Pellagra

Pellagra (pelle agra - rough, rough) is a disease that occurs as a result of a deficiency in the body of nicotinamide, tryptophan, and vitamins belonging to group B. If the clinical manifestations of the disease were first described by the Spanish doctor G. Casal (1735), then the Italian doctor F. Frappoli called the disease pellagra.

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What causes pellagra?

There are scientific facts that pellagra develops due to deficiency of nicotinamide (vitamin PP), B vitamins (B1, B2, B6) and other protein substances (tryptophan, leucine, isoleucine, etc.) in the body. Therefore, the disease occurs in large numbers during periods of famine, war, and natural disasters. Pellagra also occurs in nations or people whose diet is dominated by corn, since it contains a large amount of nicotinamide, but this substance is in a bound form and therefore is poorly absorbed from the intestine into the blood. Sometimes, with gastrointestinal diseases (chronic gastritis, colitis), alcoholism, giardiasis, acholia, cirrhosis of the liver, B vitamins, vitamin PP and tryptophan are not completely or insufficiently absorbed.

Pellagra in a patient suffering from liver cirrhosis (symptom of "glove") in the body. As a result, secondary pellagra occurs.

A decrease in the above-mentioned substances in the body increases the skin's sensitivity to sunlight.

Symptoms of Pellagra

Pellagra manifests itself with the following classic triad: dermatitis; gastrointestinal tract dysfunction (diarrhea); neuromuscular dysfunction (dementia). Pellagra is mainly observed in spring and summer. The initial clinical signs of pellagra manifest themselves as dermatitis on open areas of the body exposed to sunlight. Dermatitis manifests itself as skin edema, erythema, which have sharp and distinct boundaries. Subjectively, patients are bothered by severe itching and burning. Erythema, located on the lateral side of the palm or foot, fingers and hand, ends in a straight line. This clinical symptom resembles gloves (the "glove" symptom). Erythema and the border of the swollen lesion on the skin of the neck are also somewhat elevated, as if separating it from the surrounding skin (the "Kozal collar" symptom). Newly appeared pathological lesions are dark red, the color of red cherry, and old ones are brown, red-brown. Subsequently, peeling begins in the center of the pathological focus, which continues along the periphery of the focus. The skin is dry, its surface is rough and atrophic, gradually infiltrating. Leucorrhea pellagra proceeds severely, and blisters containing turbid or hemorrhagic fluid appear on the hyperemic skin. The tongue, like a raspberry, is red, swollen, and teeth marks are visible on its lateral side. The papillae of the tongue are flat or disappear entirely. Such a lesion of the tongue is called glossitis.

Patients with pellagra lose or decrease their appetite, their stomach is painful, and they have diarrhea. Neuromuscular dysfunction occurs in the form of pellagrotic polyneuritis, depression, anxiety, and dementia, accompanied by paresthesia and decreased skin sensitivity. In mild cases, if gastrointestinal dysfunction or mental disorders are not detected and the disease manifests itself only as dermatitis, this condition is called pellagroid erythema, or pellagroderma. Pellagra can last for years, is accompanied by severe diarrhea, and its clinical course resembles scurvy. In very severe cases, it can simulate typhoid fever. Patients die quickly.

How is pellagra recognized?

Pellagra should be distinguished from such similar clinical diseases as solar dermatitis, porphyria, erysipelas, and Hartnup disease.

Treatment of pellagra

Pellagra is treated in a complex manner. Nicotinic acid is used in the form of tablets (0.1 g. 3-4 times a day) or injections (1-2% solution is administered 4/10 ml intramuscularly or intravenously). Vitamins of group B (B1, B2, B6, B12) and ascorbic acid are recommended. The diet should be rich in proteins. Corticosteroid ointments are applied externally.