What Is Pellagra? Symptoms, Causes and Treatment

Pellagra is mostly caused by a deficiency in niacin and tryptophan. Perhaps such deficiencies are behind many stomach complications. Yeast, milk, bran, almonds, and meats are all healthy niacin sources.

Pellagra is not genetic. It is caused by a shortage of niacin and tryptophan. This vitamin helps with skin and nervous system integrity. It’s pretty easy to prevent with a multivitamin and balanced diet. Deficiency can result in skin and nervous system problems.

What Is Pellagra?

Pellagra is a disease characterised by diarrhoea (a condition in which faeces are discharged from the bowels frequently and in a liquid form), dermatitis (skin irritation) and dementia (cognitive decline such as forgetfulness) due to deficiency of niacin (vitamin B-3). If pellagra is left untreated, it can result in death.

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For most cellular processes, niacin is very essential. Since tryptophan can be converted into niacin in the body in the diet, both of these need to be deficient for the development of pellagra. The skin features of pellagra include peeling, redness, scaling, thickening and spots due to sun exposure.

What Causes Pellagra?

Pellagra is caused by consuming very little dietary niacin or tryptophan. It can also occur if those nutrients are not properly absorbed or utilized by the body.

Pellagra may also develop due to:

  • Excessive alcohol use
  • Gastrointestinal diseases
  • Weight loss (bariatric) surgery
  • Anorexia
  • Carcinoid syndrome (a group of symptoms associated with tumours of the small intestine, colon, appendix, and bronchial tubes in the lungs)
  • Certain medicines, such as isoniazid, 5-fluorouracil, 6-mercaptopurine

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People in the most isolated third world countries suffer from this disease, but alcoholics in developed countries tend to be prone to it. People who undergo surgery and are put on anaesthetic drugs to knock them out during surgery are at risk of having pellagra. During surgeries, the niacin is drained. Post surgery symptoms of pellagra are quite common but will subside when diet is balanced.

Pellagra Signs and Symptoms

The signs and symptoms of pellagra are usually referred to as the four “Ds”. They include Dermatitis, Diarrhea, Dementia and Death (if pellagra remains untreated). These signs and symptoms can further be broken down as follows:

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Dermatological (skin) Symptoms Of Pellagra

  • Reddened skin: This is usually the first sign with superficial scaling in areas exposed to sunlight, heat and friction. This can look like severe sunburn and gradually subsides, leaving a dusky brown-red colour.
  • Skin rash:  This is also known as pellagra rash. Usually symmetrical with clear edges between affected and unaffected areas of the skin.
  • Skin itching
  • Burning sensation
  • Thickened, hardened, scaly and cracked skin: This occurs as time goes on. Bleeding may result in blackened crusts.
  • Skin Lesions: This may occur anywhere on the body especially on the hands, arms, lower legs, feet, face, and neck (known as Casal’s necklace).
  • Lips, tongue and gums may become sore and start peeling.
pellagra on the neck region

Gastrointestinal Symptoms of Pellagra

  • Diarrhoea: This occurs in 50% of cases.
  • Lack of appetite
  • Abdominal pain
  • Nausea
  • Vomiting
  • Malnutrition: Due to lack of appetite and difficulty in eating and drinking.

Neurological Symptoms Of Pellagra

  • Apathy and slight depression: These are the initial neurological symptoms but may go unnoticed for long.
  • Headache
  • Confusion
  • Irritability
  • Restlessness
  • Anxiety
  • Tremor
  • Delusions
  • Disorientation
  • Psychosis
  • Patients eventually become stuporous, comatose and may die if not given medical attention.

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How is Pellagra Treated?

During the treatment, the two major types of the pellagra (primary and secondary) are handled distinctly. The main treatment for primary pellagra (due to niacin deficiency) includes the supplementation of vitamin B3 to your diet. If the trigger is secondary (certain factors prevent the body from being able to access the niacin in the diet), alcoholism is the most common cause. Although, there are several other causes.

The medical information provided in this article is provided as an information resource only. This information does not create any patient-physician relationship and should not be used as a substitute for professional diagnosis and treatment.

Is Pellagra Contagious?

Pellagra is not contagious, and the condition can be reversed. It is not considered an infectious disease.

What Is Pellagra Rash?

Skin problems related to pellagra usually causes a rash on the face, lips, feet, or hands. This rash is known as pellagra rash.

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Does Corn Cause Pellagra?

Corn does not cause Pellagra. However, pellagra is prevalent in poor areas of the world, including Africa and India, where maize is a staple diet. This is because corn is a poor source of niacin and tryptophan.

Final Words

Pellagra is a disease caused by the deficiency of niacin and tryptophan. It is not genetic, contagious or infectious. Pellagra can easily be treated by eating foods or taking supplements rich in niacin. For secondary pellagra, the treatment entails correcting the cause of the problem. If left untreated, it can lead to death. Consult your health professional when in doubt.

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