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Pellagra: Causes, Symptoms, And Treatment

Pellagra: Causes, Symptoms, And Treatment

Pellagra is a medical condition associated with a deficiency of vitamin B3, a B-complex vitamin that is also called niacin. This may also occur due to the absence of its precursor tryptophan, a type of amino acid.

Niacin deficiency is often accompanied by deficiency of other nutrients such as protein, riboflavin, thiamine, vitamin A, magnesium, and others. Vitamin B3 deficiency is currently a rare disorder in the developed countries. However, in some developing countries, the disorder is quite prevalent and remains one of the leading types of nutritional deficiencies amongst adults.

Symptoms of Pellagra

Vitamin B3 deficiency is often referred to as the “disease of the 4 Ds,” based on the primary symptoms that the medical condition manifests itself through.

These symptoms are:

To elaborate on the above four diseases, the likely pellagra symptoms are as below:

  • Watery stools
  • Stools accompanied with blood and mucus occasionally
  • Itchiness of the skin
  • Scaly or flaky skin on exposure to the sun
  • Trauma of the skin
  • Eruptions and burning sensation on the affected skin
  • Hyperpigmentation
  • The appearance of a sunburn in the initial stages of acute dermatitis
  • Vesicles on skin
  • Delusions
  • Depression
  • Mental disorientation
  • Hallucination
  • Photophobia or photosensitivity of buttocks, trunk, and thighs
  • Loss of memory
  • Psychosis
  • Soreness of the mouth


The primary causes of niacin deficiency are:

Gastrointestinal malabsorption

The causes here are usually anorexia, recurrent or chronic diarrhea, epigastric discomfort, etc. Malabsorbative anorexia and diarrhea may lead to malnutrition and cachexia.


Certain drugs like 6-mercaptopurine, isoniazid, and phenobarbital, amongst many others, may lead to a deficiency of vitamin B3 in some individuals.

Chronic alcoholism

This is yet another important cause of this medical condition.

Risk Factors of Pellagra

Niacin deficiency does not develop as an underlying cause of the personal medical history of an individual. It is also not a genetic condition.

The common risk factors of this deficiency are:

  • Lack of sufficient consumption of food products that are rich in vitamin B3
  • Excessive consumption of alcohol over a prolonged period of time
  • Gastrointestinal complications
  • Certain medications, as discussed earlier in the article


The diagnostic procedure for niacin deficiency is as below:

Investigation of medical condition

Your doctor will thoroughly investigate the symptoms. They will want to know when the symptoms develop, the extent and type of discomfort, and other related queries. They are most likely to enquire about the presence of 3 out of the 4Ds – diarrhoea, dermatitis, and dementia, which are associated with the disease.

The doctor will also conduct a close check of other medical conditions that you might be currently having as well as those you may have had in the past. This will enable them to eliminate some of the probable medical conditions that they might be suspecting. Thus, narrowing down on the medical research.

Investigation of medicines

The doctor will want to know about the medications you might be taking at present and also in the recent past. This is because there are certain medications that may trigger the symptoms of niacin deficiency. They will also want to confirm whether you are under the medication of any of these drugs. If yes, the dosage may be adjusted or a suitable substitute may be prescribed for you. Take your medical documents like prescriptions of your medical history along with you, so that the doctor can examine them closely.

There are no diagnostic tests that can definitively confirm pellagra.


One can prevent pellagra by consuming 15-20 mg of niacin everyday, no matter your age.

Also, the pellagra treatment focuses on curing niacin deficiency. So, the intake of niacin is considered to cure the condition. Your doctor may prescribe a daily dose of 300 mg nicotinamide to be taken in divided doses throughout the day. This treatment may go on for three to four weeks continuously. Diarrhea, along with minor mouth and tongue inflammation,n will go away in a few days post this treatment. Skin problems and dementia also improve within the first week. Chronic conditions may take longer to recover, but overall health improves rapidly.

Your doctor may also ask you to intake a vitamin B complex preparation or a yeast product as pellagra patients sometimes also experience a deficiency of some other vitamin B compounds.

Lifestyle Changes

The other treatment options are mostly lifestyle changes that you need to bring about in your daily diet and skin care to prevent or keep pellagra in check. They are:

  • Topical management – Topical treatment for skin lesions to control and heal skin eruptions and irritations.
  • Daily nutrition – A daily diet that is not only rich in vitamin B3 but also nutrients like zinc and magnesium. The diet should be high in calories. Food products that are laden with vitamin B3 are eggs, fish, poultry, red meat, bran, seeds, and legumes.
  • Avoid consumption of alcohol.

Learn more about Other Healthy Eating Tips here.


BMR Calculator

Use our calorie-intake calculator to determine your daily caloric needs based on your height, weight, age, and activity level.



Hello Health Group does not provide medical advice, diagnosis or treatment.


Pellagra and its prevention and control in major emergencies, https://www.who.int/nutrition/publications/emergencies/WHO_NHD_00.10/en/, Accessed on 16/06/2020

[Pellagra], https://pubmed.ncbi.nlm.nih.gov/16207585/, Accessed on 16/06/2020

Pellagra: A Non-Eradicated Old Disease, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019925/, Accessed on 16/06/2020

Pellagra: Dermatitis, Dementia, and Diarrhea, https://pubmed.ncbi.nlm.nih.gov/14693013/, Accessed on 16/06/2020

Pellgra revisited, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228662/, Accessed on 16/06/2020

Skin Manifestations of Pellagra, https://pubmed.ncbi.nlm.nih.gov/30988221/, Accessed on 16/06/2020

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Written by Nikita Bhalla Updated Apr 20
Medically reviewed by Janie-Vi Villamor Ismael-Gorospe, MD