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Pellagra is a nutritional wasting illness caused by a deficiency of niacin (Vitamin B3) and tryptopan, in the body.

Niacin plays an important part in cell respiration, where both nutrients and oxygen are absorbed by the body for the storage and production of energy. Niacin can be found in yeast, meat, fish, liver, breads, legumes and whole grain cereals. An adult requires at least 15 - 20mg of niacin daily. Tryptopan, meanwhile, is an essential amino acid that can also be found in meat, fish, poultry, fish, eggs and some dairy products, like milk.

Pellagra is prevalent among regions whose primary food source is untreated maize, which is a poor source of niacin and tryptopan. Areas in rural South America, whose staple food is corn, and Africa, with its cases of malnutrition, are examples of these places.


Pellagra is also seen in regions where sorghum, or millet is a staple in the diet. This type of grain contains large amounts of leucine, which prevent tryptophan from metabolizing, which in turn interferes with the synthesis of niacin in the body.

Although Pellagra is rare in countries who consume a balance diet, it used to be a big health concern in the United States between 1906 to 1940 when 3 million people acquired the disease, of which 100,000 died from severe symptoms. This was true in the rural areas of the South like Mississippi and Alabama, where people's diet consisted mainly of pork fatback, molasses and cornmeal. It was also noted jails and orphanages during that period, and it is still a problem in third world countries where malnutrition and a lack of niacin-rich foods are absent.


There are two kinds of Pellagra. Primary Pellagra results from a niacin-poor diet. This is also true for people who are hospitalized and are unable to eat, who have to rely on vitamin-deficient intravenous fluids for feeding. Secondary Pellagra can occur even when there is sufficient niacin in the diet. These cases are seen in ailments whose primary symptoms include diarrhea and ulcerative colitis; people who suffer from chronic alcoholism and cirrhosis of the liver; patients who have long-term use of isoniazid, an anti-tuberculosis medication, and azatioprine; patients who suffer from malignant carcinoid tumors, and those who have acquired Harnup disease, a genetic disorder which prevent the intestines and kidney from absorbing amino acids like tryptopan.

Pellagra is called a “disease of the four D's” because of its accompanying symptoms: diarrhea, dermatitis (a scaly skin rash), dementia, and if left untreated, death. Symptoms of the disease are more pronounced in adults than they are in infants and very young children.


Other symptoms of Pellagra include a high sensitivity when exposed to sunlight; irritability and aggression; red skin lesions and rashes; mouth ulcers; poor appetite, nausea and vomiting; restlessness, anxiety and insomnia; tremors, delusions and mental confusion; seizures; weakness; ataxia (a balance disorder); headaches; depression; stupor, and glossitis (a tongue infection accompanied by inflamation).

At its most severe, Pellagra sufferers experience encepalopathic syndrome which is characterized by stiffness and inability to move their arms and legs, altered states of consciousness, and involuntary grasping and sucking motions.
Image: Pellagra

People who have the highest risk for the disease include those who live in poverty and have poor nutrition; chronic alcoholics; people who are constantly on fad diets or those whose personal or religious beliefs allow them to eat only certain types of food; patients whose bodies suffer from poor absorption of nutrients; patients undergoing prolonged isoniazid therapy; Hartnup disease sufferers; patients diagnosed with cirrhosis of the liver or diabetis mellitus; those who suffer from long-standing diarrhea or a febrile illness; people suffering from malnutrition, and HIV-positive patients.

A diagnosis of Pellagra can be determined by an examination of the sufferer's collective symptoms and by taking a closer look at the person's diet. When there are only very few symptoms present, the doctor can diagnose Pellagra by measuring a patient's vitamin B deficiency in terms of the amounts of thiamine, riboflavin, pyridoxine, cobalamin and niacin deficiency in their bodies through a sample of their urine.


To treat Pellagra, supplements of niacinamide (a form of niacin) can be given via injection or orally. As soon as symptoms have been reduced, the patient will still need to take niacin, B-complex and polyvitamin supplements as maintenance, and to take steps to incorporate foods rich in protein and Vitamin B into their diets.

To treat the skin lesions, dermatitis and rashes that accompany the disease, the doctor may prescribe a topical ointment or emollient, and the use of sunscreen to remedy sunlight sensitivity. Patients suffering from the Pellagra symptom glossitis will require a liquid or semi-solid diet until they their tongues fully recover.

For severe cases, the patient is advised to take a mandatory bed rest and to avoid sun exposure while recovering. It will also be more difficult to treat secondary Pellagra due to the underlying conditions and causes of the disease.


Pellagra is completely preventable with a balanced diet containing foods rich in protein and niacin, like meats, peanuts, milk, green leafy vegetables, and whole grains. There are also Vitamin B supplements and brewer's yeast tablets available for people who are on a strict diet.

In areas where corn or maize is the primary staple, it will help to diversify the diet with additional foods rich in B vitamins, like fortified cereal-legume blended meals, or rice and wheat. However, in parts of the world where poverty or famine is present, Pellagra becomes an unavoidable disease.

If left untreated, Pellagra will result in death after 4 to 5 years, usually from complications of the disease which include infections, advanced malnutrition, blood loss from gastrointestinal bleeding, multi-organ failure, or encephalopathic syndrome at its most severe. In secondary Pellagra, failure of the intestines and kidney to absorb nutrients (malabsorptive state) will result in a failure to thrive, and eventually, to death.

The amount and length of niacininamide treatments, whether orally or intravenously, will depend on the number of symptoms and how far the disease has progressed.

There have been findings published stating that Pellagra is a rare secondary complication of the eating disorder, anorexia nervosa. Patients diagnosed with anorexia have been found to exhibit symptoms of sunlight sensitivity, glossitis and stomatitis.
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