JASMA

What Is Pellagra?

Pellagra is a systemic disease most often caused by niacin deficiency. Niacin is essential for making molecules
that help your cells create energy and repair damage. When niacin levels drop too lowbecause intake is insufficient, absorption is impaired,
or the body can’t use it properlymultiple body systems can struggle at the same time, especially the skin, gastrointestinal tract, and brain.

Why It’s Uncommon (But Not Impossible) in the U.S.

Pellagra is rarer in the United States today largely due to the enrichment/fortification of certain grain products and generally better access
to varied diets. Still, it can occurespecially in people with malnutrition, alcohol use disorder, certain digestive conditions, or metabolic disorders
that affect niacin or tryptophan availability.

Pellagra Pictures: What It Typically Looks Like (and Where)

When people search “pellagra pictures,” they’re usually trying to match a rash. That’s understandablebut also risky: many rashes look similar.
Pellagra’s skin findings are often photosensitive (worse with sun exposure) and tend to be symmetrical on sun-exposed areas.

Common Visual Clues Seen in Photos

• Sun-exposed rash that may start looking like a bad sunburn and later become darker, rough, scaly, or thickened.
• “Casal necklace”: a band-like rash around the neck where sunlight hits.
• “Pellagra gloves”: rash and thickening on the backs of the hands and wrists (sun-exposed zones).
• Sharp borders where clothing blocks sun (a telltale “tan line” effectjust much less fun).
• Mouth changes: redness, soreness, cracks at the corners, or an inflamed tongue may show up in close-up photos.

Alt-Text Ideas for Web Images (If You Add Photos Later)

• “Symmetrical sun-exposed rash on hands consistent with pellagra (niacin deficiency).”
• “Casal necklace: darkened, scaly rash around the neck in pellagra.”
• “Pellagra dermatitis on forearms showing sharp border where clothing covered skin.”

Important: a photo match is not a diagnosis. If you have a new, worsening, or painful rashespecially with GI symptoms or confusionseek medical care.

Pellagra Symptoms: The Classic “Three Ds” (Plus a Few More)

1) Dermatitis (Skin Symptoms)

Pellagra dermatitis is typically photosensitive and appears on areas exposed to sunlight: face, neck, forearms, and hands.
It can begin as redness and burning (sunburn-like), then progress to roughness, scaling, thickening, and hyperpigmentation.
People may describe itching or tenderness, and the rash often appears on both sides of the body in a similar pattern.

2) Diarrhea (Digestive Symptoms)

The digestive tract needs healthy, fast-repairing cells. Niacin deficiency can lead to inflammation and malfunction in the gut,
causing symptoms such as diarrhea, abdominal discomfort, poor appetite, nausea, or generalized GI upset.
Some people lose weight because eating becomes unpleasant and nutrient absorption may already be compromised.

3) Dementia (Neurologic and Mental Symptoms)

“Dementia” in pellagra doesn’t always start as dramatic confusion. It may begin subtly:

• brain fog or trouble concentrating
• irritability, low mood, anxiety, sleep problems
• memory issues or feeling “not quite themselves”
• progressing confusion or disorientation in more severe cases

Other Symptoms People Might Notice

• Fatigue and weakness (your cells are basically running on low battery)
• Headaches
• Mouth soreness, glossitis (inflamed tongue), or stomatitis
• General signs of malnutrition (dry skin, hair changes, weight loss)

Quick Symptom Snapshot

What Causes Pellagra?

Pellagra happens when the body doesn’t have enough usable niacin. That can occur in two main ways:

Primary Pellagra (Not Enough Intake)

This is the “diet doesn’t provide enough niacin/tryptophan” pathway. Historically, outbreaks were linked to limited diets,
including heavy reliance on certain staple foods without adequate protein diversity.

Secondary Pellagra (Not Absorbing or Using Niacin Properly)

This is more common in places where food supply is adequate but a person’s body can’t absorb, convert, or utilize niacin well.
Examples include:

• Alcohol use disorder (can reduce intake and impair absorption)
• Malabsorption conditions (some chronic GI diseases or prolonged diarrhea)
• Metabolic and genetic disorders (rare, but real)
• Carcinoid syndrome (can divert tryptophan away from niacin production)
• Medication-related risk in specific situations (a clinician can evaluate this)

Who’s Most at Risk?

Pellagra is uncommon in most well-nourished populations, but risk rises when nutrition is limited or the gut can’t do its job.
People may be at higher risk if they have:

• food insecurity or a highly restricted diet (for any reason)
• chronic alcohol use with poor nutrition
• conditions that reduce absorption (certain inflammatory bowel problems or long-term diarrhea)
• severe illness, frailty, or limited access to balanced meals

How Pellagra Is Diagnosed

Pellagra is often a clinical diagnosismeaning clinicians weigh your symptoms, diet history, physical exam, and risk factors.
Because the rash is fairly characteristic and the condition can be dangerous if missed, treatment may begin even while evaluation continues.

What a Clinician Will Usually Ask

• What you’ve been eating (and what you haven’t)
• Any recent weight loss, vomiting, diarrhea, or appetite changes
• Alcohol intake and general nutrition access
• Digestive or chronic health conditions
• When the rash started and whether sun exposure makes it worse

Possible Tests (Depending on Setting)

There isn’t always one perfect “pellagra test” used everywhere, but clinicians may use labs to assess nutritional status,
rule out other conditions, or look for markers related to vitamin B3 status. Another practical clue is response to treatment:
if symptoms improve rapidly after appropriate niacin therapy, that supports the diagnosis.

Conditions That Can Mimic Pellagra

Several conditions can resemble pellagra dermatitis or cause similar symptoms:
sun-related rashes, eczema, medication photosensitivity, certain autoimmune disorders, infections, and other nutrient deficiencies.
This is why medical evaluation mattersespecially if you have GI symptoms or neurologic changes.

Pellagra Treatment: What Actually Works

Pellagra is treatable, and improvement can begin within days when the deficiency is corrected. Treatment usually has two goals:
(1) replace niacin and (2) fix the reason it happened (nutrition, absorption, or another medical issue).

Niacin Replacement (The Core Treatment)

Clinicians often use nicotinamide (a form of vitamin B3) because it treats deficiency without the “niacin flush”
that can come with nicotinic acid in higher doses. Dosing varies by severity and clinical guidance, but medical references commonly describe
therapeutic regimens in the range of a few hundred milligrams daily, often divided across the day, for several weeks in confirmed or suspected pellagra.
Don’t self-prescribe high-dose niacinespecially if you have liver disease, diabetes, gout, peptic ulcer disease, or take certain medications.

Supportive Care That Helps the Skin Heal

• Sun protection (protective clothing, shade; sunscreen can help but clothing is the MVP)
• Gentle skin care (fragrance-free moisturizers; avoid harsh exfoliants)
• Address irritation (your skin is already stresseddon’t start a new “acid peel era” today)

Nutrition: Food as the Long-Term Fix

Supplements correct the emergency, but nutrition prevents the sequel. Niacin and tryptophan-rich foods can help rebuild stores:

• High-niacin foods: poultry, beef, fish, peanuts, legumes, fortified cereals/grains
• Tryptophan sources: turkey, chicken, dairy, eggs, beans, seeds

If pellagra is part of broader malnutrition, clinicians may recommend a balanced refeeding plan and sometimes other B vitamins too.

Treat the Underlying Cause

If the root issue is malabsorption, chronic diarrhea, alcohol use disorder, or another medical condition, treating that condition is essential
to prevent recurrence. Pellagra that keeps coming back is basically your body sending you a calendar invite you didn’t accept: “Let’s revisit the cause.”

How Fast Do People Recover?

Recovery timing depends on severity, how quickly treatment starts, and whether the underlying cause is addressed. In many cases:

• Energy and appetite may start improving within days.
• GI symptoms can settle as the gut lining recovers.
• Skin changes often take longerweeksespecially if there was thickening or hyperpigmentation.
• Neurologic symptoms may improve with treatment, but longer-standing or severe symptoms can take more time and may not fully reverse in every case.

Prevention: How to Keep Pellagra Off Your Bingo Card

Prevention is mostly about ensuring adequate nutrition and addressing medical issues that interfere with absorption. Practical strategies include:

• Eat a varied diet with adequate protein and fortified grains when available.
• If you have chronic GI symptoms (especially persistent diarrhea), seek evaluationdon’t normalize it.
• If alcohol use is affecting nutrition, consider medical support; the goal is health and stability, not shame.
• If you’re on a medically restricted diet, consider dietitian guidance to avoid nutrient gaps.

When to Seek Medical Care

Seek prompt care if you have a new photosensitive rash plus any of the following:

• persistent diarrhea or vomiting
• confusion, memory changes, severe mood changes, or disorientation
• significant weight loss or inability to maintain nutrition
• symptoms of severe dehydration

Vitamin deficiencies are treatable, but they can become dangerous when ignored. If your body is waving a red flag, it’s not being dramaticit’s being efficient.

Conclusion

Pellagra is a serious but often reversible condition caused by severe niacin (vitamin B3) deficiency. The hallmark signsphotosensitive dermatitis,
gastrointestinal upset (often diarrhea), and neurologic or mental changescan show up together or creep in gradually. Because the skin findings can be distinctive
(Casal necklace, pellagra gloves), clinicians often recognize it through a careful history and exam, supported by nutritional assessment and response to therapy.

The most important takeaway is hopeful: with appropriate treatment (often nicotinamide plus nutrition support) and attention to the underlying cause,
many people improve substantially. If you suspect pellagra, don’t rely on photo-matching aloneget a medical evaluation and treat the deficiency early.

Real-World Experiences (500+ Words): What Pellagra Can Feel Like in Everyday Life

Medical descriptions are helpful, but they can feel a little like reading a user manual for a toaster: technically accurate, emotionally uninspiring,
and missing the part where someone says, “Yes, this is confusing, and you’re not imagining it.” So here are realistic, composite “experience-style”
snapshots based on how pellagra and severe niacin deficiency commonly show up in clinical and real-life contexts.

Experience 1: “Why Does My Sunburn Keep Coming Back?”

A common story begins with a person noticing what looks like an odd sunburn on the backs of their hands or forearms. They swear they weren’t outside that long.
The redness stings, the skin feels tender, and the pattern looks strangely evenalmost mirrored left and right. They try aloe, they try a new lotion,
they blame their detergent, and for a few days it quiets down… until the next time they’re in daylight. Eventually, the rash stops acting like a normal sunburn
and starts looking darker and rougher, like the skin is trying to armor up. The moment a clinician asks, “Does it get worse in the sun?” and the person says,
“Wait, yeshow did you know?” the puzzle pieces start fitting together.

Experience 2: “My Stomach Is a Mess, and I’m Too Tired to Care”

Another real-world pattern: persistent GI issues that wear someone down. It may start as appetite loss and “food just doesn’t sound good.” Then diarrhea
becomes frequent enough that they plan errands around bathrooms. Fatigue creeps in. They’re not just sleepy; they feel drained, like their internal battery
never reaches 100%. Friends might say, “You seem stressed,” and the person agreesbecause that’s easier than explaining that eating feels like a chore and
their skin hurts in sunlight. In nutrition-related deficiencies, the symptoms often feed each other: GI issues reduce intake, low intake worsens deficiency,
and deficiency worsens GI function. It’s not weaknessit’s physiology.

Experience 3: “I’m Not MyselfAnd That’s the Scariest Part”

The neurologic side can be subtle at first, which is why it’s sometimes missed. People may describe brain fogforgetting why they walked into a room,
struggling to focus at work, or feeling unusually irritable. Some say it feels like thinking through a heavy curtain. Family members might notice a personality shift:
less patience, more confusion, or odd sleep patterns. Because these symptoms can mimic stress, depression, or burnout, they can be dismisseduntil the rash and GI symptoms
make it clear this is a whole-body problem. When treatment starts and mental clarity improves, people often describe it as “coming back online.”

Experience 4: “The Fix Wasn’t Just a PillIt Was a Plan”

In many cases, the best outcomes happen when supplementation is paired with practical nutrition support. Dietitians often focus on realistic, doable changes:
adding fortified cereals, peanut butter, eggs, beans, fish, or poultry depending on budget and preference; building meals that include protein (tryptophan);
and addressing barriers like dental issues, limited cooking access, nausea, or food insecurity. People frequently say the most helpful part wasn’t a lecture
about “healthy eating,” but a simple plan that fit their life: “Here are three foods you can tolerate, and here’s how we’ll use them this week.”

Experience 5: “It’s Not Your Fault, But It Is Treatable”

Pellagra can carry stigma because it’s associated with malnutrition. In real life, malnutrition isn’t always about “not knowing better.”
It can be about money, access, chronic illness, medications, alcohol dependence, disability, caregiving stress, or simply a season of life where meals fell apart.
One of the most meaningful shifts people report is moving from self-blame (“How did I let this happen?”) to problem-solving (“Okaywhat support do I need?”).
With treatment and follow-up, many regain energy, skin comfort, and stability. The takeaway from these experiences is simple: if you recognize yourself in any part
of this, you deserve careand there’s a clear path forward.