Dermatologic findings of vitamin B 12 deficiency in infants

Background/Objectives Vitamin B 12 deficiency in infants is uncommonly reported from developed countries and generally lacks dermatologic manifestations. On the contrary, infantile vitamin B 12 deficiency is common in India and cutaneous manifestations are a constant feature, although often overshadowed by neurologic and hematological manifestations. The aim of this study was to describe the skin changes of vitamin B 12 deficiency in infants. Materials and Methods A retrospective chart review of vitamin B 12 deficient infants for clinical and laboratory parameters was performed and data analyzed. Results Forty‐three infants, 30 boys and 13 girls, aged 4 to 27 months, with vitamin B 12 deficiency were identified. Skin hyperpigmentation was present in 41 infants; it was localized to the dorsa of hands and feet in 26. Fifteen infants had generalized hyperpigmentation; 10 had a reticulate pattern, and 5 had a homogeneous pattern. Brown and sparse scalp hair were present in all. Glossitis was seen in 5 infants and cheilitis in 3. Of the 32 infants who underwent laboratory investigations, 28 had anemia and 21 macrocytosis. Serum vitamin B 12 was measured in 30 infants; it was low in 19. Of the 11 with normal serum vitamin B 12 , 9 had received vitamin B 12 before referral but had macrocytosis and low maternal serum vitamin B 12 . The infants were treated with vitamin B 12 . Skin pigmentation and mucosal changes resolved completely by 3‐4 weeks, but hair changes were slower to reverse. Conclusion Cutaneous findings are a common feature of vitamin B 12 deficiency in Indian infants and resolve with treatment.