Trinidadian dermatologists, who live on the Caribbean Sea northeast of the northeast coast of South America, call it black skin.
In a new study, published in the Journal of Medicine, doctors from the University of the West Indies in Trinidad and Toba reported a rare case of severe blackouts in the black man.
A 59-year-old man came to the endocrinology hospital complaining of exhaustion for two months and severe skin irritation of his hands and feet for a year.
He worked as a tile floor and said his symptoms stemmed from work-related injuries at first.
His tongue was smooth, with scattered mucosal patches on the body (Panel A).
Hyperpigmentation was also present on palms (Panel B) and metal.
Blood tests showed a decrease in leukopenia and thrombocytopenia, as well as hemoglobin of 9.4 g per deciliter (14 to 18), an average dose of 117 fl (80 to 94), and a significant increase in body mass. 117 fl (reading area, 80 to 94).
Vitamin B12 content was 40 pg per milliliter (30 pmol per liter; calculators, 200-1100 pg per ml [150–810 pmol per liter]), and serum intrinsic factor antibody concentrations were greater than 200 reference units per milliliter (reference value, 18), in relation to secondary vitamin B12 deficiency for autoimmune gastritis.
Skin hyperpigmentation is caused by an excess of melanin in those who lack vitamin B12, and is more common in people with dark skin.
With treatment, hyperpigmentation often disappears.
The patient was treated with parenteral vitamin B12, and within four months after exposure, hyperpigmentation and fatigue subsided (Panel C and D).
Anemia is caused by a deficiency of hemoglobin in erythrocytes and is often indicated by symptoms of muscle hypoxia.
Symptoms of anemia are:
- rapid fatigue,
- shortness of breath and headache.
Also, depending on the cause of the anemia, it may be accompanied by other symptoms:
- jaundice (damage to erythrocytes or vascular disorders in the absence of vitamin B12),
- darkening of the skin and mucous membranes (in anemia – deficiency of vitamin B12 – due to increased melanin synthesis in melanocytes).
The exact mechanism of hyperpigmentation is unknown, and is found in only 10% of patients, so doctors often miss this symptom.
Damage to the skin and mucous membranes often indicates a problem with the body. For example, American women have a blue tongue due to antibodies to an enzyme that is involved in the synthesis of adrenal hormones. The color change was reversible, but the woman had to take hormone replacement therapy for life.
Source: 10.1056 / NEJMicm2113099
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