Pellagra Treatment in Asheville, NC
Do you have red, flaky, crusty, or scaly skin? Do you feel depressed, anxious, or mentally unstable? Have you recently changed diets or medication, or have you been diagnosed with alcoholism, cirrhosis, Hartnup disease, or an eating disorder? You maybe experiencing pellagra, a niacin (vitamin B3) deficiency.
Pellagra is rare in industrialized nations, but it can occur in certain circumstances. This is a serious medical condition that can be fatal, so seeking medical attention is extremely important if you suspect you have pellagra.
What are the symptoms of pellagra?
Pellagra is typically identified using the "three Ds": dementia, diarrhea, and dermatitis.
General pellagra symptoms include:
- low appetite
- trouble eating, drinking, or swallowing
- sores on the lips, gums, or tongue
- nausea and vomiting
Common dermatitis symptoms include:
- red, flaky skin
- areas of red or brown skin discoloration
- thick, scaly, or crusty skin
- itchy, burning skin patches
Skin symptoms usually appear on your face, lips, hands, or feet. In some cases, dermatitis symptoms appear around the neck. This is known as Casal necklace.
These psychological symptoms can be hard to identify because they're common to other medical conditions:
- mood swings
- delusional thoughts
If you're experiencing any of these symptoms, don't wait - seek medical attention immediately. Pellagra typically isn't immediately life-threatening, but it can be fatal if left untreated.
What causes pellagra?
Two types of pellagra exist: primary and secondary.
Primary pellagra is caused by eating a diet low in niacin (vitamin B3) and tryptophan, a vital amino acid in your body. Primary pellagra is very rare in industrialized nations, mostly affecting countries in Latin America, Africa, and parts of Asia.
Populations that rely heavily on corn for sustenance are at a higher risk because corn contains niacytin, a type of niacin humans can't digest and absorb unless prepared very carefully and correctly.
Secondary pellagra happens when your body can't absorb niacin. Things that can slow or stop your body from absorbing enough niacin include:
- eating disorders like anorexia and bulimia
- gastrointestinal disorders like Crohn's disease and ulcerative colitis
- intestinal bacteria overgrowth
- cirrhosis of the liver
- carcinoid tumors
- Hartnup disease: a hereditary metabolic disorder that makes it hard for your body to absorb certain amino acids from your intestines and reabsorb them from your kidneys. Also caused by vitamin B deficiency
When suffering from malabsorption, patients' bodies can't absorb the nutrients necessary for fending off the deficiencies that cause pellagra. In these cases, very careful medical attention is necessary to save a patient's life. These treatment options vary from person to person and can change drastically depending on the patient's medical history.1
How is pellagra diagnosed?
Diagnosing pellagra is usually difficult because it causes a wide range of symptoms and there are no specific tests to identify niacin deficiency. However, your doctor will give you a physical examination and other tests to diagnose or rule out gastrointestinal disorders, and if pellagra is still suspected, you'll likely undergo a urine test.
Niacin is excreted in the urine, so your sample will be sent to a lab for close analysis and a positive or negative diagnosis of niacin deficiency.
How is pellagra treated?
While pellagra is a painful and potentially life-threatening condition, treating it is fairly straightforward. Primary pellagra is treated by adding more niacin-rich foods to your diet and a niacin or nicotinamide supplement. In many cases, early enough treatment can start reversing the condition within a few days. Skin symptoms typically resolve within a few months.
Secondary pellagra must be treated by addressing its underlying cause, such as an eating disorder, alcoholism, or Hartnup disease. In many cases, people with secondary pellagra respond well to dietary changes and niacin or nicotinamide supplements.
Covering and moisturizing your skin and wearing sunscreen is vital during your recovery time, as sun exposure can intensify your pellagra symptoms and pain.
Treating pellagra with supplements can sometimes cause side effects. These include:
- dry skin
- nausea and vomiting
- glucose intolerance
- swollen eyes or eye cysts
- flushed skin: can occur with very high doses of nicotinamide
- hepatotoxicity: jaundice (yellowing skin or eyes) can happen when you consume very high doses of nicotinamide
To avoid side effects patients treat pellagra with niacin-rich foods like:
- rice bran, animal liver, fish, peanuts, bacon: all contain high levels of vitamin B3
- oranges: contain flavonoids like hesperidin and naringenin, which have anti-inflammatory effects; vitamin C, which boosts the immune system; and vitamin B3
- bananas, cabbage, avocado, tomatoes, kiwi, potatoes, peas, artichoke: all contain high levels of B3
- pumpkin seeds and spinach: contain tryptophan and glutamate, folic acid, thiamin, zinc, phosphorous, vitamin K, vitamin A, manganese, iron, vitamin C, calcium, and potassium
- oats: contains magnesium, potassium, zinc, vitamin E, vitamin K, and B3
- ginger: a digestive that helps quell nausea and abdominal cramps
- poultry, walnuts, hazelnuts: lysine in poultry can also fight B3 deficiency, so eating these foods can help increase B3 levels
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While primary pellagra is rare in developed nations, secondary pellagra can occur if you have certain medical conditions like Crohn's disease or alcoholism. If you're experiencing any of the symptoms or conditions of primary or secondary pellagra, don't wait - call your doctor or get emergency medical attention right away. Pellagra isn't immediately life-threatening, but it can be fatal if left untreated.
1. Pfeiffer, Ronald F. "Other Neurologic Disorders Associated with Gastrointestinal Disease." Aminoff's Neurology and General Medicine, Apr. 2014, pp. 237–253., doi:10.1016/b978-0-12-407710-2.00013-8.
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