Everything You Need To Know About Pellagra

Overview | Causes | Types | Symptoms |  Risks factors | Diagnosis | Treatment | Tips | Summary |

What Is Pellagra?

Pellagra is a disorder prominently caused due to the deficiency of Vitamin B3, also known as niacin and nicotinic acid. And It is also considered a ‘disease of 4 D’s’. so These 4 D’s are as follows:

  • Diarrhoea – frequently loose motions and its other symptoms.
  • Dermatitis – A scaly rash on the skin exposed to light or trauma
  • Dementia – mental disorientation including depression
  • Death

All these together can accurately describe the pellagra. If not diagnosed and treated, pellagra can be life-threatening. but Pellagra affects your digestive system, skin, nerves, etc.

Pellagra comes from the Latin words ‘pelle’ and ‘agree; which means rough skin.

Pellagra can vary from mild to severe when it comes to severity level. and Its signs and symptoms can be constant or appear periodically. If left untreated, it can be fatal and life-threatening, can even lead to death.

You may be wondering that what is niacin?

Well, niacin is prepared by amino acids in our body. and Niacin is also found in animal proteins, fruits, vegetables, chicken and sunflower seeds, etc.

Causes Of Pellagra:

Things that can prevent your body from absorbing niacin are as follows —

  • Deficiency of Vitamin B3 or niacin in your diet  
  • Non-consumption of rich sources of niacin such as veggies, fruits and seafood etc.
  • Alcohol consumption
  • Eating disorders
  • Malnutrition
  • Certain medications, such as immunosuppressive drugs etc.
  • Anorexia
  • Gastrointestinal diseases such as ulcerative colitis etc.
  • HIV
  • Cirrhosis of liver
  • Last stage of cancer
  • Hartnup disease
  • Crohn’s disease
  • Dialysis
  • Certain drugs
  • Carcinoid tumours etc.

Types Of Pellagra:

  • Primary Pellagra – This type of pellagra develops due to lack of niacin or vitamin B3 in your diet. This type is more common than secondary. Non-consumption of seafood, green vegetables, meat ajd eggs lead to primary pellagra.
  • Secondary Pellagra – Secondary pellagra develops when you consume enough amount of niacin in your diet, but due to any condition, your body becomes unable to absorb the consumed niacin. For example,

Some conditions including alcohol consumption, any type of digestive disorder, HIV etc. Creates hindrance and makes it unable to absorb by the body, and results in pellagra. Tryptophan, and gastrointestinal diseases.

Those individuals who are alcoholics, or suffering from malnutrition have a high risk of getting secondary pellagra.

Symptoms Of Pellagra:

Pellagra causes gastrointestinal, skin, and neurological issues. All these have different symptoms with respect concerning.

Still, the common symptoms are as follows —

  • Diarrhoea
  • Dementia
  • Lethargy
  • Dermatitis
  • Headache
  • Skin inflammation
  • Weakness

Gastrointestinal Symptoms Are —

  • Diarrhoea (most common)
  • Severe dehydration
  • Malnutrition
  • Nausea
  • Vomiting
  • Abdominal pain
  • Indigestion
  • Decreased appetite
  • Oral ulcers
  • Tongue swelling

Dermatological Symptoms Are —

  • Thickened, crusty, cracked and scaly skin
  • Rashes on face, lips, hands and feet
  • Skin discolouration, ranging from brown to red
  • Itchy and burning discolouration of the skin
  • Casals collar
  • Skin sensitivity
  • Appearance and sensation of sunburn of the affected area
  • Cheilitis (cracking and inflammation of the corners of the mouth)
  • Mucus membrane inflammation
  • Angular palpebritis (redness in the eyelids corners)

Neurological Symptoms Are —

  • Anxiety
  • Depression
  • Irritability
  • Apathy
  • Difficulty in writing, thinking, reading, and talking
  • Memory loss
  • Mood swings
  • Confusion
  • Delusions
  • Psychosis (in some rare cases)  
  • Headaches

Alcohol-Induced Pellagra Has Symptoms That Relate To The Brain Are As Follows —

  • Intermittent confusion
  • Stiffness of muscles
  • Exaggerated startle responses

Symptoms That Need Urgent Medical Treatment Or Help—

  • Serious psychological conditions
  • Alcohol withdrawal
  • Suicidal thoughts

Risks Factors:

  • Malnutrition
  • Alcoholism
  • HIV
  • Anorexia nervosa
  • Last stage of cancer
  • Diet high in corn
  • Dialysis
  • Digestive disease
  • Hartnup disease
  • Low dietary intake of tryptophan
  • Crohn’s disease
  •  Certain drugs
  • Carcinoid syndrome

Diagnosis Of Pellagra:

Diagnosis of pellagra is not an easy task, in fact, it is quite difficult. Because there are no specific tests to which can help to diagnose pellagra or deficiency of niacin, and its range of symptoms is quite wide.

Still, if you go for a diagnosis, your doctor will begin with the gastrointestinal problems check-ups along with any mental state issue or change in your mental state. Urine tests and blood tests can also be conducted.

If your doctor suspects your condition of pellagra, he/she will give you some niacin supplements to check whether your symptoms are responding to the supplements or not.

However, alcohol-induced pellagra often goes undetected, because its presentation is similar to that of alcohol withdrawal delirium.

Treatment Of Pellagra:

Your doctor will be able to recognize and diagnose pellagra if you have diarrhea, dementia, and dermatitis; all at the same time or simultaneously.

To treat primary pellagra, you must have a diet rich in niacin. Meat, eggs, fruits, veggies, fish, legumes, lentils, peas, etc. Are a rich source of niacin. Apart from it, your doctor can also prescribe you some vitamin and niacin or nicotinamide supplements to help you regain healthy levels of niacin. Nicotinamide is another form of vitamin B3.

When it comes to secondary pellagra, the treatment would be the same but along with the treatment of that underlying cause which prevents your body from absorbing the niacin present in your body.

On taking treatment, one can get improve quickly.  Your doctor may prescribe high doses of niacin for 5 days and you can observe the improvement in your condition within 2 days.

With early diagnosis and treatment, one can easily get rid of pellagra your improvement will begin in just a few days after the treatment begins. Skin improvement may need few months. However, if left untreated, pellagra can be the cause of your death within four or five years of the beginning of pellagra.


  • Follow your treatment plans precisely and take all medications on time, as prescribed.
  • Keep your skin rashes moisturized and away from sunlight for sure 
  • Eat niacin rich food like meat, fruits,  cereals, milk, fish etc.
  • Eat tryptophan-rich foods, as tryptophan plays a role in the production of niacin.
  • Follow such diet which includes a variety of foods from each group, to make sure the intake of all essentials.
  • Avoid alcohol.


Pellagra is a disorder caused due to deficiency of niacin prominently. Primary pellagra occurs when one consumes a niacin-deficient diet, while the second type of pellagra – secondary pellagra occurs when one consumes a niacin-rich diet bit his/her body fails to absorb niacin due to some underlying health conditions. By getting proper treatment, one can easily be fit and fine. But if not treated, it can even lead to one death.


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