Dermatologic Manifestations of Pellagra Workup

Author: Vladimir Hegyi, MD, PhD; Chief Editor: Dirk M Elston, MD more...

Updated: May 15, 2012

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Laboratory Studies
Other Tests
Histologic Findings
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Laboratory Studies

The therapeutic response to niacin in a patient with the typical symptoms and signs of pellagra establishes the diagnosis.

Blood counts (anemia), findings of hypoproteinemia, higher levels of serum calcium and lower levels of serum kalium and phosphorus, liver function test results, and serum porphyrin levels can help in diagnosing pellagra.

Low serum niacin, tryptophan, NAD, and NADP levels can reflect niacin deficiency and confirm the diagnosis of pellagra.

Low urinary levels of N- methylnicotinamide and pyridone suggest niacin deficiency and support the diagnosis of pellagra. The combined excretion of N- methylnicotinamide and pyridone of less than 1.5 mg in 24 hours indicates severe niacin deficiency.

Other Tests

Order other medical examinations as needed (eg, neurologic, psychiatric examinations).

Histologic Findings

Nonspecific dermatitic changes are usually evident. Early changes include a perivascular lymphohistologic infiltrate in the upper dermis, with mild edema in the papillary dermis; dilatation of capillaries; and, later, dermal fibrosis. Epidermal changes include early subcorneal blisters; pallor of the upper epidermis; and, later, hyperkeratosis, parakeratosis, and epidermal atrophy. In recurrences in the same site, blisters (pemphigus pellagrosus) contain lymphocytes, neutrophils, and histiocytes.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Vladimir Hegyi, MD, PhD Associate Professor, Department of Pediatric Dermatovenereology, School of Medicine, Comenius University, Bratislava

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

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-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.

Specialty Editor Board

James Fulton Jr, MD, PhD Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC

James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation

Disclosure: Vivant Pharmaceuticals Grant/research funds Consulting

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside 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: 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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

References

Hegyi J, Schwartz RA, Hegyi V. Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol. Jan 2004;43(1):1-5. [Medline].
Rajakumar K. Pellagra in the United States: a historical perspective. South Med J. Mar 2000;93(3):272-7. [Medline].
Rille JH. Medizinische Gesellchaft Leipzig. Sitzug vom 16. November 1926. Ueber Pellegra (mit Lichtbildern). Dermatol Wochenschrift. 1927;6:189.
Elvehjem CA, Madden RJ, Strong FM, Woolley DW. Relation of nicotinic acid and nicotinic acid amide to canine black tongue. J Am Chem Soc. 1937;59:1767-68.
Murray MF. Niacin as a potential AIDS preventive factor. Med Hypotheses. Nov 1999;53(5):375-9. [Medline].
Murray MF, Langan M, MacGregor RR. Increased plasma tryptophan in HIV-infected patients treated with pharmacologic doses of nicotinamide. Nutrition. Jul-Aug 2001;17(7-8):654-6. [Medline].
Pitche P, Kombate K, Tchangai-Walla K. [Prevalence of HIV infection in patients with pellagra and pellagra- like erythemas]. Med Trop (Mars). 1999;59(4):365-7. [Medline].
Ladoyanni E, Cheung ST, North J, Tan CY. Pellagra occurring in a patient with atopic dermatitis and food allergy. J Eur Acad Dermatol Venereol. Mar 2007;21(3):394-6. [Medline].
Kertesz SG. Pellagra in 2 homeless men. Mayo Clin Proc. Mar 2001;76(3):315-8. [Medline].
Lorentzen HF, Fugleholm AM, Weismann K. [Zinc deficiency and pellagra in alcohol abuse]. Ugeskr Laeger. Dec 11 2000;162(50):6854-6. [Medline].
Lu JY, Yu CL, Wu MZ. Pellagra in an immunocompetent patient with cytomegalovirus colitis. Am J Gastroenterol. Mar 2001;96(3):932-4. [Medline].
Baquet S, Wuillaume F, Van Egmond K, Ibanez F. Pellagra outbreak in Kuito, Angola. Lancet. May 20 2000;355(9217):1829-30. [Medline].
Stratigos JD, Katsambas A. Pellagra: a still existing disease. Br J Dermatol. Jan 1977;96(1):99-106. [Medline].
Oztürk F, Koca R, Aydin M, Cantürk MT, Akpolat I, Küçüködük S. Pellagra: a sporadic pediatric case with a full triad of symptoms. Cutis. Jul 2001;68(1):31-4. [Medline].
Isaac S. The "gauntlet" of pellagra. Int J Dermatol. Aug 1998;37(8):599. [Medline].
Karthikeyan K, Thappa DM. Pellagra and skin. Int J Dermatol. Aug 2002;41(8):476-81. [Medline].
Stratigos AJ, Antoniou C, Papathanakou E, Daboudi M, Tranaka K, Tsara K, et al. Spectrum of idiopathic photodermatoses in a Mediterranean country. Int J Dermatol. Jun 2003;42(6):449-54. [Medline].
Brown TM. Pellagra: an old enemy of timeless importance. Psychosomatics. 2010;51(2):93-97. [Full Text].
Kapas I, Majtenyi K, Törö K, Keller E, Voigtländer T, Kovacs GG. Pellagra encephalopathy as a differential diagnosis for Creutzfeldt-Jakob disease. Metab Brain Dis. Jun 2012;27(2):231-5. [Medline].
Shah GM, Shah RG, Veillette H, Kirkland JB, Pasieka JL, Warner RR. Biochemical assessment of niacin deficiency among carcinoid cancer patients. Am J Gastroenterol. Oct 2005;100(10):2307-14. [Medline].
Nogueira A, Duarte AF, Magina S, Azevedo F. Pellagra associated with esophageal carcinoma and alcoholism. Dermatol Online J. 2009;15(5):8. [Full Text].
Reichman O, Sobel JD. Vulvovaginal pellagra and lichen sclerosus complicating carcinoid syndrome. Obstet Gynecol. 2009;113(2 Pt 2):543-545. [Full Text].
Kaimal S, Thappa DM. Diet in dermatology: revisited. Indian J Dermatol Venereol Leprol. Mar-Apr 2010;76(2):103-15. [Medline].

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