There are two types of deficiency a person can have.
While the condition can be cured if diagnosed, pellagra can be fatal if left untreated.
Untreated pellagra will lead to death, sometimes called the “fourth D,” within a few years.
Verywell / Nusha Ashjaee
Diarrhea
In the early stages, pellagra symptoms may be vague.
The rash, however, is seen in the majority of cases.
Watery diarrheais usually the first symptom and is the result of inflammation of the gastrointestinal mucosa.
DermNet / CC BY-NC-ND
In fact, it often looks like a sunburn.
Areas of affected skin may be itchy, painful, and sensitive to the sun.
This photo contains content that some people may find graphic or disturbing.
At first, a person may experience memory loss, trouble sleeping, and mood changes.
In extreme cases, the neurological symptoms of pellagra appear dementia-like or even stroke-like.
What Causes Pellagra?
Primary and secondary pellagra have different underlying causes.
Primary pellagra takes place if a person is low in niacin ortryptophan.
This may be due to an underlying condition or brought on by a medication.
Pellagra occurs equally in men and women.
It primarily occurs in adults but in some cases, infants and children may be at risk.
They will perform a physical exam and ask the person about diet and lifestyle.
Findings that support a clinical diagnosis of pellagra include the characteristic skin rash.
Patients often report diarrhea or other gastrointestinal symptoms, including swollen tongue.
Pellagra is uncommon in children, but it does occur.
Younger patients may not present with the typical symptoms of pellagra, however, which can make diagnosis tricky.
They may also be looking for other abnormalities, such as low tryptophan, NAD, and NADP levels.
Tests can also help rule out other conditions that have similar symptoms.
If a person is found to have pellagra, the next step will be determining the cause.
Other patients may need additional tests to determine the reason for the deficiency.
After several years, the condition causes major damage to the internal organs, which is ultimately fatal.
How Is Pellagra Treated?
The main treatment for pellagra is nicotinamide, a water-soluble form of niacin, for 34 weeks.
This form causes fewer side effects than regular niacin.
Treatment may also include addressing underlying problems such as chronic alcohol dependence.
Meat, dairy, and nuts are good sources of niacin, as are green, leafy vegetables.
A healthcare provider can help a person decide what regimen they need.
2021 Apr 25;13(4):e14682.
doi:10.1136/bcr-2020-239741
Bilgili SG, Karadag AS, Calka O, Altun F.Isoniazid-induced pellagra.Cutan Ocul Toxicol.
2011;30(4):317-319. doi:10.3109/15569527.2011.574303
MedlinePlus.Hartnup disease.
2012;103(1):51-58. doi:10.1016/j.adengl.2011.05.003
Gupta Y, Shah I.Ethionamide-induced pellagra.J Trop Pediatr.
doi:10.1136/bcr-2018-227454
Badawy AA-B.Pellagra and alcoholism: a biochemical perspective.Alcohol Alcohol.
2018;114(9/10).
doi:10.17159/sajs.2018/4597
World Health Organization.Pellagra and its prevention and control in major emergencies.
