Pellagra – Causes, Symptoms & Treatment


Pellagra is a hypovitaminosis caused by a lack of vitamin B3 (niacin). It is usually the result of malnutrition or malnutrition. However, there is also a genetic form of pellagra called Hartnup’s disease.

What is pellagra?

Pellagra represents an undersupply of the body with vitamin B3 (niacin, nicotinic acid). Today, this disease only plays a major role in poor countries with frequent famines and in countries where corn is the main food. In corn, niacin is only present in a bound form. Niacin can only be used by the body in alkaline processed corn. After corn was introduced as a foodstuff in Europe after Christopher Columbus discovered America, a strange disease spread, the main symptom of which was rough skin.

There were other physical and mental symptoms as well. It was already suspected that corn had something to do with this disease. However, there was speculation as to whether any specific plant toxins or mold could be the cause of this disease. The lack of knowledge about proper nutrition contributed to the fact that veritable pellagra epidemics occurred in the 18th and 19th centuries.


Pellagra is mainly caused by an undersupply of nicotinic acid in the body. Nicotinic acid, also known as vitamin B3 or niacin, is abundant in meat, liver, fish and whole grains. Milk and milk products also contain a lot of vitamin B3. In maize or sorghum, niacin is initially present in a non-usable form.

It is firmly bound in the molecule and can only be released through alkaline treatment of these foods. A one-sided diet with untreated maize or sorghum therefore leads to a lack of vitamin B3. However, niacin can also be synthesized in the body from the amino acid tryptophan.

If the unbalanced diet is also associated with a protein deficiency , this also results in a particularly pronounced niacin deficiency. Niacin is involved in numerous metabolic processes in the organism. It plays an important role in the production of energy from carbohydrates, fats and proteins. It is also involved in the formation of skin, muscle and nerve cells and in the repair of genetic material.

Errors in DNA and RNA that occur during cell renewal processes due to a lack of niacin can no longer be corrected sufficiently. Furthermore, niacin also improves memory through its influence on the nervous system . Therefore, the lack of niacin causes a symptom complex called pellagra.

Symptoms, Ailments & Signs

Pellagra manifests itself through the occurrence of many different symptoms. This is due to the central role niacin plays in metabolism. The main symptom is roughening of the skin. Itching , reddening of the skin , thickening of the skin , brown discoloration of the skin,

Inflammation of the mucous membranes in the digestive tract and nerve damage. Typical symptoms are diarrhea , dermatitis and dementia . The tongue also turns black . There are also body aches , exhaustion , fever , headaches , cramps , tremors , paralysis and mental disorders .

In severe cases, the disease can be fatal within weeks. A niacin deficiency due to general malnutrition is often also associated with a deficiency in other vitamins. Therefore, in addition to the typical symptoms of pellagra, there are often other symptoms as well.

Diagnosis & disease progression

Since pellagra is extremely rare in Europe today, the diagnosis is not made in the majority of cases, despite the typical symptoms. Many diseases can have similar symptoms. Only in connection with a conspicuous malnutrition, such as anorexia , can these symptoms lead to the suspicion of a niacin deficiency.

This suspicion should be confirmed by determining niacin and its degradation products in the urine. However, there is also a genetic metabolic disease that is characterized by an extreme lack of niacin. This is what is known as Hartnup’s disease . When pellagra-like symptoms occur without a dietary cause, urinalysis should determine amino acid concentrations.

Because Hartnup’s disease is characterized by the body’s inability to retain the amino acids from broken down proteins in the blood, there is a high concentration of amino acids in the urine. A genetic analysis can confirm the diagnosis.


A lack of vitamin B3 is initially noticeable through rough skin, itching and reddening or brown discoloration of the skin. Since a vitamin deficiency is virtually non-existent in the western world, pellagra is often not diagnosed even when all the typical symptoms are present. If the vitamin deficit is not corrected, a number of complications can arise.

Inflammation of the mucous membranes in the digestive tract often occurs. The general performance decreases. The affected person develops symptoms that are also typical of a cold. In particular, he suffers from exhaustion, headaches and fever. The skin is getting worse. Dental health also suffers from a persistent lack of vitamins.

In particular, the gums become severely inflamed, the patient develops severe gingivitis, which can lead to tooth loss. In an advanced stage, damage to the nerves and the brain occurs. The patient can no longer concentrate and his memory is constantly deteriorating. In extreme cases, dementia develops.

If the underlying disease still remains unrecognized, there is an acute danger to life for the person concerned. This is especially true if the pellagra is due to malnutrition, for example due to anorexia, since these patients usually also have other nutrient deficiencies and a weakened immune system.

When should you go to the doctor?

Symptoms such as headaches, intestinal disorders or cramps should be clarified promptly by a doctor, as they indicate pellagra or another disease caused by a vitamin and nutrient deficiency. At the latest with skin changes, inflammation of the mucous membranes and neurological complaints, a doctor’s visit is recommended. If left untreated, pellagra can lead to conditions such as dementia or dermatitis, or even death. People who eat an unbalanced diet and eat corn or millet in particular are particularly likely to develop pellagra. The genetic defect that underlies Hartnup’s disease can also be the cause of the disease.

Patients at risk, such as people who regularly fast or have an unbalanced diet due to a mental illness, should consult their family doctor if they suspect a secondary illness. If other risk factors are present, you should see a doctor quickly if you experience the symptoms mentioned. The first points of contact are the family doctor, the gastroenterologist and the dermatologist if skin problems are among the symptoms. The routine examinations can be carried out by a general practitioner. Any injections are usually administered in hospital.

Treatment & Therapy

Treating pellagra is simple. The lack of niacin can be well compensated by a diet with meat, fish, liver, whole grain products or dairy products. In the case of extreme niacin deficiency, nicotinic acid can also be administered initially. Brewer’s yeast is also good for remedying the vitamin deficiency. Nicotinic acid deficiency is often treated with additional doses of tryptophan.

If the niacin deficiency is genetic, as in Hartnup’s disease, replacement therapy with nicotinamide is performed. The state of health usually improves as a result. However, sometimes the substitution has no effect. However, since nicotinamide is liver-toxic, niacin should be used in large doses. The subsequent reddening of the skin disappears again after a few weeks of treatment.

In parallel with the substitution, a high-protein diet with dairy products, poultry, beef, nuts and potatoes is recommended. In contrast to classic pellagra, this protein and tryptophan-rich diet should be maintained for life in Hartnup disease.

Outlook & Forecast

The disease called pellagra, which is based on a chronic niacin or vitamin deficiency, should be able to be eradicated by an adequate food supply with fruit and vegetables. But the abundance of appropriate foods only benefits economically highly developed countries.

Climate change is causing more and more parts of the earth to become karst. Other parts of the planet are increasingly threatened by flooding. Both aggravate the nutritional situation – and this means that pellagra cannot be made to disappear either. The global economic and ecological forecast is to be considered here as well as the health.

Survival when pellagra occurs depends crucially on whether treatment is given immediately or not. In addition, the duration and severity of the niacin deficiency determine whether the pellagra can still be treated successfully. If the general state of health is still robust and the age of those affected is not too old, pellagra can often be treated successfully.

The prognosis, on the other hand, is poor if treatment is not provided promptly. The worse the condition of the other parameters mentioned above, the worse the chances of complete recovery. Since the medical care in many regions of the world affected by pellagra is far from good, many deaths have already been recorded as a result of pellagra.


Pellagra is very rare in Europe because the diet contains sufficient niacin. To prevent this disease, however, an extremely one-sided and low-protein diet should be avoided. Since pellagra today mainly occurs as part of a pathological anorexia, it is important to identify and treat the causes of this eating disorder .


The best way to prevent pellagra is to eat a varied diet. People should avoid an unbalanced diet consisting of corn and millet products. Instead, the consumption of eggs, peanuts and meat makes sense. They contain nicotinic acid. This self-responsible aftercare usually ensures that the typical symptoms subside.

In the context of a mild progressive form, the doctor imparts appropriate knowledge to his patient. This should not lead to any further complications. Pellagra can also be due to a genetic defect. Long-term follow-up care is then necessary because the symptoms can recur again and again. A diet is required. The patient begins therapy with nicotinic acid or nicotinamide.

Depending on the severity of the symptoms, the doctor and patient agree on the check-up appointments. These serve to agree on the current situation. A physical examination and an analysis of the blood and urine allow conclusions to be drawn about the current condition. Especially in Europe, pellagra raises the suspicion of deliberate malnutrition, such as that found in anorexia.

Because with a normal diet, the disease should not occur. If such a suspicion is confirmed, psychotherapy may be indicated. The success of the aftercare then depends heavily on the extent to which the patient is willing to deviate from a certain ideal of beauty.

You can do that yourself

Pellagra is a vitamin B3 deficiency disease caused solely by a vitamin B3 (niacin) deficiency. In the advanced stage, an immediate supply of niacin in the form of nicotinic acid or nicotinamide is required. If the vitamin deficiency is not caused by malnutrition , but by a disturbed absorption capacity of the small intestine, intravenous administration is recommended instead of oral administration.

If the disease is less pronounced, everyday and self-help measures consist of eating foods with a high proportion of niacin. Meat and offal from pork and beef, as well as salmon and herring, as well as dairy products and egg dishes are recommended for non-vegetarians. The advantage of vitamin B3, which comes from animal products, is its good absorbability, because the niacin is usually in the easily digestible form of nicotinamide. But nature also has food with a high vitamin B3 content for vegetarians and even vegans. In detail, these are different types of whole grain cereals, walnuts, peanuts and dried apricots . A food with a particularly high proportion of vitamin B3 is the freshwater algae Spirulina platensis.

If the vitamin deficiency is due to impaired absorption in the small intestine, it should be checked whether the deficiency is caused by taking certain medications or by chronic inflammation of the intestinal mucosa or chronic excessive alcohol consumption.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.