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Pellagra: Vitamin Deficiency Disease in Alcoholism

Learn about pellagra, a disease caused by lack of niacin (Vitamin B3), common in the 3rd world but rare in developed countries. Symptoms include dermatitis, diarrhea, and dementia. The rash is bilateral, symmetrical, and starts in sun-exposed areas, progressing to hands, face, neck, and chest. References provided.

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Pellagra: Vitamin Deficiency Disease in Alcoholism

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  1. Pellagra in the Chronic Alcoholic Andy McWilliams Morning Report 4/2/2010

  2. Pellagra Defined • Disease of vitamin deficiency • Lack dietary Niacin (Vitamin B3 – a water soluble vitamin) • Still common in the 3rd world • Rarely found in developed countries due to dietary modifications • Must keep on differential for alcoholism, anorexia, malnutrition, malabsorption, and carcinoid syndrome

  3. Signs and SymptomsDermatitis, Diarrhea, Dementia • Vague gastrointestinal (GI) symptoms of anorexia, abdominal pain, and vomiting prior to the typical rash or diarrhea • In addition, patients may experience dysphagia secondary to glossitis, change in taste sensation • Spectrum of neurologic symptoms including hallucinations and depression - can progress to delirium and coma if untreated. • Multi-organ system failure

  4. The Rash of Pellagra • Bilateral and symmetrical • Usually starts in sun exposed areas • Then classically dorsa of hands, face, neck, and chest. Casal’s necklace – broad band at collar-line • Can have intense pruritis • Starts as well demarcated erythematous patches • Second stage – dry, scaley, hyperkeratotic

  5. Pellagra Rash

  6. Pellagra Rash

  7. Pellagra Rash

  8. Acknowledgements and References Julie Joseph and Kamal Kolappa 1. Hegyi J, Schwartz RA, Hegyi V. Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol. 2004;43(1):1-5. 2. Nogueira A, Duarte AF, Magina S, Azevedo F. Pellagra associated with esophageal carcinoma and alcoholism. Dermatol Online J. 2009;15(5):8. 3. Park YK, Sempos CT, Barton CN, Vanderveen JE, Yetley EA. Effectiveness of food fortification in the United States: the case of pellagra. Am J Public Health. 2000;90(5):727-738. 4. Ishii N, Nishihara Y. Pellagra among chronic alcoholics: clinical and pathological study of 20 necropsy cases. J Neurol Neurosurg Psychiatry. 1981;44(3):209-215. 5. Prousky JE. Pellagra may be a rare secondary complication of anorexia nervosa: a systematic review of the literature. Altern Med Rev. 2003;8(2):180-185.

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