Pellagra causes and treatments

Pellagra is a disease that occurs due to a deficiency of vitamin B3, otherwise known as niacin. It can cause many symptoms, but the most common are diarrhea, dermatitis, and dementia. Without diagnosis and treatment, pellagra can be life-threatening. Here are the risk factors and treatment options.

Definition of pellagra

Pellagra is a disease that occurs when a person does not get enough niacin, or vitamin B3. There are two types of pellagra: primary and secondary. Primary pellagra results from an insufficient intake of niacin in the diet, while secondary pellagra develops when the body is unable to absorb niacin. Niacin is found in animal protein, fruits and vegetables . The body can also make niacin from essential amino acids. The body acquires these amino acids from other foods, such as chicken and sunflower seeds. Primary pellagra is more common in places where people have a corn-based diet because the niacin in corn is in the form of niacetin, which people cannot digest and absorb. Certain conditions, such as alcohol use disorders and HIV, prevent the body from absorbing niacin and can cause secondary pellagra.

Main symptoms of pellagra

Pellagra causes gastrointestinal, skin and neurological problems. The main symptoms are:

– diarrhea
– inflammation of the skin
– dementia

Gastrointestinal symptoms

The most common gastrointestinal problem is diarrhea. Diarrhea is the passing of loose, watery stools at least three times a day. Diarrhea can lead to dangerous dehydration and ultimately malnutrition, as it can affect the absorption of nutrients from food. It is also often the first symptom of pellagra to appear.

Other gastrointestinal symptoms are:

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– vomitings
– abdominal pain
– nausea
– indigestion
– decreased appetite
– mouth ulcers
– swelling of the tongue

Dermatological symptoms

Pellagra-related dermatitis often causes thickened, scaly skin, rashes, and discoloration. Doctors refer to the appearance of these symptoms around the neck as a necklace. The affected area of ​​skin may become sensitive to light and look like a sunburn. Other dermatological symptoms include cheilitis, which results in cracking and inflamed corners of the mouth, and angular palpebritis, which causes redness and cracking in the corners of the eyelids.

Neurological symptoms

Certain neurological disorders, such as anxiety and depression, are early symptoms of pellagra. As pellagra progresses, sufferers may experience symptoms of dementia, including:

– memory loss
– delusions
– confusion
– in some cases, psychosis

The three main symptoms of alcoholic pellagra involve the brain and nerves. Those are :

– intermittent confusion
– stiff and difficult to use muscles
– exaggerated startle reactions
– Without treatment, pellagra can be life-threatening and cause death.

Causes and risk factors for the occurrence of pellagra

The underlying causes of primary and secondary pellagra are different. Primary pellagra occurs when a person’s diet is low in niacin. People most at risk for primary pellagra are those whose diet is based primarily on corn. It is very rare in developed countries, where manufacturers routinely fortify flour with niacin. A person who cannot absorb vitamin B-3, despite a diet high in niacin, may develop secondary pellagra. An important risk factor for secondary pellagra is alcohol use disorder.

Alcohol use disorder can cause pellagra through malnutrition. A person may not eat enough foods containing niacin, and alcohol may prevent the body from absorbing it. Alcohol can also prevent certain proteins from turning into niacin, which increases the risk of developing pellagra. However, alcohol-induced pellagra often goes unnoticed because its presentation is similar to that of alcohol withdrawal delirium.

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Other risk factors for secondary pellagra include Trusted Source:

– malnutrition due to homelessness, anorexia, HIV or terminal cancer
– Crohn’s disease
– Hartnup’s disease
– dialysis
– certain drugs, such as isoniazid for tuberculosis
– carcinoid syndrome, a set of symptoms due to carcinoid tumors.

Pellagra Treatment

A doctor will be able to diagnose pellagra if diarrhea, dermatitis, and dementia are all present simultaneously. However, the disease can be more difficult to diagnose if these symptoms do not appear at the same time. A doctor can test the person’s urine and blood to check for niacin deficiency as well as other abnormalities associated with pellagra.

Primary pellagra can be treated by eating a diet rich in niacin. Meat, eggs, fish, and legumes, such as peas and lentils, are high in niacin. However, a doctor will likely prescribe vitamin supplements to help a person regain healthy niacin levels. Treatment for secondary pellagra is similar, but doctors will also treat the underlying cause. Symptoms should begin to improve quickly. Doctors can prescribe high doses of niacin for 5 days, and the person will usually see their symptoms improve within 2 days.

The RDA of niacin is:

14-16 milligrams (mg) per day for adults.
18 mg per day for pregnant or breastfeeding women
6-16 mg per day for people under 18 years old.


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