Vitamin B12 is an essential active that plays a crucial role in maintaining our skin and wider health.
Naturally found in liver, oily fish, eggs and dairy products, this vitamin is a popular food supplement that contributes to red blood cell and DNA production, the functioning of the nervous system and digestion. In beauty products, vitamin B12 is primarily known and used as a naturally derived colourant with an attractive pink hue, but it also offers potential for other applications.
The vitamin provides day-to-day skin health benefits, such as enhanced collagen production and regulation of skin hydration. A role for vitamin B12 has also been found in the development and treatment of skin conditions, such as skin sensitivity and inflammatory disorders.
Here, we’ll dive into the science behind this essential vitamin and explore what can happen to our skin in the event of an imbalance, as well as its cosmetic and therapeutic potential.
Vitamin B12 and its role in skin health
Vitamin B12 plays a crucial role in skin health by providing essential nutrients for collagen production and by helping to maintain the skin’s natural moisture balance. Vitamin B12 also helps to promote healthy cell growth, which can help to reduce the appearance of wrinkles and other signs of aging .
However, vitamin B12 is one of the most common vitamin deficiencies, particularly in older populations. Its biochemistry is complex — vitamin B12 exists in many forms within the body and its uptake and metabolism depends on multiple enzymes — and the complexity of this system means there are many opportunities for deficiency or imbalances to occur due to malabsorption . Malabsorption issues commonly arise because of health defect such as enteritis, anaemia or overgrowth of intestinal bacteria, or in response to gastric acid-blocking agents (particularly in the aging population). Vitamin B12 deficiency has been tied to the genetics of different populations, which can affect the pathways of uptake and metabolism .
In addition to the potential implications for the day-to-day condition of our skin, vitamin B12 imbalances within the body have also been linked to several dermatological conditions. These cutaneous conditions include inflammatory condition, such as rosacea and acne, and skin sensitivity, as well as skin pigmentation disorders such as vitiligo . Gaining an understanding of the mechanisms at play is crucial for recognizing vitamin B12 imbalances as the potential cause of such dermatological complications, and for effective use of vitamin B12 therapy to restore deficiencies or to help treat other skin conditions.
Here we will explore what is currently known around vitamin B12’s role in the development of such skin conditions, as well as how these interactions are influenced by the skin microbiome.
Vitamin B12 and inflammatory skin conditions
As highlighted above, inflammatory disorders are one set of skin conditions where a role for vitamin B12 has been implicated.
Rosacea, for example, is a chronic inflammatory skin disease characterized by recurrent flushing, erythema, papules, telangiectasia, oedema and pustules, or a combination of these symptoms.
The underlying causes of rosacea are not fully understood, but genetic factors, immune dysregulation, microorganisms, chronic inflammation, vascular hyperreactivity and other environmental factors are all thought to play a role in its development, also with links to skin microbiome dysbiosis  (see our past article on rosacea here). Previous studies have also linked rosacea to an imbalanced gut microbiome, and the prevalence of gastrointestinal disorders such as celiac disease, Crohn’s disease, ulcerative colitis, small intestinal bacterial overgrowth and irritable bowel syndrome has been found to be significantly higher among patients with rosacea .
Recently, associations between the amino acid homocysteine and inflammatory skin diseases, including psoriasis and hidradenitis suppurativa, have been reported. Vitamins B12, B6 and B9 (also known as folate or folic acid) break down homocysteine to create other chemicals needed by our bodies, and so high homocysteine levels may indicate a vitamin deficiency . In line with these findings, a possible association between excess homocysteine (hyperhomocysteinemia) and vitamin B12 deficiency in patients with rosacea has now been found. Vitamin B12 and folic acid levels were significantly lower in patients with rosacea than in the healthy individuals — the more severe the rosacea, the lower the levels of vitamin B12 and folic acid. Rosacea severity was also positively correlated with homocysteine levels, which increased as vitamin B12 and folic acid levels decreased .
It may be that the gastrointestinal diseases and associated microbiome imbalances that co-occur with rosacea lead to the impaired absorption of vitamin B12 and vitamin B9, which vitamin B12 often works closely with to ensure a healthy and functioning body. This, in turn, may contribute to the inflammatory symptoms of rosacea patients .
Although more studies are needed to confirm the effects of vitamin B12 in the treatment of rosacea, it has been suggested that dietary supplementation with antioxidant vitamins and folic acid in rosacea patients with hyperhomocysteinemia may improve symptoms by reducing homocysteine levels. Another study has found that intramuscular administration of hydroxocobalamin, a form of vitamin B12, was effective for immediate reduction of facial erythema associated with rosacea. However, again, more studies are needed to determine the optimal dosage, efficacy of oral form, treatment duration and long-term therapeutic effects and side effects .
Vitamin B12 and sensitive skin conditions
Vitamin B12 has also been implicated in the development and treatment of skin sensitivity. To build on existing knowledge and gain a better understanding of this link, a team from DSM conducted a series of studies to investigate: (1) skin inflammatory reactions caused by inflammasome activation; (2) skin sensitivity and inflammation caused by mast cell degranulation; and (3) the role of vitamin B12 in preventing over colonisation of skin microbiota associated with skin inflammation .
Study 1: Could vitamin B12 reduce skin inflammatory reactions caused by inflammasome activation?
Inflammasomes are intracellular multiprotein complexes that form part of our innate immune response, playing a defensive role against pathogens.
In skin, UV radiation, pollution and oxidative stress induce the formation of the NLRP3 inflammasome within the epidermis (the outer layer of the skin). The NLRP3 inflammasome is responsible for regulating the immunological response and triggers an inflammatory response by producing cytokines such as IL-1β. Chronic activation of the NLRP3 inflammasome can lead to skin irritation, symptoms such as redness, irritation and skin sensitivity, and signs of premature skin aging.
In the study led by DSM, it was shown that vitamin B12 acts as a negative regulator of the NLRP3 inflammasome via miR-22-3-p (a microRNA). Supplementation with vitamin B12 upregulated miR-22-3p by 61% and downregulated inflammasome components following exposure to UVB stress – including a 35% reduction in IL-1β production.
Overall, these findings give an encouraging indication that vitamin B12 could help relieve symptoms of skin sensitivity induced by UV exposure and other external stressors through the reduction of inflammasome activity.
Study 2: Could vitamin B12 reduce skin sensitivity and inflammation caused by mast cell degranulation?
Mast cells are immune cells that are present in most tissues, but they are particularly prominent in areas exposed to the environment – such as the skin.
They can be activated by environmental stress factors such as allergens, UV light and pollution, leading to the release of inflammatory mediators such as cytokines and histamine – a process known as degranulation. When mast cells in the skin degranulate, they cause allergic reactions and symptoms such as itching, stinging, burning and redness, and dry and sensitive skin. If mast cell degranulation can be inhibited, it may be possible to counter these uncomfortable and unpleasant skin conditions, also improving skin appearance.
The second study by DSM investigated the ability of vitamin B12 to block this process, and found that supplementation decreased mast cell degranulation by 27% even at low concentrations. The findings indicate that by stabilizing mast cells and helping to block the release of histamine, vitamin B12 can help protect against inflammation-induced skin barrier damage and relieve skin sensitivity and irritations cause by environmental stress factors.
Study 3: Could vitamin B12 play a role in preventing over colonization of skin microbiota associated with skin inflammation?
In the third study, DSM analyzed the impact of vitamin B12 on the colonization of a skin pathogenic bacteria: Staphylococcus aureus. When there is an imbalance in the skin microbiome, S. aureus can become dominant, impact skin barrier function and trigger inflammatory processes.
After adding vitamin B12 to a microbial cell culture, counting the proportion of S. aureus microbes in relation to two commensal bacteria – Staphylococcus epidermidis (which acts as a sentinel of skin microbiota, helping to limit inflammation) and Staphylococcus hominis (which has a potent activity against pathogenic bacteria) – revealed significant changes in how the proportions of S. aureus and either S. epidermidis or S. hominis changed in response to supplementation with vitamin B12.
S. aureus was drastically reduced at lower concentrations of vitamin B12 and completely inhibited at the maximum concentration given, while S. epidermidis remained at the same level and S. hominis was only slightly modulated. By preventing over-colonization of S. aureus and promoting the share of beneficial bacteria, vitamin B12 could therefore play a role in maintaining a healthy skin microbiome, protecting against symptoms of skin sensitivity.
In summary, it is clear that vitamin B12 presents an interesting opportunity for further explorations around its role in skin health and the development and treatment of certain skin conditions.
Imbalances should be considered when rosacea or acne occurs, and the studies by DSM highlight the potential of vitamin B12 for the development of natural formulations to soothe skin. By modulating inflammasome production, reducing mast cell degranulation and reducing proportions of pathogenic bacteria in the skin microbiome, it could relieve irritated, inflamed and sensitive skin while providing protection against skin barrier damage and promoting a vibrant complexion.
2. Brescoll, J. & Daveluy, S. A Review of Vitamin B12 in Dermatology. Am J Clin Dermatol (2015) 16:27–33.
3. Aaron, S. et al.Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency-related neurological syndromes. Neurol India. 2005;53(1):55–8.
4. Chung, B. Y. et al. Relationships of Serum Homocysteine, Vitamin B12, and Folic Acid Levels with Papulopustular Rosacea Severity: A Case- Control Study. BioMed Research International Volume 2022, Article ID 5479626.
5. Kang, D. et al. Vitamin B12 modulates the transcriptome of the skin microbiota in acne pathogenesis. Sci. Transl. Med. 7, 293 (2015).
6. Paul, F. & Imfeld, D. Vitamin B12 – more than just a colourant. Personal Care Magazine (October 2022).