Pellagra: Symptoms, Causes, and Treatment Options

What is Pellagra?

Pellagra is a medical condition resulting from niacin or vitamin B3 deficiency. Niacin plays a pivotal role in cell functioning throughout our body. Insufficient intake or absorption of this nutrient can trigger symptoms in various parts of the body, including the skin, mouth, bowels and even the brain. If left untreated, pellagra can cause an irreparable damage to your nervous system and could be fatal.

Pellagra is most prevalent in populations with limited access to diverse diets, especially those that rely heavily on corn, which is low in bioavailable niacin. An effective pellagra prevention method involves ensuring adequate dietary intake of niacin-rich foods, such as meat, fish, and legumes. While it is rare in developed countries due to better nutrition and food fortification, pellagra remains a significant health issue in some developing regions where malnutrition is common.

What is Niacin and What do I Need it for?

Niacin or vitamin B3 aids in converting food calories into energy. The niacin we consume gets absorbed through the small intestine into our body tissues where it gets transformed into a coenzyme called nicotinamide adenine dinucleotide (NAD). This coenzyme plays a crucial role in over 400 different enzymatic reactions in our body.

NAD helps convert the energy potential in macronutrients, carbohydrates, proteins, and fats, into ATP (adenosine triphosphate), the form of energy that our cells can utilise. It also partakes in specific cellular functions like DNA repair and cellular communication.

How Does Niacin Deficiency Affect my Body?

The paucity of NAD due to niacin deficiency most visibly impacts parts of the body with high energy requirements or cell turnover rates. These include your skin, gastrointestinal tract lining (mucous lining), and your brain. Therefore, classic pellagra symptoms are the "3 Ds": diarrhoea, dermatitis, and dementia. In some cases, a fourth "D" is added for death as it could be the final result if pellagra is left untreated for several years.

Diarrhoea (Gastrointestinal Mucositis)

Diarrhoea in pellagra occurs when the mucous lining of the intestines fails to regenerate fast enough. This deficiency can lead to improper digestion and increase susceptibility to inflammation. Chronic inflammation may affect the mucous lining along with your entire gastrointestinal tract, causing symptoms such as stomach pain, indigestion, mouth sores, and a red, swollen tongue

Dermatitis (Skin Photosensitivity)

People with pellagra often experience a distinctive type of dermatitis on the sun-exposed areas of the body, such as the face, neck, arms, legs, hands, and feet. This dermatitis start as rashes resembling sunburns but further progresses into rough, scaly, hyperpigmented plaques over time. One of the distinguishing signs of pellagra is a dark collar around the neck, known as 'Casal's collar.

Dementia (Brain and Nerve Damage)

Pellagra affects the body systemically as cells lack the energy they need. Over time, this deficiency can impact the brain and nervous system, leading to symptoms like lethargy, apathy, difficulty concentrating or anxiety and depression. As it progresses, symptoms may worsen into confusion and delusions. In severe cases, pellagra can cause permanent dementia and neurological damage, leading to balance problems and muscle tremors.

Where is Pellagra Most Commonly Found?

History

Historically, pellagra was common in impoverished populations around the world where protein was limited and corn was a staple food. This includes areas such as Europe, Africa, Asia, and the Southern United States.

In Central and South America, where corn was also a staple, people used a traditional method of making corn tortillas by soaking corn in limewater overnight. This process made the niacin in corn more absorbable and as a result, pellagra was rarely seen in these populations.

However, in the early 1900s, pellagra was so rampant in the Southern United States that it led to a congressional investigation into the disease. This investigation discovered that pellagra was due to a poor diet, (published in 1923) and later the missing nutrient was identified as niacin.

Current Day

Today, pellagra is rare in industrialised countries like the United States because bread and cereal products are fortified with niacin. However, primary pellagra still exists in the lesser developed regions, especially among tribal populations t where corn is still the staple diet. It is most commonly found today in India, China, and sub-Saharan Africa.

What are the Symptoms of Pellagra?

The primary pellagra symptoms are dermatitis, dementia and diarrhoea.

Dermatitis

This often manifests as a rash on sun-exposed areas such as face, lips, feet or hands. Some people may also show a "Casal necklace," which is dermatitis around the neck.

Other symptoms include:

• Red, flaky skin
• Areas of discolouration
• Thick, crusty or cracked skin
• Itchy, burning patches of skin

Dementia

Early signs of dementia due to pellagra may include apathy, depression, confusion, or mood changes. As the condition progresses one may experience headaches, restlessness or anxiety and even disorientation or delusions.

Other possible pellagra symptoms include:

• Sores on lips, tongue or gums
• Decreased appetite
• Trouble eating and drinking
• Nausea and vomiting

What are the Causes of Pellagra?

Pellagra is primarily caused by a deficiency of niacin (vitamin B3) or tryptophan, an amino acid that the body converts into niacin. There are two main types of pellagra: primary and secondary.

• Primary pellagra occurs due to inadequate dietary intake of niacin or tryptophan, often seen in populations that rely on corn as a staple food. Corn contains niacytin, which is not well absorbed unless it is processed correctly, resulting in nutritional deficiencies.
• Secondary pellagra arises when the body cannot absorb niacin effectively, which may be due to conditions like alcoholism, gastrointestinal diseases (such as Crohn's disease), or certain medications. These factors disrupt the absorption of nutrients, ultimately leading to pellagra symptoms.

Understanding these pellagra causes is important for developing an effective prevention strategies such as promoting a balanced diet rich in niacin and addressing any underlying health issues that might affect nutrient absorption. Effective Pellagra prevention focuses on ensuring adequate dietary intake and managing conditions that can lead to nutrient deficiencies.

How is Pellagra Diagnosed?

Your healthcare provider will check your symptoms and ask about your medical history and diet. If they think you might have pellagra, they may order a urine test to confirm it. This test looks at certain chemicals in your urine to see if you have enough niacin. They might also give you niacin supplements to see if that helps your symptoms.

What is the Cure for Pellagra?

Treatment for primary pellagra involves dietary changes and using niacin or nicotinamide supplements, which could be given orally or intravenously. Many people can make a full recovery and start feeling better within a few days of starting treatment early.

Treatment for secondary pellagra usually focuses on addressing the underlying cause. However, some cases of secondary pellagra also respond well to oral or intravenous niacin or nicotinamide supplementation.

While recovering from either primary or secondary pellagra, it's important to keep any rashes moisturised and protected with sunscreen.

Are there any Side Effects to the Treatment?

If you follow the prescribed dosage of the supplements, you usually won’t experience any side effects. However, some people might experience reactions like skin flushing or upset stomach. While side effects can arise from overdosing, it’s generally challenging to do so when addressing a deficiency.

How Do you Prevent Pellagra?

To prevent pellagra, it's crucial to consume a balanced diet rich in niacin. Foods like lean meats, fish, nuts, whole grains and fortified cereals are good sources of this nutrient. It's also advised to limit alcohol consumption as it interferes with the body's ability to absorb niacin.

How Long Does it Take to Recover from Pellagra?

The recovery time from pellagra can vary depending on how long the condition has been present and the severity of the symptoms. With early treatment, many people start feeling better within a few days of starting treatment. However, skin improvement might take a few months.

Conclusion

Pellagra, while rare in developed countries, remains a serious health issue in populations that rely heavily on corn as a dietary staple and have low niacin intake. Understanding the pellagra causes, symptoms, and pellagra treatment options is essential for managing this condition effectively.

At Metropolis Healthcare, we are committed to delivering accurate diagnostic services and preventive health check-ups that empower you to take charge of your health. Our skilled technicians offer convenient at-home sample collection for testing at our advanced diagnostic labs. Test reports are conveniently shared online, ensuring you have access to reliable healthcare data whenever needed!