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What is pellagra?

Pellagra is a disease characterised by diarrhoea, dermatitis and dementia. If left untreated, death is the usual outcome. It occurs as a result of niacin (vitamin B-3) deficiency. Niacin is required for most cellular processes. Since tryptophan in the diet can be converted to niacin in the body, both of these need to be deficient for pellagra to develop.

How common is pellagra?

Please discuss with your doctor for further information.


What are the symptoms of pellagra?

The common symptoms of pellagra are:

  • Thick, scaly pigmented rash on skin exposed to sunlight
  • Swollen mouth and bright red tongue
  • Vomiting and diarrhea
  • Headache
  • Apathy
  • Fatigue
  • Depression
  • Disorientation
  • Memory loss

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes pellagra?

Pellagra is caused by a deficiency in niacin. This can occur in 2 ways:

  • Primary pellagra results from inadequate niacin and/or tryptophan in the diet (mainly in developing countries or poverty stricken areas)
  • Secondary pellagra occurs when there is enough niacin in the diet but something prevents its absorption and processing. Causes of secondary pellagra include:
    • Chronic alcoholism
    • Prolonged diarrhoea
    • Gastrointestinal diseases such as ulcerative colitis
    • Liver cirrhosis
    • Carcinoid tumours
    • Hartnup disease (tryptophan metabolism disorder)
    • Drugs e.g. isoniazid, azathioprine

Risk factors

What increases my risk for pellagra?

Please discuss with your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is pellagra diagnosed?

After niacin has been processed it can be excreted in the urine. The products detected in the urine include nicotinic acid, niacin oxide and metabolites including 2-pyridone and 2-methyl nicotinamide.

The latter two metabolites can be measured to assess niacin deficiency (low levels will be present).

RBC levels of NAD/NADP can also be useful in the diagnosis.

How is pellagra treated?

Pellagra can be effectively cured with intravenous or oral niacin or nicotinamide.

An improvement in primary pellagra should be seen within two days of commencing treatment. A high protein diet supplemented with B-group vitamins is needed for complete recovery. Secondary pellagra may be harder to treat in view of its possible causes.

Skin lesions may be treated with topical emollients. Sun protection is important during the recovery phase. Cover up and apply a broad spectrum sunscreen to all exposed areas daily.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage pellagra?

The following lifestyles and home remedies might help you cope with pellagra:

  • The recommend daily allowance (RDA) for niacin is 16 milligrams per day for men and 14 milligrams per day for women. Good sources of niacin include red meat, fish, poultry, fortified breads and cereals, and enriched pasta and peanuts.
  • If you don’t eat a lot of niacin-rich foods or if you have a medical condition that affects the absorption of niacin or tryptophan, speak to your doctor. Niacin supplements or multivitamin/mineral supplements, which usually contain at least 20 milligrams of niacin, can help prevent niacin deficiency.
  • Supplements of niacin such as nicotinic acid or nicotinamide are approved by the FDA for treating and preventing niacin deficiency. Under the supervision of a doctor, high doses of over-the-counter or prescription niacin or nicotinic acid can be used to treat high cholesterol, including high triglycerides. The most common side effect of niacin supplementation is flushing. Other side effects include nausea, vomiting, pruritus, hives, abnormally high liver enzymes, and constipation. However, too much nicotinic acid or niacin can be harmful. Avoid taking more than your doctor prescribes or recommends. If you are taking doses of more than 100 milligrams per day, doctors recommend periodic liver function tests.
  • If you have a history of gout, you should be careful with how much niacin you consume because it is also known to elevate serum uric acid concentration.

If you have any questions, please consult with your doctor to better understand the best solution for you.

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