eMedicine Specialties > Pediatrics: General Medicine > Nutrition

Pellagra: Follow-up

Author: Simon S Rabinowitz, MD, PhD, Professor of Clinical Pediatrics, New York Medical College; Chairman, Chief and Medical Administrator, Department of Pediatrics, Chief, Pediatric Gastroenterology and Nutrition, Richmond University Medical Center
Coauthor(s): Sujana Reddy, MD, Staff Physician, Department of Pediatrics, Richmond University Medical Center, Staten Island; Kumaravel Rajakumar, MD, Assistant Professor, Department of Pediatrics, University of Pittsburgh School of Medicine; Consulting Staff, Children's Hospital of Pittsburgh and Magee Women's Hospital
Contributor Information and Disclosures

Updated: Aug 21, 2008

Follow-up

Further Inpatient Care

  • Patients with acute cases of pellagra require bed rest during the initial phase of treatment.
  • Patients with severe glossitis require a liquid or a soft solid diet to overcome the dysphagia.
  • Various high-calorie drinks rich in protein and B vitamins (including niacin).
  • Topical management of skin lesions with emollients may reduce discomfort.

Deterrence/Prevention

  • Avoid sun exposure during active phase of the disease.
  • Close dietary follow-up of the patient upon recovery helps prevent recurrence of pellagra.

Complications

  • Dermatitis of pellagra can be distressing and disfiguring. Denudation of the vesiculated and blistered skin lesions can potentially become secondarily infected.
  • Severe glossitis causes dysphagia.
  • GI involvement leads to a malabsorptive state.
  • Depression, anxiety, delusions, hallucinations, and coma are the neuropsychiatric complications observed among 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 and potential medical/legal liability.
  • Patients with alcoholism who have signs and symptoms of vitamin B deficiency need to be treated with a combination of B vitamins that contains niacin.
 


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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  2. Seal AJ, Creeke PI, Dibari F, Cheung E, Kyroussis E, Semedo P. Low and deficient niacin status and pellagra are endemic in postwar Angola. Am J Clin Nutr. Jan 2007;85(1):218-24. [Medline].

  3. Spivak JL, Jackson DL. Pellagra: an analysis of 18 patients and a review of the literature. Johns Hopkins Med J. Jun 1977;140(6):295-309. [Medline].

  4. Dumitrescu C, Lichiardopol R. Particular features of clinical pellagra. Rom J Intern Med. Apr-Jun 1994;32(2):165-70. [Medline].

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  6. Beretich GR Jr. Do high leucine/low tryptophan dieting foods (yogurt, gelatin) with niacin supplementation cause neuropsychiatric symptoms (depression) but not dermatological symptoms of pellagra?. Med Hypotheses. 2005;65(3):628-9. [Medline].

  7. 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].

  8. Tremeschin MH, Cervi MC, Camelo Junior JS, et al. Niacin nutritional status in HIV type 1-positive children: preliminary data. J Pediatr Gastroenterol Nutr. May 2007;44(5):629-33. [Medline].

  9. Creeke PI, Dibari F, Cheung E, et al. Whole blood NAD and NADP concentrations are not depressed in subjects with clinical pellagra. J Nutr. Sep 2007;137(9):2013-7. [Medline].

  10. Serdaru M, Hausser-Hauw C, Laplane D, et al. The clinical spectrum of alcoholic pellagra encephalopathy. A retrospective analysis of 22 cases studied pathologically. Brain. Aug 1988;111 ( Pt 4):829-42. [Medline].

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  12. Barness LA. Niacin deficiency. In: Nelson Textbook of Pediatrics. 14th ed. Philadelphia, PA: WB Saunders; 1992:137-8.

  13. Carpenter KJ. Pellagra. In: Benchmark Papers in Biochemistry. Vol 2. Stroudsburg, Pennsylvania: Hutchinson Ross Publishing Company; 1981:1-391.

  14. Etheridge EW. The Butterfly Caste: A Social History of Pellagra in the South. Wesport, CT: Greenwood Publishing Co; 1972:1-278.

  15. Goldsmith GA. Vitamin B complex. Thiamine, riboflavin, niacin, folic acid (folacin), vitamin B12, biotin. Prog Food Nutr Sci. 1975;1(9):559-609. [Medline].

  16. Greene HL. Disorders of the water-soluble vitamin B-complex and vitamin C. In: Suskind RM, Lewinter-Suskind L, eds. Textbook of Pediatric Nutrition. 1993:73-89.

  17. Hegyi J, Schwartz RA, Hegyi V. Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol. Jan 2004;43(1):1-5. [Medline].

  18. Hendricks WM. Pellagra and pellagralike dermatoses: etiology, differential diagnosis, dermatopathology, and treatment. Semin Dermatol. Dec 1991;10(4):282-92. [Medline].

  19. Jagielska G, Tomaszewicz-Libudzic EC, Brzozowska A. Pellagra: a rare complication of anorexia nervosa. Eur Child Adolesc Psychiatry. Oct 2007;16(7):417-20. [Medline].

  20. Marks HM. Epidemiologists explain pellagra: gender, race, and political economy in the work of Edgar Sydenstricker. J Hist Med Allied Sci. Jan 2003;58(1):34-55. [Medline].

  21. Sakai K, Nakajima T, Fukuhara N. A suspected case of alcoholic pellagra encephalopathy with marked response to niacin showing myoclonus and ataxia as chief complaints. No To Shinkei. Feb 2006;58(2):141-4. [Medline].

  22. Shah GM, Shah RG, Veillette H, et al. Biochemical assessment of niacin deficiency among carcinoid cancer patients. Am J Gastroenterol. Oct 2005;100(10):2307-14. [Medline].

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Further Reading

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Keywords

pellagra, nutritional wasting disease, niacin deficiency, tryptophan, Alpine scurvy, maidism, mal de la rosa, mal rosso, mayidism, psychoneurosis maidica, Saint Ignatius itch, Saint Ignatius' itch, maize, corn, dementia, black tongue, dermatitis, diarrhea, gastritis, gastric mucosal atrophy, malabsorptive state, failure to thrive, anxiety, depression, delusions, hallucinations, headaches, insomnia, stupor, acute pellagraphic encephalopathy, anorexia, angular stomatitis, colitis, enteritis, Casal necklace, facial seborrheic dermatitis, anorexia nervosa, Hartnup disease, liver cirrhosis, human immunodeficiency virus, HIV

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Contributor Information and Disclosures

Author

Simon S Rabinowitz, MD, PhD, Professor of Clinical Pediatrics, New York Medical College; Chairman, Chief and Medical Administrator, Department of Pediatrics, Chief, Pediatric Gastroenterology and Nutrition, Richmond University Medical Center
Simon S Rabinowitz, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, New York Academy of Sciences, North American Society for Pediatric Gastroenterology and Nutrition, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Sujana Reddy, MD, Staff Physician, Department of Pediatrics, Richmond University Medical Center, Staten Island
Sujana Reddy, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Kumaravel Rajakumar, MD, Assistant Professor, Department of Pediatrics, University of Pittsburgh School of Medicine; Consulting Staff, Children's Hospital of Pittsburgh and Magee Women's Hospital
Kumaravel Rajakumar, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American Society for Bone and Mineral Research, and American Society for Nutritional Sciences
Disclosure: Nothing to disclose.

Medical Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, State University of New York, Downstate Medical Center College of Medicine; Distinguished Lecturer, New York Medical College, School of Public Health
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Wyeth Grant/research funds Other; Med Immune Grant/research funds Other; Ovation  None

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Wyeth Grant/research funds Other; Med Immune Grant/research funds Other; Ovation  None

 
 
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