To the Editor.—
The development of hyperpigmentation in vitamin B12 deficiency has been well documented,1 but the relationship between folic acid deficiency and increased skin pigmentation is poorly understood. We recently saw a case of hyperpigmentation that is apparently secondary to folate deficiency.
Report of a Case.—
A 70-year-old alcoholic man was admitted to the hospital with pneumonia. The patient was seen in consultation by the Department of Dermatology because of a peculiar brownish color of his skin. He had dry skin and diffuse areas of grayish-brown pigmentation on the chest, back, and upper extremities. The pigmentation was not limited to the sun-exposed areas. Mucous membranes were not involved. Laboratory studies disclosed the following values: hemoglobin, 7.4 gm/100 ml; hematocrit reading, 23.3%; mean corpuscular volume, 106 cu μ; serum iron, 40μg/100 ml; serum total iron-binding capacity, 200μg/100 ml. A peripheral blood smear showed macrocytosis with hypersegmented neutrophils. The
Downham TF, Rehbein HM, Taylor KE. Hyperpigmentation and Folate Deficiency. Arch Dermatol. 1976;112(4):562. doi:10.1001/archderm.1976.01630280080043