Pellagra: Symptoms, Diagnosis & Treatment

Pellagra, also known as vitamin B3 (niacin) deficiency, results due to inadequate consumption of the vitamin. Vitamin B3 plays an essential role in our body functions. It helps the body convert energy from the foods we eat, as well as improving our nervous system and skin health.

If left untreated, it could be fatal, and can kill within four or five years of getting the condition. 

On the other hand, the entire disease and symptoms can be prevented by continuous healthy consumption of vitamin B3 (niacin) in foods, or by taking supplements as prescribed by a doctor.

Pellagra is a disease chatacterized by the three (3) D’s; Diarrhea, Dermatitis & Dementia. It occurs most commonly in the developing countries, specifically sub-Saharan Africa.



Types and Causes

There are two main types of pellagra, primary and secondary. The cause varies depending on the type.

Primary pellagra occurs as a result of not having enough niacin and tryptophan in the diet.

 Secondary pellagra can be caused due to:

  • Inbility to use niacin from diet.
  • Chronic alcoholism.
  • Long-term diarrhea.
  • Carcinoid syndrome.
  • Hartnup disease.
  • Some medications eg. isoniazid.





The symptoms are usually in accordance with that of diarrhea, dermatitis and dementia. They include:


  • Loose watery stool.
  • Poor appetite.
  • Abdominal discomfort.
  • Nausea and vomiting.



  • Rash on the face, lips, feet, or hands.
  • Itchy, burning patches of skin.
  • Casal necklace (or casal collar is dermatitis formed around the neck).
  • Red, flaky skin.
  • Sores on the lips, tongue, or gums.
  • Areas of discoloration, ranging from red to brown.
  • Thick, crusty, scaly, or cracked skin.



  • Headache.
  • Poor appetite.
  • Difficulty eating or swallowing. 
  • Depression.
  • Apathy.
  • Confusion, irritability, or mood changes.
  • Restlessness or anxiety.
  • Delusions.





There are no specific test for diagnosing pellagra because it causes a range of symptoms. This makes it difficult to diagnose. Diagnosis is typically based on symptoms and may be assisted by urine testing.




Treatment involves adequate dietary intake of niacin. High doses of niacin or nicotinamide supplements could be the next best treatment option should diet fail to correct symptoms.

However the therapy should also include other B vitamins, zinc and magnesium.

Topical ointments may help reduce  skin discomfort. Decrease exposure to sunlight and proper clothing is important while the skin heals. 









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