University of Medicine and Pharmacy Nicolae Testemițanu
Pellagra
Elaborated by:Tambur Vadim
Group:M2016
What is pellagra?
Pellagra is a disease caused by low levels of niacin, also
known as vitamin B-3. It’s marked by dementia,
diarrhea, and dermatitis, also known as “the three Ds”.
If left untreated, pellagra can be fatal.
While it’s much less common than it used to be,
thanks to advancements in food production, it’s still a
problem in many developing countries. It can also
affect people whose bodies don’t properly absorb
niacin.
What are the symptoms?
The main symptoms of pellagra are dermatitis, dementia, and
diarrhea. This is because niacin deficiency is most noticeable in
body parts with high rates of cell turnover, such as your skin or
gastrointestinal tract.
Dermatitis related to pellagra usually causes a rash on the face,
lips, feet, or hands. In some people, dermatitis forms around the
neck, a symptom known as Casal necklace.
Additional dermatitis symptoms include:
red, flaky skin
areas of discoloration, ranging from red to brown
thick, crusty, scaly, or cracked skin
itchy, burning patches of skin
What causes it?
There are two types of pellagra, known as primary pellagra and secondary pellagra.
Primary pellagra is caused by diets low in niacin or tryptophan. Tryptophan can be
converted to niacin in the body, so not getting enough can cause niacin deficiency.
Primary pellagra is most common in developing countries that depend on corn as a
staple food. Corn contains niacytin, a form of niacin that humans can’t digest and
absorb unless prepared properly.
Secondary pellagra occurs when your body can’t absorb niacin. Things that can
prevent your body from absorbing niacin include:
alcoholism
eating disorders
certain medications, including anti-convulsants and immunosuppressive drugs
gastrointestinal diseases, such as Crohn’s disease and ulcerative colitis
cirrhosis of the liver
carcinoid tumors
Hartnup disease
How is it diagnosed?
Pellagra can be difficult to diagnose because it causes a
range of symptoms. There’s also no specific test for
diagnosing niacin deficiency.
Instead, your doctor will start by checking for any
gastrointestinal problems, rashes, or changes in your
mental state. They may also test your urine.
In many cases, diagnosing pellagra involves seeing if
your symptoms respond to niacin supplements.
How is it treated?
Primary pellagra is treated with dietary changes and a niacin or
nicotinamide supplement. It may also need to be given intravenously.
Nicotinamide is another form of vitamin B-3. With early treatment, many
people make a full recovery and start feeling better within a few days of
starting treatment. Skin improvement may take several months. However,
if left untreated, primary pellagra usually causes death after four or five
years.
Treating secondary pellagra usually focuses on treating the underlying
cause. However, some cases of secondary pellagra also respond well to
taking niacin or nicotinamide either orally or intravenously.
While recovering from either primary or secondary pellagra, it’s important
to keep any rashes moisturized and protected with sunscreen.
Living with pellagra
Pellagra is a serious condition that’s caused by low
levels of niacin, due to either malnutrition or an
absorption problem. If left untreated, it can cause
death. While primary pellagra responds well to niacin
supplementation, secondary pellagra can be harder to
treat, depending on the underlying cause.
