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</div><div><span>Pellagra</span></div></div>
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<article><div id="d-article"><div class="page-info"><div class="page-title"><a name="start" id="start">
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</a><h1 class="with-also" itemprop="name">Pellagra</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Pellagra is a disease that occurs when a person does not get enough <a test="test" href="./002409.htm">niacin</a> (one of the B complex vitamins) or <a test="test" href="./002332.htm">tryptophan</a> (an amino acid).</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>Pellagra is caused by having too little niacin or tryptophan in the diet. It can also occur if the body fails to absorb these nutrients. </p><p>Pellagra may also develop due to:</p><ul><li>Gastrointestinal diseases</li><li>Weight loss (bariatric) surgery</li><li>Anorexia</li><li>Excessive alcohol use</li><li><a test="test" href="./000347.htm">Carcinoid syndrome</a> (group of symptoms associated with carcinoid tumors of the small intestine, colon, appendix, and bronchial tubes in the lungs)</li><li>Certain medicines, such as isoniazid, 5-fluorouracil, 6-mercaptopurine, pyrazinamide, hydantoin, ethionamide, phenobarbital, azathioprine, and chloramphenicol</li></ul><p>Pellagra is most common among poor and food-limited populations. The disease is more common in parts of the world (such as certain parts of Africa) where people have a lot of untreated corn in their diet. Corn is a poor source of tryptophan, and niacin in corn is tightly bound to other components of the grain. Niacin is released from corn if soaked in limewater overnight. This method is used to cook tortillas in Central America where pellagra is rare. Pellagra is rare in the United States and may be associated with severe alcoholism or medical causes of malnutrition.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Symptoms of pellagra include:</p><ul><li>Delusions or mental confusion</li><li><a test="test" href="./003126.htm">Diarrhea</a></li><li>Weakness</li><li>Loss of appetite</li><li>Pain in abdomen</li><li>Inflamed mucous membrane</li><li>Scaly skin sores, especially in sun-exposed areas of the skin</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>Your health care provider will perform a physical exam. You will be asked about the foods you eat.</p><p>Tests that may be done include urine tests to check if your body has enough niacin. Blood tests may also be done.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>The goal of treatment is to increase your body's niacin level. You will be prescribed niacin supplements. You may also need to take other supplements. Follow your provider's instructions exactly on how much and how often to take the supplements.</p><p>Symptoms due to the pellagra, such as skin sores, will be treated.</p><p>If you have conditions that are causing the pellagra, these will also be treated. </p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>People often do well after taking niacin.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>Left untreated, pellagra can result in nerve damage, particularly in the brain and death. Skin sores may become infected.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Contact your provider if you have any symptoms of pellagra.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Prevention</h2></div><div class="section-button"><button type="submit" aria-controls="section-8" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-8"><p>Pellagra can be prevented by following a well-balanced diet. </p><p>Get treated for health problems that may cause pellagra. </p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Vitamin B3 deficiency; Deficiency - niacin; Nicotinic acid deficiency</p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Images</h2></div><div class="section-button"><button type="submit" aria-controls="section-tnails" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/24429t.jpg" alt="Vitamin B3 deficit" title="Vitamin B3 deficit" class="side-img"/><a href="../imagepages/18103.htm">Vitamin B3 deficit</a></li>
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</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Elia M, Lanham-New SA, Kok K. Nutrition. In: Feather A, Randall D, Waterhouse M, eds. <em>Kumar and Clarke's Clinical Medicine.</em> 10th ed. Philadelphia, PA: Elsevier; 2021:chap 33.</p><p>Meisenberg G, Simmons WH. Micronutrients. In: Meisenberg G, Simmons WH, eds. <em>Principles of Medical Biochemistry.</em> 4th ed. Philadelphia, PA: Elsevier; 2017:chap 31.</p><p>So YT. Deficiency diseases of the nervous system. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. <em>Bradley and Daroff's Neurology in Clinical Practice.</em> 8th ed. Philadelphia, PA: Elsevier; 2022:chap 85.</p></div></div></section>
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<section><div class="section"><div class="section-header"><div class="section-title"><h2>Review Date 10/25/2022</h2></div><div class="section-button"><button type="submit" aria-controls="section-version" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<div id="section-version" class="section-body"><p>Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.</p>
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