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The BNF recently (2019) changed its guidance for the frequency of injections of hydroxocobalamin: • Every 2 months in patients who have neurological symptoms • Every 2 or 3 months when there are no neurological symptoms

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The strongest human evidence is topical, including the Leyden 2002 photoaging trial and a 2023 IRB-approved 21-woman topical NEEL gel study reporting an average 28% increase in skin collagen density at 3 months