The 4D’s of Pellagra

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Let’s begin with some background info about Pellagra and Niacin…

The word “pellagra” they say is of Italian origin and means “rough skin” which most likely is referring to the dermatitis that is one of the characteristic symptoms of the disease. It is a disease of Niacin deficiency. Niacin is also referred to as Vitamin B3, one of the B complex vitamins.

Interesting fact alert! If like me you’ve ever wondered why and how the B complex vitamins got allocated their numbers, for instance, why is niacin B3 and not B1? Well, I read somewhere that it’s because Niacin was the third B complex vitamin to be discovered and so was allocated the number 3. Are you in awe? Lol!

Niacin is one of those very important vitamins needed by vital organ systems to function especially the nervous system, the digestive system, and the skin. It can also be used as a treatment for dyslipidemia because it’s able to increase high-density lipoprotein (HDL) levels.

Examples of the foods with the highest concentrations of niacin include:

  • Meats such as pork, beef, chicken, turkey, and lamb. Liver is also pretty high up on the list
  • Fish especially anchovies, salmon, mackerel, tuna, rainbow trout and herring
  • Plant sources include peanuts, mushrooms, avocado, and green peas.

Pellagra can present in the following ways:

  • Dermatological: Dermatitis that is typically a rash along the C3/C4 dermatomes (broad collar rash), and also on the face and extremities especially the parts that are normally exposed to the sun
  • Gastrointestinal: nausea, vomiting, constipation, diarrhea, and glossitis
  • Neurological: headaches, dementia, hallucinations, delusions, delirium, depression, ataxia, seizures and peripheral neuritis
  • Death if untreated.

To make things easy for you,  here’s the popular mnemonic used to remember the 4 main clinical manifestations of pellagra.


Featured image credit:

Dr Wendy Evans-Uhegbu

The author Dr Wendy Evans-Uhegbu

Dr. Wendy Evans-Uhegbu is a graduate of The Royal College of Surgeons in Ireland, with experience in Connected Health, Medical Technology, Clinical Research, Medical Education, Medical Communications, and Web Design/Development. She is a part of the Medics Abroad team with the role of Chief Communications Officer. She is also a Medical Writer at 3D4 Medical and runs a Medical Communications and Children's books company (ODR Integrated Services/ ODR Books).  She is the author of the newly published children's book series "The Things Around Me".

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