eMedicine Specialties > Dermatology > Internal Medicine

Pellagra: Follow-up

Author: Vladimir Hegyi, MD, PhD, Associate Professor, Department of Pediatric Dermatovenereology, Pediatric Hospital, Comenius University, Bratislava
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Apr 18, 2008

Follow-up

Further Inpatient Care

  • Patients with acute pellagra require bedrest during the initial phase of treatment.
  • Patients with severe glossitis require a liquid or a soft solid diet to overcome dysphagia.
  • Ensure that the patient has a balanced diet that is rich in protein and niacin.
  • The topical treatment of skin lesions with topical emollients may reduce discomfort.

Deterrence/Prevention

  • Primary prevention
    • The primary prevention of pellagra involves an adequate diet.
    • Food sources of niacin and/or tryptophan include nutritional yeast, eggs, bran, peanuts, meat, poultry, fish with red meat, cereals (especially fortified cereals), legumes, and seeds.
    • The recommended daily allowance of niacin for infants is 5-6 mg; for children, 9-13 mg; for adults, 13-20 mg; for pregnant women, 17 mg; and for breastfeeding women, 20 mg.
    • Optimal supplementation is 20-30 mg daily.
  • Secondary prevention
  • Patients should avoid sun exposure during the active phase of the disease.
  • Patients should follow a convenient dietary regimen.
  • Close dietary follow-up after the patient's recovery helps prevent the recurrence of pellagra.

Complications

  • Dermatitis of pellagra can be distressing and disfiguring.
  • Denudation of the vesiculated and blistered skin lesions can potentially become infected secondarily.
  • Severe glossitis causes dysphagia.
  • GI tract involvement leads to a malabsorptive state.
  • Depression, anxiety, delusions, hallucinations, and coma are the neuropsychiatric complications observed in patients with pellagra.
  • The malnourished state associated with pellagra results in death if untreated.

Prognosis

  • If pellagra is diagnosed and treated appropriately, the prognosis for recovery is excellent.

Miscellaneous

Medicolegal Pitfalls

  • Individuals with pellagra who present with significant psychiatric manifestations and minimal skin involvement are at risk for misdiagnosis, which is a potential source of medical and/or legal liability.
 


More on Pellagra

Overview: Pellagra
Differential Diagnoses & Workup: Pellagra
Treatment & Medication: Pellagra
Follow-up: Pellagra
References
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References

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Further Reading

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Keywords

avitaminosis, niacin deficiency, vitamin deficiency, vitamin B-3 deficiency

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Contributor Information and Disclosures

Author

Vladimir Hegyi, MD, PhD, Associate Professor, Department of Pediatric Dermatovenereology, Pediatric Hospital, Comenius University, Bratislava
Vladimir Hegyi, MD, PhD is a member of the following medical societies: European Academy of Dermatology and Venereology
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

James Fulton Jr, MD, PhD, Medical Director, Fulton Skin Institute
James Fulton Jr, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Academy of Dermatology, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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