Dermatologic Manifestations of Pellagra Follow-up
- Author: Vladimir Hegyi, MD, PhD; Chief Editor: Dirk M Elston, MD more...
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.
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.
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.
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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