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[3] Hyperpigmentation in B12 deficiency occurs as a result of (1) decreased levels of reduced glutathione which activates tyrosinase and results in increased melanin synthesis, (2) defect in transfer of melanin from melanocytes to keratinocytes resulting in pigment incontinence, (3) increased biopterin in B12 deficiency increases hydroxylated phenylalanine which results in hyperpigmentation

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The nasal mucosa provides direct access to the bloodstream through a dense network of capillaries