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Take home message: B12 deficiency can lead to patchy hyperpigmentation of the skin, especially in people with darker skin tones A new case study from Rajasthan, India, reports: 23 year old "strict vegetarian" woman with fatigue, dyspnea on exertion for 3 months severe pallor and darker pigmentation over the knuckles of both hands She had too little hemoglobin, and red blood cells that were too big (typical for B12 deficiency)

This can be due to having low levels of intrinsic factor in the digestive system, having a digestive condition, or following a plant-based diet

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