Pellagra
Overview | Manifestation | Diagnosis | Treatment
Overview
Alternative names
vitamin deficiency - niacin; deficiency - niacin
Definition
A disease caused by a deficient diet or failure of the bodyto absorb niacin (one of the B complex vitamins) or an amino acid (tryptophan).Common in certain parts of the world (in people consuming large quantities ofcorn), the disease is characterized by scaly skin sores, diarrhea, mucosalchanges, and mental symptoms (especially a schizophrenia-like dementia). It maydevelop after gastrointestinal diseases or alcoholism.
- Etiology-severe deficiency of niacin
- lack of animal protein
- maize/millet diet, S Africa; Alkali, Mexico
- Isoniazid/niacin antagonism
- 1700’s Casal attributed pellagra to diet
- 1914-1926 Joseph Goldberger, infectious diseases specialists assigned byUSPHS, using epidemiology found it to be a nutritional disease, responsiveto yeast extract, related to alkaline treated maize diet, hominy and grits
- Distribution-poverty/poor nutrition
- Clinical presentation
- Dermatitis
- confluent over sun exposed areas
- collar of Casal, dermatosis around neck
- Progression
- erythema, desquamation, hyperpigmentation, atrophy
- Seasonality
- worst after sun exposure
- Dermatitis
Manifestation
- Gastrointestinal
- stomatitis, glossitis, gastritis, enteritis, malabsorbtion (edematous,painful mucosa, desquamation, glossy-scarlet tongue)
- Neuropsychiatric (late stage)
- confusion, irritability
- depression, delusions, suicidal ideation
There were asylums in the southern US for victims of centralnervous system pellagra/ niacin deficiency
Diagnosis
- Clinical-4 D’s®Dermatitis, Diarrhea, Dementia, Death
- Laboratory-urine and methylnicotinamide
- Differential-phototoxic dermatitis
- Drugs-tetracycline
- Plant food toxin, chenopodium
- Kwashiorkor, “flacky paint”
Treatment
- Niacin
- 100mg PO QID x 2
- then 50mg TID until rash resolved
- with severe stomatitis, pharyngeal lesiona may need IM niacin
- Prevention-animal protein(provides niacin & tryptophan
- provide B complex vitamin with isoniazid to prevent neuropathy
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