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Dermatologic Manifestations of Pellagra Follow-up

  • Author: Vladimir Hegyi, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 22, 2016
 

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.

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Deterrence/Prevention

Primary prevention is as follows:

  • 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 is as follows:

  • 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.
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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.

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Prognosis

If pellagra is diagnosed and treated appropriately, the prognosis for recovery is excellent. Untreated pellagra results in death from multiorgan failure. The morbidity of pellagra is related to its effects on the organ systems involved.

Dermatitis tends to be pruritic, often with a painful burning sensation during the acute phase, although patients may be asymptomatic. The skin eventually becomes hypopigmented, and some patients consider this disfiguring.

Systemic effects of the disease include malaise, apathy, weakness, and lassitude. GI tract involvement leads to a malabsorptive state and a subsequent failure to thrive.

Neurologic manifestations include anxiety, depression, delusions, hallucinations, and stupor.

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Contributor Information and Disclosures
Author

Vladimir Hegyi, MD, PhD Professor, Institute of Clinical and Experimental Dermatovenereology, Slovak Republic

Vladimir Hegyi, MD, PhD is a member of the following medical societies: European Academy of Dermatology and Venereology, Slovakian Dermatovenerological Society, European Dermatology Forum

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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