Pellagra

Pellagra (pelle agra) is a disease that occurs as a result of deficiency in the body of nicotinamide, tryptophan, 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 the pellagra develops due to the deficiency in the body of nicominamide (vitamin PP), vitamins of group B (B1, B2, B6) and other protein substances (tryptophan, leucine, isoleucine, etc.). Therefore, the disease occurs during periods of famine, war, natural elements in large numbers. Pellagra is also found in people or people whose corn diet is dominated by corn, since it contains a large amount of nicotinic acid, but this substance is in a related form and is therefore poorly absorbed from the intestine into the bloodstream. Sometimes with gastrointestinal diseases (chronic gastritis, colitis), alcoholism, giardiasis, acholia, liver cirrhosis, B group vitamins, vitamin PP and tryptophan are not fully or insufficiently absorbed

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

Reduction in the body of the above substances increases the sensitivity of the skin to the sun's rays.

Symptoms of Pellagra

Pellagra is manifested by the following classical triad: dermatitis; disruption of the gastrointestinal tract (diarrhea); neuromuscular activity (dementia). Pellagra is mainly observed in spring and summer. Initial clinical signs of pellagra appear as dermatitis in open areas of the body, on which the sun's rays fall. Dermatitis is manifested by edema of the skin, erythema, which have sharp and clear boundaries. Subjective patients are disturbed by severe itching and burning. Erythema, located on the lateral side of the palm or foot, fingers and hand, ends with a straight line. This clinical symptom resembles gloves (a symptom of "gloves"). Erythema and the border of the swollen focus on the skin of the neck also rises somewhat, as if separating it from the surrounding skin (the symptom of the "collar of Kozal"). Newly emerging pathological foci are dark red, red cherry, and old ones are brown, red-brown. Subsequently, in the center of the pathological focus begins peeling, which continues along the periphery of the focus. The skin is dry, its surface rough and atrophied, gradually infiltrated. If the pellagra flows heavily, bubbles appear on the hyperemic skin containing a cloudy or hemorrhagic fluid. The tongue, like a raspberry, is red, swollen, traces of teeth are visible on its lateral side. Papillae flat or completely disappear. Such a defeat of the language is called glossitis.

In patients who have a pellagra the appetite disappears or decreases, the abdomen is painful, diarrhea is observed. Violation of nerve-muscular activity occurs in the form of pellagrotic polyneuritis, depression, fear and dementia, accompanied by paresthesia and a decrease in the sensitivity of the skin. With mild disease, if there are no violations of gastrointestinal activity, the psyche of patients and the disease manifests itself only by dermatitis, this condition is called pellagroid erythema, or pellagroderma. Pellagra can last for years, accompanied by severe diarrhea and in clinical course resembles scurvy. In very severe disease, she can feign typhoid fever. Patients quickly die.

How is pellagra recognized?

The disease of pellagra should be distinguished from such similar in clinical course diseases as sunny dermatitis, porphyria, erysipelas, 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 at 4/10 ml intramuscularly or intravenously). Recommended vitamins of group B (B1, B2, B6, B12), ascorbic acid. The food ration should be rich in proteins. External apply corticosteroid ointments.