Pellagra is a condition caused by a deficiency of niacin, a B vitamin. It is called systemic disease, meaning it can affect your entire body.

It is characterised by a set of symptoms known as the “3 Ds”: dermatitis, diarrhea and dementia.

Without enough niacin, people develop a deficiency of tryptophan, another amino acid. Tryptophan is needed to make serotonin, a neurotransmitter that affects mood.

Pellagra can be treated with niacin supplements and changes to the diet. If left untreated, it can be fatal.

Types of Pellagra

It can be classified into three types: primary, secondary and tertiary.


Primary pellagra is the most common type and is caused by a lack of dietary niacin. Symptoms include skin lesions, diarrhea, depression and dementia.


Secondary pellagra is caused by an inability to absorb or metabolise niacin due to certain medical conditions, such as Crohn’s disease or liver disease. Symptoms are similar to those of primary pellagra.


Tertiary pellagra is caused by medications that interfere with niacin metabolism. It usually occurs in people taking isoniazid, an antibiotic used to treat tuberculosis. Symptoms may include confusion, fatigue and irritability.


The following are some of the symptoms of pellagra:

Skin rashes: Red, scaly patches that typically appear on the hands, arms, face and neck.

Mouth sores: Cracks and sores on the tongue, lips and inside of the mouth.

Diarrhea: Frequent, watery stools that can be accompanied by abdominal pain and cramping.

Fatigue: Constant tiredness and lack of energy.

Dementia: This can include confusion, memory loss and difficulty concentrating

Depression: Feelings of sadness, hopelessness and despair.

If you suffer from these symptoms, it’s important to speak to your ASAP.

With proper diagnosis and treatment, you can manage your symptoms and prevent any further complications.


Some of the common causes of pellagra include:

Malnutrition: People who do not have access to a balanced diet are at risk of developing pellagra due to lack of essential nutrients, including niacin.

Alcoholism: Excessive alcohol consumption can prevent the body from absorbing and utilising niacin, leading to a deficiency.

HIV/AIDS: HIV/AIDS can interfere with the absorption and utilisation of niacin, leading to a deficiency.

Certain medications: Some medications, such as isoniazid and hydralazine, can interfere with the absorption and utilisation of niacin, leading to a deficiency.

Intestinal disorders: Certain intestinal disorders, such as celiac disease and Crohn’s disease, can impede the absorption of niacin, leading to a deficiency.

Exposure to certain toxins: Such as some found in moldy corn and tobacco, which can interfere with the body’s use of niacin.


A diagnosis of pellagra is typically made through a combination of physical examination, medical history and laboratory tests.

Blood tests are used to evaluate levels of niacin, tryptophan (an amino acid that is the precursor to niacin) and other nutrients in the body.

Urine tests can also be used to check for levels of kynurenine, an amino acid that is produced when tryptophan is broken down in the body.

In some cases, a skin biopsy may be conducted to check for signs of the condition.

While these tests can provide important information about the presence and severity of pellagra, they are not always necessary and should only be used when indicated.


Treatment of pellagra typically involves replenishing the body’s niacin levels.

Niacin can be obtained through dietary sources such as meat, fish, nuts and dairy products.

If dietary sources are not sufficient, a doctor may prescribe niacin supplements.

In addition, it is important to treat any other associated symptoms. For example, if the patient suffers from insomnia or depression, those should be addressed as well.

With proper treatment, pellagra can be cured and most symptoms can be alleviated.

Is Pellagra Preventable?

Yes, pellagra is preventable by ensuring that you get enough niacin in your diet.

The best way to do this is to make sure you are eating a balanced diet with plenty of whole grains, fruits, vegetables and lean proteins.

Niacin is also found in some fortified foods like breakfast cereals, so make sure to check the label for nutritional information.

For foods rich in niacin, click here.

Additionally, some people may require additional niacin from supplements, so it’s a good idea to talk to your doctor if you think you may be deficient.

By following these steps, you can help prevent pellagra and make sure your body has the nutrients it needs to stay healthy.


If you have a question related to this blog post, write to us here and we will update this post with a response.

Sources: National Library of Medicine, Medical News Today, Healthline, The Lancet Global Health, Cleveland Clinic, AOCD, DermNet, MedScape, ScienceDirect, MSD Manual and Med India.

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