II. Causes
- Primary Pellagra
- Inadequate Niacin and Tryptophan intake (from meat, dairy, eggs and certain plants)
- Secondary Pellagra (conditions interfering with absorption or metabolism or Tryptophan or Niacin)
- Anorexia Nervosa
- Chronic Diarrhea
- Chronic Alcoholism
- Most common cause of Pellagra in the United States
- Chronic colitis or ileitis (e.g. Inflammatory Bowel Disease) resulting in malabsorption
- Cirrhosis
- Hartnup Disease
- HIV Infection
- Malignant Carcinoid Tumor
- Medications
- Isoniazid (Niacin analog)
- Pyrazinamide
- Phenobarbitone
- 6-Mercaptopurine
- Fluorouracil
- Phenytoin
- Azathioprine
III. Pathophysiology
- Results in decreased NAD production
- Dermatitis results from poor healing in response to UV light exposure
- May be exacerbated by other B Vitamin Deficiencies
IV. Symptoms
- Abdominal Pain
- Anorexia
- Fatigue
- Nausea or Vomiting
- Watery Diarrhea (Steatorrhea)
- Constipation
- Mucous membrane inflammation may also be present
VI. Signs: Dermatitis
- May be absent despite neurologic changes (esp. chronic Alcoholism)
- Early (wet Pellagra)
- Sunburn-like skin dermatitis
- Erythema in sun exposed areas progresses to overlying vessicles or bullae
- Later
- Scaly, symmetric red-brown Skin Discoloration involving face, neck (casal necklace), extensor hands/Forearms
- Dull red discoloration of nose with yellow Scaling
- Other skin and mucosal findings
VII. Signs: Neurologic changes
- Ataxia
- Confusion or Memory Loss
- Major Depression
- Photophobia
- Peripheral Neuropathy
VIII. Labs
- Avoid lab testing (treat empirically based on symptoms, signs)
- Serum Levels (e.g. Niacin, Tryptophan) are typically unreliable
- Urine metabolites (e.g. N-methylnicotinamide, 2-pyridone) are unreliable
IX. Management
- Precautions
- Replacement of other B Vitamins without B3 replacement may exacerbate pellegra encepholopathy
-
Vitamin B3 replacement
- Observe for rapid improvement in symptoms after starting replacement
- Initial
- Niacinamide 50 mg orally every 6 hours until major signs and symptoms resolve
- Next
- Niacinamide 50 mg orally every 8-12 hours until skin lesions resolve
X. Complications
XI. References
- Jhun et al. in Herbert (2016) EM:Rap 16(9): 8-10
- Rendon et al. (2017) Crit Dec Emerg Med 31(6): 15-21
- Ghosh (2013) Am Fam Physician 88(7):457-458 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | A disease due to deficiency of NIACIN, a B-complex vitamin, or its precursor TRYPTOPHAN. It is characterized by scaly DERMATITIS which is often associated with DIARRHEA and DEMENTIA (the three D's). |
| Concepts | Disease or Syndrome (T047) |
| MSH | D010383 |
| ICD9 | 265.2 |
| ICD10 | E52 |
| SnomedCT | 56550003, 238127001, 267491008, 154725000, 418186002, 418279001 |
| English | Pellagra, Pellagras, PELLAGRA, NIACIN DEFICIENCY <PELLAGRA>, Niacin deficiency [pellagra], pellagra, pellagra (diagnosis), NIACIN DEFICIENCY PELLAGRA, Pellagra [Disease/Finding], deficiencies niacin, deficiency niacin, nicotinamide deficiency, pellagra disorder, vitamin b3 deficiency, Niacin (-tryptophan) deficiency, niacin deficiency, deficiency; niacin, deficiency; nicotinamide, deficiency; nicotinic acid, niacin; deficiency, nicotinamide; deficiency, nicotinic acid deficiency, nicotinic acid; deficiency, Niacin-tryptophan deficiency, Niacin deficiency, Nicotinamide deficiency, Nicotinic acid deficiency, Vitamin PP deficiency, Vitamin B3 deficiency, Pellagra (disorder), Niacin deficiency (disorder) |
| Spanish | deficiencia de niacina, deficiencia de nicotinamida, deficiencia de vitamina B3, deficiencia de ácido nicotínico, pelagra (trastorno), pelagra, deficiencia de niacina (trastorno), deficiencia de vitamina PP, hipovitaminosis PP, Déficit de ácido nicotínico, Pelagra |
| Italian | Carenza di acido nicotinico, Pellagra |
| Dutch | pellagra, deficiëntie; niacine, deficiëntie; nicotinamide, deficiëntie; nicotinezuur, niacine; deficiëntie, nicotinamide; deficiëntie, nicotinezuur; deficiëntie, Niacinedeficiëntie [pellagra], nicotinezuurdeficiëntie, Pellagra, Niacinedeficiëntie |
| French | Pellagra, Carence en niacine, Carence en vitamine B3, Carence en vitamine PP, Carence en acide nicotinique, Pellagre |
| Japanese | ペラグラ, ニコチン酸欠乏, ﾆｺﾁﾝｻﾝｹﾂﾎﾞｳ, ﾍﾟﾗｸﾞﾗ |
| Swedish | Pellagra |
| Czech | pelagra, Pelagra, Deficit kyseliny nikotinové |
| Finnish | Pellagra |
| Russian | PELLAGRA, ПЕЛЛАГРА |
| German | Niazinmangel [Pellagra], Nikotinsaeuremangel, Pellagra |
| Korean | 니아신 결핍증[펠라그라] |
| Polish | Hipowitaminoza PP, Pelagra |
| Hungarian | Pellagra, Nicotinsav hiány |
| Norwegian | Pellagra |
| Portuguese | Carência de ácido nicotínico, Pelagra |
