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Concept
Pellagra
Summary
Pellagra is a disease caused by a lack of the vitamin niacin (vitamin B3). Symptoms include inflamed skin, diarrhea, dementia, and sores in the mouth. Areas of the skin exposed to either sunlight or friction are typically affected first. Over time affected skin may become darker, stiffen, peel, or bleed.
There are two main types of pellagra, primary and secondary. Primary pellagra is due to a diet that does not contain enough niacin and tryptophan. Secondary pellagra is due to a poor ability to use the niacin within the diet. This can occur as a result of alcoholism, long-term diarrhea, carcinoid syndrome, Hartnup disease, and a number of medications such as isoniazid. Diagnosis is typically based on symptoms and may be assisted by urine testing.
Treatment is with either niacin or nicotinamide supplementation. Improvements typically begin within a couple of days. General improvements in diet are also frequently recommended. Decreasing sun exposure via sunscreen and proper clothing is important while the skin heals. Without treatment death may occur. The disease occurs most commonly in the developing world, often as a disease of poverty associated with malnutrition, specifically sub-Saharan Africa.
The classic symptoms of pellagra are diarrhea, dermatitis, dementia, and death ("the four Ds").
A more comprehensive list of symptoms includes:
Sensitivity to sunlight
Dermatitis (characteristic "broad collar" rash known as casal collar)
Hair loss
Swelling
Smooth, beefy red glossitis (tongue inflammation)
Trouble sleeping
Weakness
Mental confusion or aggression
Ataxia (lack of coordination), paralysis of extremities, peripheral neuritis (nerve damage)
Diarrhea
Dilated cardiomyopathy (enlarged, weakened heart)
Eventually dementia
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Official source
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