PELLAGRA-LIKE DERMATITIS - A CASE REPORT

Abstract

Pellagra-like dermatitis refers to a skin condition resembling the dermatologic manifestations of pellagra, which is a systemic disease resulting from niacin (vitamin B3) deficiency. Vitamin B3 is needed for several metabolic processes, cell signaling and DNA repair. This condition is characterized by a photosensitive rash that typically affects sun-exposed areas. The classic skin changes include symptoms known as the 4Ds: dermatitis, diarrhea, dementia and death. The main causes of pellagra are: nutritional deficiency of niacin, restrictive diets, chronic alcoholism, gastrointestinal malabsorption, metabolic disorders and certain medications. 

We present the case of a 55-year-old farmer, with megaloblastic anemia and a seven-month history of skin changes, including erythematous lesions on sun-exposed areas such as the face, neck, bilaterally on forearms, dorsum of the hands and feet, along with itching and desquamation. Gastrointestinal symptoms included intermittent diarrhea, weight loss, neurological symptoms, and anxiety. Laboratory tests revealed anemia, hypoproteinemia, low levels of folic acid and serum iron. Skin biopsy results were consistent with pellagra, but did not exclude contact dermatitis. Treatment with niacin, folic acid, vitamin B12 and iron led to significant clinical improvement. Regular follow-up visits with hematology, gastroenterology, neurology specialists, and nutritional therapy were recommended.  

While pellagra is rare in modern clinical practice due to better nutrition, it still occurs sporadically. Diagnosis relies on the classic 4D features, laboratory findings and histopathological features. Despite its rarity, pellagra-like dermatitis should be considered in differential diagnoses for dermatological and gastrointestinal symptoms. Early diagnosis and treatment can result in significant improvement.