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The most common skin manifestations include a pale, washed-out complexion from anemia, dryness and cracking (particularly at the corners of the mouth), hyperpigmented patches on the hands or face, and glossitis a swollen, smooth, unusually red tongue

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Cautious use of parenteral cyanocobalamin is also recommended in patients with renal impairment, including premature neonates, because of the possibility of greater aluminum accumulation, which may cause central nervous system and bone toxicity