Related articles: Pellagra
Definition
Pellagra is a disease caused by a deficiency or lack of absorption of niacin (also called vitamin PP or B3).
Today, this pathology affects some areas of the world in endemic form (Africa, South America or certain regions of India), where maize and sorghum flour are basic foods in the diet.
The primary deficiency derives from an extremely inadequate and unbalanced intake of niacin, B vitamins or tryptophan (an amino acid necessary for the synthesis of niacin).
The secondary deficiency of niacin may be due, instead, to diarrhea, cirrhosis, chronic alcoholism and other pathological conditions that interfere with the absorption and assimilation of the vitamin.
Pellagra can also occur in the context of the carcinoid syndrome (tryptophan is diverted into 5-hydroxytryptophan and serotonin) and Hartnup's disease (in which the absorption of tryptophan by the intestine and kidneys is defective).
Most common symptoms and signs *
- Oral aphthosis
- Aggression
- Anorexia
- Apathy
- Redness of the face
- Asthenia
- Boccarola
- bubbles
- Bubbles on the Tongue
- Burning to the tongue
- Retrosternal burning
- Confabulation
- Delirium
- Dementia
- Depression
- Diarrhea
- Temporal and spatial disorientation
- Abdominal distention
- Mood disorders
- Abdominal pain
- Erythema
- Glossitis
- Abdominal swelling
- Insomnia
- Hypertonia
- Inflated tongue
- Yellow tongue
- Nausea
- Nervousness
- Nystagmus
- Weight loss
- Intense salivation
- Scales on the skin
- Confusional state
- He retched
Further indications
Pellagra causes symptoms in the skin and mucous membranes, the central nervous system and the gastrointestinal tract.
The clinical picture of pellagra is characterized by "three Ds":
- Pigmented rash (dermatitis);
- Gastroenteritis (diarrhea);
- Widespread neurological deficits, including cognitive impairment (dementia).
Cutaneous symptoms include various types of lesions that are usually bilateral and symmetrical, including deep red erythema, blistering eruptions and flaking. Characteristic is the distribution of dermatitis in pressure points (eg feet, legs, back of hands and forearm).
In regions exposed to sunlight, however, pellagra causes reactions of skin photosensitivity, such as the collar of Casal (dermatosis desquamante of the area around the neck) and lesions in the shape of a butterfly on the face (pellagrosa mask).
As for the mucous membranes, the alterations mainly affect the mouth, but can also affect the vagina and the urethra. Acute niacin deficiency is also characterized by glossitis and stomatitis; if this condition continues, the tongue and oral mucosa become red and edematous, with subsequent pain and increased salivation. Ulcerations can also appear, especially on the mucosa of the lower lip, under the tongue and laterally to the molar teeth.
Gastrointestinal symptoms that occur early in pellagra include pharyngo-esophageal burning, abdominal pain and distention. Subsequently, nausea, vomiting and diarrhea may appear.
The neurological symptoms associated with pellagra include psychosis, encephalopathy (characterized by loss of consciousness) and cognitive impairment (dementia). Psychosis is characterized by alterations of memory, disorientation, confusion and confabulation; the predominant symptom may be excitement, depression, mania, delirium or paranoia.
Possible complications of pellagra can be identified in lesions affecting the central nervous system, with associated patterns of hypertonia (excessive and permanent increase in muscle tone), nystagmus (oscillatory eye movements) and pyramidal syndrome (characterized by various motor disorders).
The diagnosis of pellagra is usually clinical.
The therapy consists of the administration of nicotinamide; if the disease is caused simply by a dietary deficiency, a balanced diet leads to complete remission of the symptom picture.
If not treated properly, pellagra can lead to death within a few years.
