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Pellagra is a disorder brought on by a deficiency of the nutrient called niacin or nicotinic acid, one of the B-complex vitamins.


Nicotinic acid plays a crucial role in the cellular process called respiration. Respiration is the process by which nutrients (specifically sugar, or glucose) and oxygen are taken in, chemical reactions take place, energy is produced and stored, and carbon dioxide and wastes are given off. This process is absolutely central to basic cell functioning, and thus the functioning of the body as a whole.
Niacin is a B vitamin found in such foods as yeast, liver, meat, fish, whole-grain cereals and breads, and legumes. Niacin can also be produced within the body from the essential amino acid called tryptophan. Dietary requirements for niacin depend on the age, gender, size, and activity level of the individual. Niacin requirements range from 5 mg in infants up to 20 mg in certain adults.

Causes and symptoms

Pellagra can be either primary or secondary. Primary pellagra results when the diet is extremely deficient in niacin-rich foods. A classic example occurs in geographic locations where Indian corn (maize) is the dietary staple. Maize does contain niacin, but in a form which cannot be absorbed from the intestine (except when it has been treated with alkali, as happens in the preparation of tortillas). People who rely on maize as their major food source often develop pellagra. Pellagra can also occur when a hospitalized patient, unable to eat for a very prolonged period of time, is given fluids devoid of vitamins through a needle in the vein (intravenous or IV fluids).
Secondary pellagra occurs when adequate quantities of niacin are present in the diet, but other diseases or conditions interfere with its absorption and/or processing. This is seen in various diseases that cause prolonged diarrhea, with cirrhosis of the liver and alcoholism, with long-term use of the antituberculosis drug called isoniazid, in patients with malignant carcinoid tumor, and in patients suffering from Hartnup disease (an inherited disorder which results in disordered absorption of amino acids from the intestine and kidney).
Pellagra causes a variety of symptoms affecting the skin; mucous membranes (moist linings of the mouth, organs, etc.); central nervous system (including the brain and nerves); and the gastrointestinal system. The classic collection of symptoms includes redness and swelling of the mouth and tongue, diarrhea, skin rash, and abnormal mental functioning, including memory loss. While early patients may simply have a light skin rash, over time the skin becomes increasingly thickened, pigmented, and may slough off in places. Areas of the skin may become prone to bacterial infection. The mouth and tongue, and sometimes the vagina, become increasingly thick, swollen, and red. Abdominal pain and bloating occur, with nausea and vomiting, and bloody diarrhea to follow. Initial mental changes appear as inability to sleep (insomnia), fatigue, and a sense of disconnected-ness (apathy). These mental changes progress to memory loss, confusion, depression, and hallucinations (in which the individual sees sights or hears sounds that do not really exist). The most severe states include stiffness of the arms and legs, with resistance to attempts to move the limbs; variations in level of consciousness; and the development of involuntary sucking and grasping motions. This collection of symptoms is called "encephalopathic syndrome."


Diagnosis is purely based on the patient's collection of symptoms, together with information regarding the patient's diet. When this information points to niacin deficiency, replacement is started, and the diagnosis is then partly made by evaluating the patient's response to increased amounts of niacin. There are no chemical tests available to definitively diagnose pellagra.

Key terms

Niacinamide — A form of niacin, which is usually used as a dietary supplement for people with insufficient niacin.
Respiration — Respiration is the process by which nutrients (specifically sugar, or glucose) and oxygen are taken in to a cell; chemical reactions take place; energy is produce and stored; and carbon dioxide and wastes are given off.


Treatment of pellagra usually involves supplementing the individual's diet with a form of niacin called niacinamide (niacin itself in pure supplementation form causes a number of unpleasant side effects, including sensations of itching, burning, and flushing). The niacinamide can be given by mouth (orally) or by injection (when diarrhea would interfere with its absorption). The usual oral dosage is 300-500 mg each day; the usual dosage of an injection is 100-250 mg, administered two to three times each day. When pellagra has progressed to the point of the encephalopathic syndrome, a patient will require 1,000 mg of niacinamide orally, and 100-250 mg of niacinamide by injection. Once the symptoms of pellagra have subsided, a maintenance dose of niacin can be calculated, along with attempting (where possible) to make appropriate changes in the diet. Because many B-complex vitamin deficiencies occur simultaneously, patients will usually require the administration of other B-complex vitamins as well.


Untreated pellagra will continue progressing over the course of several years, and is ultimately fatal. Often, death is due to complications from infections, massive malnutrition brought on by continuous diarrhea, blood loss due to bleeding from the gastrointestinal tract, or severe encephalopathic syndrome.


Prevention of pellagra is completely possible; what is required is either a diet adequate in niacin-rich foods, or appropriate supplementation. However, in many geographic locations in the world such foods are unavailable to the general population, and pellagra becomes an unavoidable complication of poverty.



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 [pĕ-la´grah, pĕ-lag´rah]
a syndrome caused by a diet seriously deficient in niacin (or by failure to convert tryptophan to niacin). Most persons with pellagra also suffer from deficiencies of riboflavin (vitamin B2) and other essential vitamins and minerals. adj., adj pellag´rous.

Pellagra occurs in many areas of the world. In the early 1900s it was the major form of acute vitamin deficiency in the southeastern United States. It is now no longer a problem because of enrichment of cereal, grain, and bread products. Pellagra also occurs in persons suffering from alcoholism and drug addiction.
Symptoms. Chief symptoms of pellagra are various skin, digestive, and mental disturbances. The mouth becomes inflamed and the tongue red and sore; cracks and sores appear in the skin around the mouth. The skin on the back of the hands may become red, thick, and scaly, as may that of the neck and chest, areas exposed to sunlight and the chafing of clothes. Vomiting and loss of appetite occur. Diarrhea often appears early and becomes worse as the disease progresses, thus hampering treatment by preventing effective absorption of essential vitamins. Mental symptoms are variable. In some cases, there may be only insomnia and minor depression. In other cases, the sufferer may become stuporous, or on the contrary become violent and irrational. Headache, irritability, and general anxiety may also be present.
Treatment. Treatment of pellagra consists of an improved diet, often combined with large doses of niacinamide. In acute cases, niacinamide must be administered by injection and must be accompanied by large doses of other vitamins. The diet should include meat (particularly liver), whole grain cereals, and peanuts, all of which are especially good sources of niacin. In severe cases of pellagra, bed rest is required. Skin lesions are treated with antibiotics.


(pĕ-lag'ră, pĕ-lā'gră),
An affection characterized by gastrointestinal disturbances, erythema (particularly of exposed areas) followed by desquamation, and by nervous and mental disorders; may occur because of a poor diet, alcoholism, or some other disease impairing nutrition; commonly seen when corn (maize) is a main nutrient in the diet, resulting in a deficiency of niacin.
[It. pelle, skin, + agra, rough]


/pel·lag·ra/ (pĕ-lag´rah) a syndrome due to niacin deficiency (or failure to convert tryptophan to niacin), marked by dermatitis on parts of the body exposed to light or trauma, inflammation of the mucous membranes, diarrhea, and psychic disturbances.pellag´rous


(pə-lăg′rə, -lā′grə, -lä′-)
A disease caused by a deficiency of niacin and protein in the diet and characterized by skin eruptions, digestive and nervous system disturbances, and eventual mental deterioration.

pel·lag′rous adj.


[pəlā′grə, pəlag′rə]
Etymology: It, pelle, skin, agra, rough
a disease resulting from a deficiency of niacin or tryptophan or a metabolic defect that interferes with the conversion of the precursor tryptophan to niacin. It once was commonly seen in individuals whose diet consisted primarily of corn, which is low in tryptophan. It is characterized by scaly dermatitis, especially of the skin exposed to the sun; glossitis; inflammation of the mucous membranes; diarrhea; and mental disturbances, including depression, confusion, disorientation, hallucination, and delirium. Treatment and prophylaxis consist of administration of niacin and tryptophan, usually in conjunction with other vitamins, particularly thiamine and riboflavin, and a well-balanced diet containing foods rich in these nutrients, such as liver, eggs, milk, and meat. Kinds of pellagra are pellagra sine pellagra and typhoid pellagra. Compare kwashiorkor. pellagrous, adj.
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Dermatitis caused by pellagra


A deficiency of niacin (nicotinic acid) caused by alcoholism or malnutrition, which is characterised by anorexia, glossitis, gastrointestinal disorders, headaches, insomnia, bilateral symmetrical scaly rashes, polyneuropathy, confusion, depression, pseudodementia and psychotic symptoms.


Niacin deficiency, nicotinic acid deficiency Nutrition A deficiency of niacin–nicotinic acid, a B vitamin, due to alcoholism or malnutrition Clinical Anorexia, glossitis, GI disorders, headaches, insomnia, bilateral symmetrical scaly rashes, inflammation of skin, vagina, rectum, mouth, polyneuropathy, confusion, depression, pseudodementia, psychotic Sx. See Niacin.


An affection characterized by diarrhea, dermatitis, and dementia due to dietary deficiency of nicotinic acid (niacin).
[It. pelle, skin, + agra, rough]


A disease caused by deficiency of the B vitamin NIACIN. It may occur in alcoholics who derive their entire caloric needs from alcohol. The disease features DIARRHOEA, a sunburn-like blistering and cracking skin disorder (dermatitis) and, in severe cases, brain involvement leading to delirium and eventual DEMENTIA. Pellagra responds dramatically to niacin by mouth or injection often within a day or two.




niacin (nicotinic acid) deficiency (e.g. in chronic alcoholism)


Disease characterized by gastrointestinal disturbances, erythema (particularly of exposed areas) followed by desquamation, and by nervous and mental disorders; may occur due to poor diet, alcoholism, or some other disease impairing nutrition.
[It. pelle, skin, + agra, rough]

pellagra (pəlā´grə, pəlag´rə),

n a nutritional deficiency resulting from faulty intake or metabolism of nicotinic acid, a vitamin B complex factor. It is characterized by glossitis, dermatitis of sun-exposed surfaces, stomatitis, diarrhea, and dementia. Thiamine, riboflavin, and tryptophan deficiencies may be associated.


a syndrome in humans caused by a diet seriously deficient in niacin (or by failure to convert tryptophan to niacin). In dogs called blacktongue. See also niacin nutritional deficiency.

feline pellagra
ulcerative stomatitis, especially of the tongue, and conjunctivitis.