Pellagra - Pictures, Symptoms, Treatment, Causes, Diagnosis
What is Pellagra?
Pellagra is a systemic disease resulting from a nutritional deficiency particularly of Niacin or Vitamin B3. The disease is marked by dermatitis, diarrhea, dementia and death while it involves the skin, digestive system and the neurologic system.
Pellagra has inflicted a population since the early 1700 in Europe and reached South of America in 1902. The disease was first noted among poor peasants of Asturias and was first described in 1735 by a Spanish Court Physician named Don Gasper Casal who first named the disease as ”mal de la rosa” denoting the feature of the disease. It was described to have a reddish and glossy rash located on the dorsum of the hands and the feet of the afflicted person. Pellagra was first blamed on diet of corn which is a staple to the people of depressed areas in South of America. Pellagra was formally named in 1771 by the Italian physician named Francesco Frapoli describing the rough skin dermatitis of the disease. The first case of Pellagra in United States was a poor farmer from Georgia who lived in a diet of Indian corn. The case was first noted and reported by Atlanta physician H.F. Harris and the epidemic of Pellagra in hospitalized patients was reported by Dr. George H. Searcy until the outbreak in 1909 in a mental hospital. The mystery of Pellagra remained o be implicated on the corn being eaten by people of American South until that mystery and myth was narrowed by Dr. Joseph Goldberg from realizing that the malady was actually the result of a faulty diet. The mystery of the malady was solved by Goldberg with his dietary modification. Goldberg went on his way to study further the disease until he came up with the dietary modification together with his colleague and came up with the P-P factor which can prevent Pellagra.
Pellagra is prevalent in adults without sexual and racial predilection although it is common in developing countries where poverty is high. Rarely does Pellagra affect young children and infants. The disease is potentially life-threatening especially when left untreated while morbidity depends on the organ affected by the disease. Pellagra used to be a dreaded disease and people afflicted with it were being ostracized and treated like lepers until the indefinable P-P factor was identified in 1937 by Conrad A. Elvehjem and completely conquered Pellagra after World War II. The year 1945 marked the extinction of the dreaded nutritional wasting disease in South America.
Pellagra is classically characterized with four D’s which denotes the part of the body involved in the disease. The symptoms of Pellagra can occur daily and which may become severe while the general symptoms differ from one person to another.
Skin is the first to be affected with a symptom of Pellagra. The skin is reddened associated with scaling and may resemble severe sunburn which gradually turns dusky brown and red discoloration after it has subsided. The rash has a clear edge and is often symmetrical and overtime the skin hardens and thickens with cracks and crusts. Itching and burning sensation may also be experienced by an afflicted individual. Hands and feet are mostly affected with the lesion although it can also occur in some parts of the body including the neck which is called Casal’s necklace.
Gastrointestinal symptoms in Pellagra are commonly characterized with diarrhea which is experienced by majority of the patients. Malnutrition is common as feeding and drinking is rather difficult including a poor appetite. Patient may also experience abdominal pain associated with nausea and vomiting. Indigestion and burning of throat is also reported including excessive salivation and constipation.
Neurological symptoms may go unnoticed with initial symptoms of slight apathy and depression. Restlessness, anxiety, tremor, disorientation and psychosis is also reported to be experienced by patients which later on may progress to stupor and comatose as the serious sign subsequently death of patient.
Pellagra is primarily due to deficiency and insufficiency in nicotinic acid or Niacin and tryptophan. Pellagra on the other hand occurs in two ways and these are:
Primary pellagra is the result of insufficiency in Niacin or tryptophan inclusion in the diet. This is the common cause for people in developing and poverty stricken countries.
Secondary pellagra is the result of niacin is prevented from being absorbed and processed by the body. It could be due to underlying conditions and disorders of the digestive system. Secondary pellagra may result to chronic alcoholism, ulcerative colitis, liver cirrhosis, and prolonged diarrhea, tumors and Hartnup disease.
Pellagra is a complex disease that is rather difficult to diagnose. Criteria are being considered in further confirming the onset of the disease and the criteria include the following:
History taking is an essential criterion especially in the dietary account of the patient which may show inadequacy in the amount of niacin and tryptophan.
Clinical manifestation of Pellagra is being examined based on the main characteristics of the disease such as:
- Skin is initially examined for dermatitis that resembles severe sunburn and scaling of rash skin which worsen when exposed to sunlight and demarcation between normal skin and the rash is usually bordered by clear edges
- Gastrointestinal symptoms are being taken especially for diarrhea which is common in all cases of Pellagra
- Neurological symptoms are also essential in diagnosing Pellagra that episodes of dementia, anxiety, depression and progression of severe derangement of patient
Laboratory procedure is done with a 24-hour urine collection to determine the by-products of niacin for levels of inadequacy and determine the extent of deficiency.
Pellagra can be treated during the early stage and it is vital not to disregard the condition as the disease is potentially life-threatening. The primary goal of treatment is towards restoration of niacin to further prevent the progression of the disease while preventing irreversible damage. The approach of treatment depends on the overall health status of the patient and the underlying cause of Pellagra. Sufficient rest is also recommended including avoidance of sunlight exposure. Dietary intake is also modified to include sufficient intake of niacin and niacin supplements. Medication is given to correct niacin deficiency while preventing complications and mortality.