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Hyperpigmentation of the extremities, especially over the dorsum of the hands and feet, with accentuation over the interphalangeal joints and terminal phalanges associated with pigmentation of the oral mucosa is characteristic of Vitamin B12 deficiency.[1,2] It is suggested that deficiency of Vitamin B12 causes decrease in intracellular reduction potential that leads to oxidation of the reduced glutathione and decrease in GSH/GSSG ratio

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This mechanism spares normal cycling cells, making it a precise tool for aging research