Pellagra is a niacin (vitamin B3) deficiency disease characterized by dermatitis, diarrhea, and dementia (the 3 D's). It was first identified in the 18th century in Spain and is caused by inadequate intake of niacin or tryptophan from the diet. Symptoms include a scaly rash, inflammation of the skin, and neurological and gastrointestinal issues. Diagnosis involves blood tests and skin biopsies showing characteristic findings. Treatment is niacin supplementation either orally or intravenously along with a diet rich in protein and tryptophan. Pellagra can be prevented by consuming foods containing niacin or its precursor tryptophan.

1. PELLAGRA
Vyan Barzan
Lava Ali
Gashbin Farhad
Hawnaz Osman

2. OUTLINES
VITAMIN B3 ( NIACIN ) PELLAGRA
Definition
Types
History
Symptoms
Diagnosis
Treatment
Prevention
Incidence Of Pellagra
Reference
NAMES OF VITAMIN B3
History
Sources Of Vitamin B3
 Properties
Structure
Biosynthesis
Function
Recommended Daily
Allowance

3. VITAMIN B3 ( NIACIN )

4. NAMES OF VITAMIN B3
Niacin
Nicotinamide
Vitamin P or (pellagra preventive)
Anti black tongue factor
Nicotinic acid

5. PROPERTIES
Niacin is odorless, white crystalline substance
Soluble in water and ethyl alcohol
Less soluble in ether and benzene
Resistance to heat , air , oxidation and alkalis
Nicotinamide , when pure occurs as white needle like
crystals

6.  White crystalline niacin

7. STRUCTURE:
Organic compound with formula C6H5NO2
Niacin has carboxyl group (COOH) at 3-position ,
whereas , in nicotinamide the carboxyl group is
replaced by carboxamide group (CONH2)

8. Plant form Animal form

9. HISTORY
First isolated in 1911 by Funk
Called it as anti black tongue factor

10.  Discovered By Joseph
Goldberger in 1928
 An Austrian-Amirican physician
of the U.S. Public Health
Service

11. Isolates by Conrad Arnold Elvehjem
In 1938

12. SOURCES OF VITAMIN B3

13. BIOSYNTHESIS
The liver can synthesize niacin from essential amino acid
tryptophan requiring 60mg of tryptophan to make one
mg of niacin.
Dietary nicotinamide , niacin and tryptophan contribute
to the synthesis of the coenzymes NAD+ and NADP+.
60mg tryptophan : 1 mg niacin

14. Tryptophan
(in presence of
Fe)
Kynurenine
(NADPH →
NADP)
Quinolinic
acid
Nicotinic acid
Mononcleotid
e (NMN)
Nicotinic acid
dinucleotide
( NAD)
Niacin

15. FUNCTION
Helps body to break down carbohydrates , fats, and
proteins into energy
Has a role in producing certain hormones in the
adrenal glands
Helps remove harmful chemicals from the liver
Normally in body:

16. For healthy function of nervous system
Helps to maintain a healthy skin
Helps to increase the flow of blood to the peripheral
capillary system

17. THERAPUTIC USES:
For lipid disorder and cardiovascular disease
Vascular anti-inflammatory effect
A specific niacin receptor in adipocyte and immune
cells
Niacin non competitively inhibits hepatocyte DGAT2,a
key enzyme for TG synthesis

18. RECOMMENDED DAILY ALLOWANCE
Adult (men) 15-20 mg/day
 Adult (women) 13-15mg/day
Children 8-15mg/day
Infant 650mcg
Lactating women 20 mg
Upper level is 35 mg

19. PELLAGRA

20. DEFINITION
Systemic disease
Nutritional disease , Result from niacin deficiency
Affect digestive system, skin and nerves
Characterized by diarrhea , dermatitis and dementia

21. TYPES
Primary
Results from inadequate amount of niacin and / or
tryptophan in the diet
Secondary
Occurs when there is enough niacin in the diet but
something prevents its absorption. This type occur in :

22. Chronic alcoholism
Prolonged diarrhea

23. Gastrointestinal disease
Liver cirrhosis

24. Carcinoid tumor
 Hartnup disease(tryptophan metabolism disorder)
 Drugs(isoniazid , phenytoin , azathioprine ,
antidepressant …)

25. HISTORY
Pelle → skin , Agra → Sour
First discovered by Spanish Don Gasper Casal in
1735 as a disease of 3D
In 1937 discovered that pellagra caused by
nicotinamide deficiency

26. SYMPTOMS
• The most common symptoms:
3Ds
Dermatitis
Dementia
Diarrhea

27. 1.DERMATITIS
Also known as eczema
Is a group of diseases that results in inflammation of
the skin
Characterized by itching , red skin ,rash and lesion
In cases of short duration , there maybe small blisters
and swelling
But in long duration , the skin may become thickened

28. Red skin with blister

29. On the neck ,the dermatitis lesions appear in the
form of a necklace called Casals necklace.

30. Rash of Pellagra
Bilateral and symmetrical
Usually start in sun expose area
Then classically dorsa of hands , face , neck and
chest.
Can have intense pruritus
Start as well demarcated erythematous patches
Second stage – dry , scaley , hyperkeratotic

32. 2.DEMENTIA
 Is a brain disease
 Cause long term decrease in the ability to think and
remember
 And also cause emotional problems
 Difficulties with language and decrease in motivation
 It does not affect level of persons consciousness

33.  The most common type of dementia is
Alzheimer‘s disease in %70 of cases
 Other type of dementia include :
(vascular dementia , frontotemporal dementia and
Parkinson‘s disease dementia )

34. 3.Diarrhea
Is a condition of having loose , liquid or
watery bowel movements each day
Lead to dehydration du to fluid lose
And also cause urination , loss of skin
color and fast heart rate

35. Other common symptoms
 CNS symptoms:
-Psychosis
-Depression
-Impair consciousness
-Paranoia
-Headache
-Tremor

36. GIT symptom: (during early deficiency )may include:
-Burning sensation of the pharynx and esophagus
-Abdominal discomfort
-Anorexia
-Dysphagia
(later symptoms)
-Nausea
-Vomiting

37.  Sensitivity to sunlight Hair loss

38. Smooth beefy red
glossitis
 Dilated
cardiomyopathy

39.  Ataxia  Psychomotor disturbance

40.  Trouble sleeping  Weakness

41. DIAGNOSIS
Pellagra is difficult to diagnose because it causes a range
symptoms
Also in most cases diagnosis of pellagra delay and lead to
death

42. Clinical diagnosis:
 Go to toilet often
 Easy to forget something
 Hard to sleep

43. Laboratory diagnosis: include:
1. Low level of serum niacin ,tryptophan and
NAD
2. Anemia ,hypoproteinemia , hypercalcemia
3. Liver function test
4. Serum porphyrin
5. Skin biopsy
o Addition to that tests we also need neurologic
and psychiatric examinations

44. Histological diagnosis:
 Hyperkeratosis
 Acanthosis
 Dilatation of capillaries
 Epidermal atrophy
 Hyperpigmentation of the basal layer
 Mild , superficial dermal infiltrate of lymphocyte

45.  There is partial necrosis and
hemorrhage involving the
superficial epidermis with
underlying psoriasiform
acanthosis.

46.  The epidermis
shows mild
hyperplasia with
characteristic pale
cytoplasm of the
cells in the upper
epidermis

47. TREATMENT
Primary pellagra
By give Nicotinamide supplement by tab
Or can also give intravenously in severe case
100-300 mg/day orally

48. Also provide the patient with dietary
protein rich specially tryptophan rich
If the patient have other vitamin B
deficiency give them vitamin B complex
supplement

49. Secondary pellagra
 Depended on first diagnoses the cause then
resolve
it and with resolution give supplement and provide
dietary protein rich
 In primary and secondary sunblock can help the
patient to protect the skin
 However if left untreated pellagra can be fatal

50. PREVENTION
Eating food rich in tryptophan, which play a role in
make niacin such as(seafood,meat,yeast,eggs,peanut)
 Following a healthy food plan that include a variety of
foods from each food groups
Practicing moderation if you drink alcohol

51. For secondary prevention avoid sun exposure during
the
active phase of disease
Adequate rest, rest is very important in curing pellagra
as
stress is bound to worsen the symptoms and complicate
the pellagra condition

52. INCIDENCE OF PELLAGRA
Alcoholism ,not eating green vegetables and meats
Common in Africa and north Korea
No racial predilection is reported
No sex predilection is described
 Pellagra is a disease of adult and also may happen
In child if they exposed to pellagra genic diet
Rarely happen in infants

53. REFERENCE
Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling
FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific
Publications.
Weedon's Skin Pathology (Third Edition)2010, Pages 481-500.e15
Aminoff's Neurology and General Medicin ( Fifth Edition )
2014, Pages 237-253
https://www.sciencedirect.com/
https://www.healthline.com/health/pellagra