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Pellagra: what it is, symptoms, causes and treatment

Pellagra is a rare disease caused by a deficiency of vitamin B3, also known as niacin, in the body, which can cause changes in the skin, diarrhea and neurological changes, such as headache, mental confusion and memory loss, for example.

The deficiency of this vitamin may happen due to the low consumption of foods rich in this vitamin, or it may be a consequence of malabsorption of vitamin B3 in the intestine, which may be due to Crohn’s disease, for example. Thus, it is important that the cause of the pellagra is identified so that it is possible to start the most appropriate treatment, which may involve changes in eating habits and the use of vitamin B3 supplements, for example.

Pellagra symptoms

Pellagra can be characterized by the triad of symptoms: dermatitis, diarrhea and dementia, which do not necessarily happen in that order, in addition to being able to occur at different intensities between people. In general, the main symptoms that can be indicative of pellagra are:

  • Symmetrical lesions on the skin that is more exposed to the sun;
  • Redness on the face, with a pattern similar to the butterfly wing;
  • Foot injuries that do not involve the area of ​​the foot that is usually surrounded by flip-flops;
  • Redness and itching on the back of the hand;
  • Presence of blisters on the skin;
  • Thickening and darkening of the skin;
  • Cracks in the feet, which can cause pain when walking;
  • Vomiting;
  • Headache;
  • Mental confusion and disorientation;
  • Memory loss;
  • Changes in mood.

In the presence of these symptoms, it is important that the doctor is consulted so that tests can be done to help confirm the diagnosis and start the most appropriate treatment, because if this is not done, it is possible that the person will start to present delusions and evolve to a coma and then death due to multiple organ failure.

Thus, to confirm the diagnosis of pellagra, the doctor may indicate the performance of urine and blood tests, in addition to imaging tests and skin biopsy to rule out other diseases in which the same symptoms may be present.

Possible causes

According to the cause, pellagra can be classified into two main types:

  • Primary pellagra, which happens due to insufficient consumption of foods rich in niacin and tryptophan, which is an amino acid that is converted to niacin in the body;
  • Secondary pellagra, which happens due to changes in the absorption of vitamin B3 in the body, which may be due to excessive alcohol consumption, medication use, Crohn’s disease, malnutrition, cirrhosis and dialysis, for example.

In addition, some types of cancer can also favor the development of pellagra, as they can directly interfere with the metabolism of tryptophan, which is not converted into niacin.

How the treatment is done

The treatment for pellagra should be guided by the doctor and nutritionist according to the cause of vitamin B3 deficiency and symptoms presented by the person. Thus, the use of nutritional supplements, such as niacinamide and nicotinic acid in combination with other B vitamins, may be indicated, in a dosage that must be determined by the doctor, depending on the person’s health status.

In addition, it is recommended to increase consumption of foods rich in tryptophan, such as cheese, cashews, almonds, eggs, peas and avocados, for example, as well as foods rich in vitamin B3, such as chicken, fish, sesame seeds, tomatoes and peanuts.

It is also important to treat the disease that causes niacin deficiency and / or to change lifestyles that may contribute to the decrease of this vitamin, as is the case of excessive alcohol use, inappropriate use of certain medications or dieting low in vitamins.

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