A 76-year-old man with an 8-month history of suspected statis dermatitis was admitted
to our institution because of weakness and painful dysesthesias in the hands and feet.
A sensory-motor type polyneuropathy was evident in a stocking-and-glove distribution,
and nerve conduction studies confirmed these clinical findings. Polyneuropathy was
worse in the lower extremities, and he was unable to walk. Extensive testing including
brain magnetic resonance imaging, spinal magnetic resonance imaging, and cerebral
spinal fluid examinations were nondiagnostic. Subsequently, serum vitamin B6 (VB6)
levels were found to be low at 3.5 ng/mL (normal values: 6.0-40.0 ng/mL for males).
Oral supplementation with 60 mg/d of pyridoxal phosphate hydrate (PPH) was initiated,
and 1 week later, VB6 levels rose to 39.3 ng/mL, and drastic improvements of polyneuropathy
and dermatitis were observed. On a numerical rating scale, the painful dysesthesias
in the lower extremities improved from 8 out of 10 to 3 out of 10 after 1 week of
PPH administration, and to 0 out of 10 at 5 weeks after PPH administration. The patient
was wheelchair-bound on admission but became able to walk unaided within 3 weeks after
initiation of PPH. As for dermatitis, a clear regression of the brown-reddish pigmentations
was observed (Figure).
FigureVitamin B6 deficiency dermatitis. (A) Photograph of lower limbs before vitamin B6 supplementation. (B) Photograph of lower limbs 5 weeks after vitamin B6 supplementation.
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References
- B vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin.CNS Neurosci Ther. 2020; 26: 5-13
- Vitamin B6 deficiency as a cause of polyneuropathy in POEMS syndrome: rapid recovery with supplementation in two cases.Hematology. 2022; 27: 463-468
- Stasis dermatitis: pathophysiology, evaluation, and management.Am J Clin Dermatol. 2017; 18: 383-390
- Peripheral neuropathies and aging.Geriatr Psychol Neuropsychiatr Vieil. 2018; 16: 409-413
- Vitamin B6 deficiency and diseases in elderly people–a study in nursing homes.BMC Geriatr. 2013; 13: 13
Article Info
Publication History
Published online: September 25, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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Copyright
© 2022 Elsevier Inc. All rights reserved.
