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Cutaneous Hyperpigmentation in Megaloblastic Anemia: a Five Year Retrospective Review
Somanath Padhi1, RajLaxmi Sarangi2, Anita Ramdas1
1Department of Pathology, Pondicherry Institute of Medical Sciences, Puducherry, India.
Summary
Cutaneous hyperpigmentation is a significant indicator of megaloblastic anemia (MA), often presenting with cytopenias. This condition, particularly knuckle pad hyperpigmentation, typically resolves with vitamin B12 therapy.
Area of Science:
- Hematology
- Dermatology
- Internal Medicine
Background:
- Cutaneous hyperpigmentation is an underrecognized sign of megaloblastic anemia (MA).
- Previous reports on this association are sporadic.
Purpose of the Study:
- To investigate the clinicolaboratory features and bone marrow (BM) findings in adult patients with cutaneous hyperpigmentation and cytopenias.
- To determine the prevalence of MA in this patient group.
Main Methods:
- Retrospective analysis of 198 adult patients undergoing BM evaluation for cytopenias.
- Detailed examination of 25 patients with cutaneous hyperpigmentation, including clinical presentation, laboratory results, and BM morphology.
- Vitamin B12 and folate levels were assessed.
Main Results:
- Megaloblastic anemia (MA) was diagnosed in 84% (21/25) of patients with hyperpigmentation, significantly higher than in those without (P<0.001).
- Knuckle pad hyperpigmentation (KP) occurred in 64% of cases, while diffuse palmar/plantar discoloration (DP) was seen in 36%.
- Pancytopenia was present in 72% of cases, and vitamin B12 deficiency was the most common cause (70.6% of cases with available data).
- Hyperpigmentation and pyrexia resolved following cobalamin therapy.
Conclusions:
- Cutaneous hyperpigmentation and cytopenias are strongly associated with MA.
- Knuckle pad hyperpigmentation is more prevalent than diffuse palmar/plantar discoloration in MA patients.
- Prompt diagnosis and treatment of MA can lead to the reversal of cutaneous manifestations.
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