Pellagra

Pellagra is a dermatitis resulting from niacin and/or tryptophane deficiency (in persons whose staple food is sorghum; patients with malabsorption, or during famine).

Clinical features

Classically, disease of the ‘three Ds’: dermatitis, diarrhoea and dementia.

• Dark red plaques, well demarcated, symmetric, located on exposed areas of the body (forehead, neck, forearms, legs). The skin becomes very scaly, pigmented, sometimes with haemorrhagic bullae.
• Gastrointestinal (glossitis, stomatitis and diarrhoea) and neuropsychiatric symptoms are seen in more serious forms.

Treatment

• nicotinamide (vitamin PP) PO [1] Citation 1. World Health Organization, United Nations High Commissions for Refugees. Pellagra and its prevention and control in major emergencies. World Health Organization, 2000.
  http://www.who.int/nutrition/publications/en/pellagra_prevention_control.pdf [Accessed 23 May 2018]

Children and adults: 100 mg 3 times daily, give with a diet rich in protein until the patient is fully cured.

• In the event of an epidemic of pellagra, for example in a refugee camp, it is vital that the food ration be modified (add groundnuts or dry vegetables) in order to meet the daily requirements (approximately 15 mg daily for adults).