By Gary M. White, MD

Pellagra results from a deficiency of niacin (Vitamin B3) or it's precursor, tryptophan and causes the 4 D's:

Causes include


A red scaly brown dermatitis rash of the photoexposed areas is characteristic. The rash about the neck may appear like a necklace (Cassal's necklace). The tongue may turn beefy-red and atrophic.


Niacinamide e.g. 300-500 mg/d or nicotinic acid (e.g. 160 mg/day) should be given.


A 63-year-old man presented with a three-month history of an evolving erythematous, scaly and bullous skin rash involving the face, neck, hands, and feet. The patient was an alcoholic with a poor diet. An SCC of the esophagus was found Derm J Online 15;8

A 65-year-old woman receiving treatment for glioblastoma multiforme presented with painful skin lesions over sun exposed sites for the past one week. She was on temozolomide and phenytoin. Indian J Dermatol 2014;59:520-1


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