Pellagra: Causes, Symptoms, Risk factors & Treatments

Picture of pellagra


What is Pellagra?

Pellagra is a disease that occurs when a person does not get enough niacin (one of the B complex vitamins) or tryptophan (an amino acid).

What causes pellagra?

Pellagra is caused by a deficiency in niacin. This can occur in 2 ways:

  • Primary pellagra results from inadequate niacin and/or tryptophan in the diet (mainly in developing countries or poverty stricken areas)
  • Secondary pellagra occurs when there is enough niacin in the diet but something prevents its absorption and processing. Causes of secondary pellagra include:
    • Chronic alcoholism
    • Prolonged diarrhoea
    • Gastrointestinal diseases such as ulcerative colitis
    • Liver cirrhosis
    • Carcinoid tumours
    • Hartnup disease (tryptophan metabolism disorder)
    • Drugs e.g. isoniazid, azathioprine

Picture of pellagra

What are the symptoms of pellagra?

Pellagra is a condition of having too little niacin in the body and affects the normal function of the nerves, digestive system, and skin. Pellagra may result in a number of symptoms. The symptoms can vary in intensity from person to person.

Common symptoms of pellagra

You may experience pellagra symptoms daily or just once in a while. At times any of these common symptoms can be severe:

  • Abdominal cramping
  • Confused or delusional thinking
  • Depression
  • Diarrhea
  • Difficulty with memory, thinking, talking, comprehension, writing or reading
  • Headache
  • Loss of appetite
  • Malaise or lethargy
  • Mucus membrane inflammation
  • Nausea with or without vomiting
  • Skin lesions that are scaly and sore
  • Weakness (loss of strength)

Symptoms that might indicate a serious condition

In some cases, if left untreated, pellagra can lead to serious emotional and psychological conditions that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Alcohol withdrawal
  • Suicidal thoughts

Picture of pellagra

Treatment for pellagra

The goal of treatment is to increase your body’s niacin level. You will be prescribed niacin supplements. You may also need to take other supplements. Follow your provider’s instructions exactly on how much and how often to take the supplements.

Symptoms due to the pellagra, such as skin sores, will be treated.

If you have conditions that are causing the pellagra, these will also be treated.

What are the risk factors for pellagra?

A number of factors increase the risk of developing pellagra. Not all people with risk factors will get pellagra. Risk factors for pellagra include:

  • Alcoholism
  • Anorexia nervosa
  • Diets high in corn
  • Digestive disease
  • Low dietary intake of tryptophan (needed to produce niacin in the body)

Reducing your risk of pellagra

You may be able to lower your risk of pellagra by:

  • Eating foods rich in tryptophan, which plays a role in making niacin, such as seafood, meat, and green vegetables
  • Ensuring your diet is rich in foods that contain niacin, such as cereal grains, eggs, green vegetables, fish, milk and yeast
  • Following a healthy food plan that includes a variety of foods from each of the food groups
  • Practicing moderation if you drink alcohol