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High-dose supplementation, particularly hydroxocobalamin injections, has been associated with acne-like eruptions and rosacea flare-ups in susceptible individuals

When high doses of vitamin B 12 are given orally, only a small percentage can be absorbed, which may explain the low toxicity (4)

For Type IV patients, we prefer mandelic acid at shallower depths, pre-treat with depigmenting agents when indicated, and apply more conservative timing during the procedure