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As evidenced by James et al ., histology from the hyper pigmented area showed irregular epidermal atrophy, absence of basal orientation of epidermal cells, patchy pigmentation of the lower epidermis, and numerous pigment-laden macrophages in the upper dermis and increase of melanin in the basal layer

However, the amount of B12 absorption it is very difficult to measure

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I couldn't even take a lap around my block

Homocysteine can also be high with folate deficiency so folate should also be measured to rule that out