a month and 146 g/dL after a few months. The pigmentation of the pulps and nails regressed quickly and completely. Pigmentation apparently specific to Vitamin B12 deficiency has been reported by Baker et al. (1963). The patients were Indian, and the pigment dark brown or brownish black, in some widely distributed but in most cases mainly over the dorsal aspects of fingers and toes. In 15 adults and 6 children, only 2 had nail pigmentation. The pigment regressed in a few weeks or months after treatment with Vitamin B12, recurring in one patient when the anaemia recurred. Watson-Williams &
Case ReportVitamin B12 deficiency can cause pigmentation on fingertips and nails, but treatment with vitamin B12 can rapidly reverse this pigmentation and improve anaemia symptoms.
Full text analysis coming soon...