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Silverstein said he decided to investigate the over-prescribing of B12 shots, because "as an internal medicine resident, I have seen many patients come into the emergency department, and they were getting B12 injections without having a really good reason for it." His study could not determine why family physicians were prescribing it inappropriately including whether it was initiated by the doctor or at the request of the patient

Protein-energy malnutrition, zinc deficiency, and pellagra can also cause hyperpigmentation [8]

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