Pellagra: Causes, Risk Factors, Symptoms, Treatment


Pellagra is a disease condition caused by low levels of vitamin B3 (Niacin), which is marked by “The three D’s “( Dermatitis, Dementia, Diarrhoea). Pellagra can be fatal if left untreated. Pellagra occurred mainly in the U.S. which belong to low socioeconomic groups. They used corn ( maize ) produced in the New World as their dietary staple. It was thought that mold or toxic substance was the cause. Later lack of nitrogen was implicated. Corn diets lack lysine and tryptophan but are rich in the essential amino acid leucine. This led to speculation that an amino acid imbalance was the cause. The skin symptoms of pellagra are aggravated by exposure to sunlight which led to the belief that it resulted from sun poisoning. It was considered to be an infectious disease because it was common among poor people. The fact that several members of the same family often developed the disease, led some people to suspect hereditary factors were involved. In 1917 a physician named Goldberger working for the United States Public Health Service demonstrated that pellagra was associated with the absence of a specific dietary factor. Goldberger conducted a series of classic experiments on a group of male prisoners who were put on a diet typical of the areas in which pellagra was prevalent. After five months they developed classic symptoms of pellagra like dermatitis, diarrhea, and depression other inmates eating normal prison diets remained healthy. He proved that it was not an infectious disease but implicated the lack of some unknown dietary factor. That factor, niacin was not properly identified until 20 years later. The Efforts to isolate The dietary factor that could prevent pellagra war complicated because many other dietary deficiencies produce similar skin conditions. In 1937 Elvehjem at the University of Wisconsin, finally demonstrated that nicotinic acid could cure black tongue in dogs. This led to the use of nicotine acid to treat pellagra in human beings with dramatic results. The typical clinical features are loss of weight and increasing debility. pellagra has been called the disease of the 3D’s: dermatitis, dementia, and diarrhea ( irreversible organic deterioration of mental faculties) leading to death, that is 4th D . Diarrhea and mental changes are not present in mild deficiency. The mental symptom is usually depression and not dementia nonspecific Signs such as anorexia, digestive disturbance, nausea, and emotional changes like irritability anxiety and insomnia may precede the onset of the disease.

If you suspect you or someone else is experiencing Pellagra, it is crucial to seek immediate medical attention by calling emergency services or consult with a Nutritionist.


Pellagra are of two types primary and secondary pellagra Primary pellagra can be caused by lack of tryptophan or niacin in diet .Tryptophan can be converted to niacin in the body so not getting enough tryptophan can cause niacin deficiency. Secondary pellagra occurs when our body can’t absorbs niacin .The general causes which prevent our body from absorbing niacin are: GI diseases ,such as ulceration colitis & crohns disease, Alcoholism, cirrhosis of liver , eating disorders, certain medications, including immunosuppressive drugs & anticonvulsants

Risk Factors

Risk factors includes staple diet, which is poor in niacin ( Indian millet, maize or jowar ) , human immunodeficiency virus ((HIV ) , Eating disorders, medications such as (carbamazepine,isoniazid, pyrazinamide, carbidopa, chloramazepine, phenobarbital, phenytoin), alcohol abuse etc .


3 D’s ( dermatitis, dementia & diarrhoea) niacin deficiency is mostly noticeable in our body parts like gastrointestinal track and our skin Dermatitis causes rashes on lips, face, hands & feets & sometimes around the neck , which is known as casal necklace. The others symptoms includes: burning patches of skin, itchy,red, flaky skin , discoloration ranges from red to brown. Scaly , crusty, thick or cracked skin , apathy, depression etc

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Biochemical tests to confirm the diagnosis are urinary N’ - methyl nicotinamide or red cell NAD, blood counts, hypoproteinemia, higher levels of serum calcium, serum porphyrin levels , serum porphyrin levels , liver function test results.


Pellagra can be cured by a good diet containing adequate amount of protein, tryptophan and /or niacin as well as other members of B- complex group of vitamins. A moderately severe case requires nicotinic acid or amide in doses of 100 - 300 mg/day orally. Mental symptoms respond within 24 -48 hours and dermal lesions required t3-4 weeks of therapy. Most cases of pellagra require riboflavin and pyridoxine particularly for neurological manifestations. Oral therapy is satisfactory in all cases except in those with very severe diarrhea.

Preventive Measures

Pellagra can be prevented by the following measures: • Consuming sorghum with good quality proteins. • Replacing sorghum with other serials. • Distribution of yeast and niacin tablets as public health program. • Fortifying bread with niacin. • Developing low leucine strains of sorghum. • Including groundnuts in everyday diet.

Do's & Don’t's

Do's Don't
Consume foods rich in niacin (B3) Avoid excessive alcohol consumption
Eat a balanced diet with whole grains, meat, fish Don't rely solely on a few food groups
Include vegetables like mushrooms, avocados Avoid prolonged exposure to sunlight
Seek medical attention for symptoms Don't self-diagnose and delay medical consultation
Take niacin supplements if prescribed Don't ignore symptoms of pellagra
Protect skin from direct sunlight Avoid diets lacking in essential nutrients

If you suspect you or someone else is experiencing Pellagra, it is crucial to seek immediate medical attention by calling emergency services or consult with a Nutritionist.

Frequently Asked Questions
Pellagra is a disease caused by a deficiency of niacin (vitamin B3) in the diet. It primarily affects the skin, digestive system, and nervous system.
Symptoms include skin rash, diarrhea, dementia, and in severe cases, death. The classic symptoms are often referred to as the "4 Ds": dermatitis, diarrhea, dementia, and death.
Pellagra is caused by a deficiency of niacin, which can result from inadequate dietary intake of niacin or tryptophan, a precursor of niacin.
Niacin is found in a variety of foods, including meat, fish, poultry, whole grains, and legumes. It can also be synthesized in the body from the amino acid tryptophan, which is present in protein-rich foods.
Pellagra is more likely to occur in populations with limited access to a diverse diet, particularly those whose primary food sources lack niacin. It can be associated with conditions such as poverty, alcoholism, and certain gastrointestinal disorders that affect nutrient absorption.
Diagnosis is often based on clinical symptoms and dietary history. Blood tests may be conducted to measure niacin levels and confirm the deficiency.
Yes, pellagra is treatable and preventable. Treatment involves niacin supplementation through diet or supplements. Improvement in symptoms is usually observed within a few days to weeks.
Yes, pellagra can be prevented by maintaining a balanced diet that includes sufficient amounts of niacin-rich foods. In some cases, dietary supplements may be recommended, especially for individuals at higher risk.
If left untreated, pellagra can lead to severe complications, including permanent neurological damage and, in extreme cases, death.
Pellagra is rare in developed countries due to the availability of a diverse and well-balanced diet. However, it can still occur in certain populations with limited access to nutritious food.
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