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Keywords: Vitamin B12 Deficiency, Hyperpigmentation, Atrophic Gastritis, Case Report, Oman Vitamin B 12 deficiency is common among individuals in developing countries.1 Its prevalence is often underestimated as it is believed to occur only in strict vegetarians and patients with pernicious anaemia.1 However, vitamin B 12 deficiency should be suspected in all patients with unexplained anaemia or neurological symptoms.2 Various dermatological manifestations associated with B 12 deficiency are skin hyper- or hypopigmentation, angular stomatitis and hair changes.3 Hyperpigmentation as the primary presenting symptom of B 12 deficiency is rarely reported in the literature.4 The case reported below describes a 28-year-old Omani man who presented with brownish-black hyperpigmentation on both hands, which proved to be due to a B 12 deficiency caused by chronic atrophic gastritis

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