Overview
Pellagra is a nutritional disorder caused by a deficiency of niacin (vitamin B3) or its precursor tryptophan. It is most commonly associated with poverty, poor nutrition, or malabsorption disorders. If left untreated, pellagra can be life-threatening. The classic presentation is known as the “three D’s”: Dermatitis, Diarrhea, and Dementia, with a fourth D—Death—if the condition progresses without treatment.
What is Pellagra?
Pellagra is a systemic disease that occurs when the body doesn’t get enough niacin (vitamin B3) or can’t convert tryptophan into niacin. Niacin is essential for cellular metabolism, especially in the skin, digestive system, and brain. A lack of niacin affects the entire body but especially tissues with high energy requirements.
Pellagra can be:
- Primary: due to insufficient niacin intake.
- Secondary: due to conditions that prevent absorption or conversion (e.g., alcoholism, chronic diarrhea, carcinoid syndrome).
Symptoms
Pellagra is often identified by its classic “three D’s”:
- Dermatitis: Symmetrical, scaly skin lesions in sun-exposed areas, often red and sensitive.
- Diarrhea: Digestive disturbances including inflammation of the tongue (glossitis), nausea, vomiting, and abdominal pain.
- Dementia: Mental changes like irritability, confusion, memory loss, hallucinations, and eventually psychosis.
Other symptoms:
- Fatigue
- Headache
- Insomnia
- Depression
- Muscle weakness
Causes
- Inadequate dietary intake of niacin or tryptophan (e.g., diets based mostly on corn without proper treatment).
- Chronic alcoholism – interferes with absorption.
- Malabsorptive disorders – such as Crohn’s disease, celiac disease.
- Carcinoid syndrome – diverts tryptophan to serotonin production.
- Hartnup disease – a genetic disorder affecting tryptophan absorption.
- Certain medications like isoniazid, 5-fluorouracil, or hydantoin.
Risk Factors
- Poor socioeconomic conditions or famine
- Alcohol dependency
- Malnutrition or unbalanced diets
- Intestinal disorders (e.g., chronic diarrhea, inflammatory bowel disease)
- Long-term use of certain drugs
- Elderly population with poor dietary intake
Complications
If untreated, pellagra can result in:
- Permanent neurological damage
- Severe malnutrition
- Increased risk of infections
- Depression and suicidal tendencies
- Death, especially in severe or chronic untreated cases
Prevention
- Balanced diet including niacin-rich foods (meat, fish, legumes, seeds, whole grains).
- Fortified grains and cereals in populations at risk.
- Proper processing of maize (nixtamalization) to release niacin.
- Nutritional supplementation in high-risk individuals (alcoholics, patients with malabsorption).
- Treat underlying conditions such as alcoholism or bowel disease promptly.
Treatment Options in Korea
South Korea offers effective, accessible treatments for pellagra, particularly in tertiary hospitals and nutrition-focused care centers. Treatment generally includes:
1. Niacin Supplementation
- Oral nicotinamide or niacin is given—usually 300-500 mg daily in divided doses.
- In severe cases, intravenous administration may be necessary.
2. Nutritional Support
- Dietitian-guided high-protein, balanced meals to replenish niacin and tryptophan.
- Rich food sources include chicken, tuna, peanuts, mushrooms, and brown rice.
3. Management of Underlying Causes
- Treat alcoholism, chronic infections, or malabsorption syndromes.
- Discontinue or adjust medications contributing to deficiency.
4. Mental Health Support
- In patients with psychiatric symptoms, collaboration with psychiatrists may be necessary.
- Psychological therapy or medications may be provided depending on the severity.
Hospitals in Korea such as:
- Seoul National University Hospital
- Asan Medical Center
- Severance Hospital
provide comprehensive diagnosis and care for nutritional deficiencies like pellagra, including blood tests, diet analysis, and vitamin therapy.
