Pellagra

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Introduction

What is pellagra?

Pellagra is a disease that affects your digestive system, skin, and nerves, resulting in dermatitis, diarrhea, and mental disorders. The most common cause of pellagra is not having enough niacin (primary pellagra). Other causes of pellagra are associated with digestive disorders that reduce the absorption of niacin in your body.

Niacin is also known as nicotinic acid, or vitamin B3. In the United States, individuals most at risk for developing pellagra are alcoholics, as a result of malnutrition.

Both alcoholism and not consuming enough green vegetables, seafood, meat, and eggs commonly cause primary pellagra. Secondary pellagra occurs when sufficient niacin is consumed but not taken up and used by the body. Secondary pellagra is often caused by gastrointestinal diseases that prevent absorption of niacin. Because tryptophan is needed to make niacin, low levels of tryptophan may also lead to pellagra.

The signs and symptoms of pellagra can be constant or occur periodically. Pellagra varies among individuals. Some people with pellagra have mild symptoms, such as fatigue, while others may develop severe depression and anxiety. Fortunately, pellagra can be treated with nutritional supplementation to resolve deficiencies in niacin. Lifestyle changes can reduce your risk for pellagra and include limiting alcohol intake, eating a well-balanced diet, not smoking, and always taking all medications and supplements as prescribed.

In some cases, if left untreated, pellagra can lead to dementia, anxiety or depression that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms, including altered mental status, alcohol withdrawal, or severe depression with suicidal thoughts.

Seek prompt medical care if you are being treated for pellagra but mild symptoms recur or are persistent.

Symptoms

What are the symptoms of pellagra?

Pellagra is a condition of having too little niacin in the body and affects the normal function of the nerves, digestive system, and skin. Pellagra may result in a number of symptoms. The symptoms can vary in intensity from person to person.

Common symptoms of pellagra

You may experience pellagra symptoms daily or just once in a while. At times any of these common symptoms can be severe:

  • Abdominal cramping
  • Confused or delusional thinking
  • Depression
  • Diarrhea
  • Difficulty with memory, thinking, talking, comprehension, writing or reading
  • Headache
  • Loss of appetite
  • Malaise or lethargy
  • Mucus membrane inflammation
  • Nausea with or without vomiting
  • Skin lesions that are scaly and sore
  • Weakness (loss of strength)

Symptoms that might indicate a serious condition

In some cases, if left untreated, pellagra can lead to serious emotional and psychological conditions that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Alcohol withdrawal
  • Suicidal thoughts

Causes

What causes pellagra?

The most common cause of pellagra is inadequate intake of the B vitamin known as niacin (primary pellagra). The most typical cause of primary pellagra is not consuming enough green vegetables, seafood, meat, and eggs. Alcoholism is commonly associated with pellagra as the result of malnutrition.

Secondary pellagra occurs when sufficient niacin is consumed but not taken up and used by the body. Secondary pellagra is usually caused by gastrointestinal diseases that prevent absorption of niacin. Because tryptophan is needed to make niacin, low levels of tryptophan may also lead to pellagra.

What are the risk factors for pellagra?

A number of factors increase the risk of developing pellagra. Not all people with risk factors will get pellagra. Risk factors for pellagra include:

  • Alcoholism

  • Anorexia nervosa

  • Diets high in corn

  • Digestive disease

  • Low dietary intake of tryptophan (needed to produce niacin in the body)

Reducing your risk of pellagra

You may be able to lower your risk of pellagra by:

  • Eating foods rich in tryptophan, which plays a role in making niacin, such as seafood, meat, and green vegetables

  • Ensuring your diet is rich in foods that contain niacin, such as cereal grains, eggs, green vegetables, fish, milk and yeast

  • Following a healthy food plan that includes a variety of foods from each of the food groups

  • Practicing moderation if you drink alcohol

Treatments

How is pellagra treated?

Treatment for pellagra begins with seeking medical care from your health care provider. To determine whether you have pellagra, your health care provider will ask you questions, request a blood sample, and possibly prescribe diagnostic testing. It is important to follow your treatment plan for pellagra precisely and to take all medications as instructed.

The treatment approach for pellagra depends on treating the underlying cause for pellagra. Treatment will include returning niacin and tryptophan (if needed) to normal levels. Administering supplements will help to replenish these substances until balance is restored.

Specific recommendations for your specific niacin requirements will be provided by your healthcare provided based on your age, gender, and health.

What are the potential complications of pellagra?

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of pellagra include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Pellagra. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000342.htm.
  2. Niacin. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/002409.htm.
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