This rare disease Not everyone is familiar with pellagra, and its first signs are so similar to minor skin problems that people do not rush to seek medical help. As a rule, the disease in question develops due to a violation of the absorption of vitamins and other substances; several factors can provoke this - for example, poor nutrition, internal illnesses chronic form of the course.
Historical reference
In the 18th century, doctors were generally confident that pellagra was an infectious disease, especially since in those years this disease most often affected the poor. But in 1916, this opinion was successfully refuted by experiments carried out by doctors - microscopic particles of biomaterial from sick people (for example, skin flakes) were mixed into the food of absolutely healthy people - not a single case of the disease was found. And literally a few years after this discovery, a medicine was found that could completely cure pellagra. Nicotinic acid became such a medicine.
Pellagra is considered a fairly dangerous disease for humans, but only if no curative measures are not undertaken - after a maximum of 8 years, such carelessness leads to death. It is extremely rare that the disease in question is diagnosed in residents developed countries, in which high level medicine and education. But in the countries of Africa and South America there are really many cases of pellagra being diagnosed. And one more nuance - most often the pathology in question occurs against the background chronic alcoholism– this is already a proven fact.
Reasons for the development of pellagra
The main reason for the development of the disease in question is the intake of small quantities of vitamin B3, as well as vitamins B1, B2, B6 and tryptophan. In turn, the following factors can lead to this:
- chronic stress state;
- previously diagnosed organ diseases digestive system– for example, gastritis, hepatitis, peptic ulcer, pancreatitis;
- progressive malignant tumors - they are able to convert tryptophan entering the body into serotonin;
- poor nutrition – this means both a violation of the diet and a violation of the regime;
- period of pregnancy and lactation;
- chronic physical fatigue due to malnutrition;
- alcoholism;
- constant exposure of the skin to ultraviolet rays - this also applies to tanning bed lovers;
- progressive infectious diseases - for example, dysentery or tuberculosis.
What happens in the body when there is a lack of nicotinic acid?
Many are amazed that a lack of just one vitamin can lead to the development of a real disease. But it’s not for nothing that doctors constantly talk about the need to maintain one’s own body, about additional intake some vitamin complexes– the consequences are really very serious. Judge for yourself which processes in the body are disrupted only with a lack of nicotinic acid:
- formation of hemoglobin and red blood cells;
- redox reactions;
- secretion gastric juice and bile;
- formation of sex hormones;
- synthesis of hormones of the pancreas and thyroid glands;
- blood glucose control;
- functioning of the central nervous system;
- processes of reducing the level of “bad” cholesterol in the blood.
And that is not all! If a deficiency of nicotinic acid is present in a pregnant woman, the processes of intrauterine formation of the nervous system of the unborn child are disrupted, and in some cases this condition leads to memory loss and disruption of the functioning of certain areas of the brain even in absolutely healthy people.
In general, a lack of nicotinic acid in the body leads to disturbances in all metabolic processes, pathological changes develop in the cardiovascular system, the blood formula deteriorates, and irreversible disorders occur in hormonal balance, the condition of the joints and skin changes dramatically for the worse.
The symptoms of the disease in question include the main triad of signs:
- dermatitis;
- diarrhea;
- dementia.
Only later, as pellagra progresses, pathological changes in the functioning of the cardiovascular, endocrine and musculoskeletal systems are revealed in the patient.
As a rule, the first signs of the disease in question appear in the hot season - under ultraviolet rays(solar) dermatitis develops. And then at the end of winter the patient begins to experience disturbances in the functioning of the digestive system (diarrhea), weakness, loss of appetite, increased drowsiness and chronic fatigue. In some cases, these symptoms develop so slowly that the lack of vitamin B3 in the body is even considered qualified doctors for nervous or mental disorders.
Pellagra can occur in acute and/or chronic form - in the first case, the symptoms begin suddenly and always with great intensity, but the chronic course of the disease is characterized by a gradual increase in symptoms.
Dermatitis
Most often, it is changes in the skin that worry the patient - they appear almost immediately after exposure to sunlight and manifest themselves in the form of dermatitis, and the mucous membranes are also affected.
With pellagra, the following changes in the skin and mucous membranes will be noted:
- Red, slightly swollen spots appear on exposed skin surfaces (legs, arms, face and neck), sometimes they appear as blisters containing a cloudy liquid. As these spots progress, they become brown, brown, and can develop into long-term non-healing ulcers.
- Hyperpigmentation appears, which has the character of “glasses”, “gloves” and/or “socks”. A person becomes sensitive to the sun's rays - they cause a feeling of burning and burning of the skin.
- Individual areas of the skin may begin to peel off, and subsequently they become keratinized. The skin takes on a gray tint.
- The mucous membranes become inflamed - this process affects the oral cavity, genitals, and nasal passages/sinuses.
Most often, changes in the skin with pellagra are localized in the face and neck. Patients may notice the appearance of red, crescent-shaped spots, and areas of brown and flaky skin may appear around the eyes and on the bridge of the nose. Specifically on the neck, the so-called Kasal collar may appear - the area of skin in this place is covered with a narrow red spot that descends from the neck to the chest.
The skin around the wrists and ankle joint– the appearance of red and slightly swollen “bracelets” in these places is often noted.
Pellagra can also manifest itself as rashes on the legs and thighs - they will have the form of papules with liquid contents, and areas of hemorrhage appear around such rashes.
If pellagra was not diagnosed at the stage of development of dermatitis, then the progression of the disease leads to disturbances in the functioning of the digestive system. This is manifested not only by diarrhea, but also by other syndromes:
- whitish ulcers appear on the oral mucosa - stomatitis is diagnosed;
- there is a constant taste of salt and a burning sensation in the mouth;
- lips and tongue periodically swell, but not too intensely;
- cracks appear in the corners of the mouth, which do not heal for a long time even with the use of specific medicines;
- the tongue takes on a crimson color and becomes “varnished”; teeth marks are clearly visible on it.
Note:with pellagra, diarrhea always alternates with constipation, and in some cases such disturbances in the functioning of the intestines are also accompanied by prolonged nausea, turning into vomiting.
When a patient with similar symptoms is examined by a doctor, bloating, decreased gastric motility, and a lack of hydrochloric acid in the gastric juice may be detected.
Neuromuscular disorders – dementia
Nervous and mental disorders can also be a consequence of a lack of nicotinic acid and tryptophan in the body. In this case, the patient will experience the following syndromes:
- total loss sensitivity of the skin in some areas of the body (usually they can be clearly localized);
- increased fatigue;
- apathy towards oneself, work, others;
- memory impairment;
- sleep disorders;
- polyneuritis;
- irritability that occurs without reason;
- paresthesia;
- depression.
If pellagra occurs in an advanced form, the patient does not undergo treatment, then in the future he may develop hallucinations, psychomotor agitation, paranoid delusions - this condition is classified by doctors as psychosis. Often, against the background of neglect of the disease in question, encephalopathy develops, which is accompanied by clouded consciousness, lack of control over sucking and grasping reflexes, and muscle hypertonicity.
How is pellagra diagnosed?
As a rule, the diagnosis of pellagra is made if the patient has the described triad of symptoms. The disease in question must be differentiated from porphyria, erysipelas, solar dermatitis and Hartnap disease.
The patient must undergo a full range of examinations. In the urine of such a patient, active secretion of nicotinic acid and B vitamins will be detected. When examining the organs of the digestive system with an endoscope, the doctor will reveal atrophy of the mucous membranes of the stomach and intestines, and in some cases, bleeding ulcers are observed on the mucous membranes of these parts gastrointestinal tract.
Treatment of the disease in question is always carried out in inpatient conditions, the doctor will prescribe complex therapy and will constantly monitor the patient’s condition. As a rule, therapy for pellagra consists of the following:
Note:if pellagra was provoked by some internal pathological process, then it is necessary to prescribe treatment to the patient.
Very important point in therapy against the disease in question is compliance with a special diet.
Patients are prescribed a specially designed menu, which contains foods rich in vitamins A, B, C and protein. These include:
All products are prepared taking into account the fact that the digestive system needs support, that is the best option will include stewing, boiling, steaming, baking. Food intake should be carried out in small portions, but quite often - at least 5 times a day. The calorie content of dishes increases gradually - for example, in the first week the patient will only need to receive 2500 Kcal.
Possible complications
Sometimes pellagra occurs in acute form and then all the symptoms described in the article appear in the patient immediately and intensely - doctors often confuse this condition with a developing stroke. In this case, pellagra is always fatal.
If the disease in question proceeds at a normal pace and is chronic, then its complications may appear in the form of typhus, scurvy or dysentery. If pellagra continues for years, with exacerbations only in the summer, then the patient develops dementia and becomes disabled.
Prevention of pellagra
To prevent the development of the disease in question, you need to remember just a few rules for prevention. These include:
- admission to spring period multivitamin complexes;
- varied diet, the menu should consist of foods high in vitamins and nicotinic acid;
- timely treatment of pathologies of the gastrointestinal tract;
- treatment of acute infectious diseases;
- preventing the development of alcoholism;
- preventing the development of stress and depression.
Pellagra is a fairly rare but still common disease. Doctors give variable prognoses for this pathology - if treatment is started on time and carried out in full, then the prognosis is extremely favorable. But if pellagra occurs “in a free form”, the patient does not take specific medicines and didn't pass necessary examinations, then doctors give an unfavorable prognosis - after 5-8 years, pellagra leads to death.
Pellagra - what kind of disease is it?
– a disease caused by acute deficiency of nicotinic acid (vitamin PP) in the body for a long time. In other words, pellagra is a vitamin deficiency PP (nicotinic acid, nicotinamide, niacin, vitamin B3).
Another substance that, when insufficiently supplied, causes pellagra is protein, especially tryptophan.
In the modern world, when a variety of foods allows you to get the necessary amount of vitamins and microelements for normal functioning body, vitamin deficiency RR, like other types of vitamin deficiencies, is quite rare, so pellagra is not familiar to many people, and has become predominantly historical disease. However, residents of some countries South Africa and South America, as well as among people dependent on alcohol (alcoholics), pellagra can still occur.
Development of pellagra
If there is a deficiency of nicotinic acid in the body (hypovitaminosis), the following disorders occur:
- hematopoiesis functions, in the video the formation of hemoglobin and red blood cells;
- control over the level of glucose and cholesterol in the blood, which leads to atherosclerosis, heart attacks, coronary heart disease and other diseases of the cardiovascular, endocrine, musculoskeletal and other systems;
- functions of secretion of bile and gastric juice, necessary for normal digestion and absorption of food;
- normal activity of the central nervous system (CNS);
- synthesis of hormones of the thyroid, pancreas, reproductive and other organs and systems;
- redox reactions;
- mental activity, memory functions;
- normal development of the intrauterine fetus;
- skin, hair and nails also lose their health.
But all of the above processes develop only with partial deficiency of vitamin PP in the body, i.e. – hypovitaminosis. Now imagine what will happen if there is a complete lack of this substance in a person, i.e. – vitamin deficiency?
Pellagra – ICD
ICD-10: E52;
ICD-9: 265.2.
The main symptoms of pellagra are three pathological conditions/diseases - dermatitis, diarrhea and dementia, and therefore this disease is also called the “three D disease”. However, some foreign doctors add a fourth “D” here - death.
Other symptoms of pellagra include:
- Photodermatosis and other skin lesions;
- Alopecia (baldness, baldness);
- Edema (increased fluid accumulation);
- Increased fatigue, muscle weakness;
- Ataxia (impaired coordination of movements due to dysfunction of the muscular system);
- Paralysis of limbs;
- Dilated cardiomyopathy (DCM);
- Aggression, apathy, neurosis, depression, confusion, dementia, insomnia;
- Headaches, dizziness;
- Peripheral neuritis;
- Glossitis, stomatitis, cheilitis;
- Constipation followed by diarrhea.
An exacerbation of symptoms usually occurs in the summer - when the skin is exposed to ultraviolet sunlight and in the winter-spring period, when it is usually not possible to eat fresh vegetables and fruits.
Complications of pellagra
Complications of pellagra include:
- Typhus;
- Scurvy;
- Dysentery;
- Encephalopathy;
- Stroke;
- Myocardial infarction;
- Disability;
- Lethal outcome (in 5-8 years, if nothing is done).
Main cause of pellagra– acute deficiency in the body of vitamin B3 (vitamin PP, nicotinic acid, nicotinamide), as well as insufficient intake of vitamins B1 (thiamine), B2 (riboflavin), B6 (pyridoxine) and tryptophan.
Vitamin B3 deficiency (RR) is caused by:
- Predominance in daily diet low-use and unhealthy food that lacks the vitamins and microelements necessary for the normal functioning of the body;
- Metabolic disorders, especially protein;
- Frequent exposure to stressful situations and depression;
- Diseases of the gastrointestinal tract: gastritis, pancreatitis, duodenitis, stomach and duodenal ulcers, hepatitis, etc.;
- Progressive development of some infectious diseases– tuberculosis, dysentery and others;
- Availability malignant neoplasms(cancer);
- Abuse alcoholic drinks(alcoholism);
- Abuse of sunbathing (solariums, beach);
- Chronic physical fatigue due to poor nutrition;
- Pregnancy and lactation period.
Diagnosis of pellagra
Diagnosis of pellagra includes the following examination methods:
- Examination of the patient, anamnesis;
- General and biochemical analysis urine;
- General and biochemical blood test;
- Endoscopy.
How to treat pellagra? Treatment for pellagra begins with accurate diagnosis and differentiating the disease from erysipelas and other diseases with similar symptoms.
Treatment for pellagra usually includes the following:
1. Peace;
2. Drug treatment;
3. Diet;
4. Preventive measures.
Important! Before using medications, be sure to consult your doctor!
1. Peace
A patient with pellagra must be provided with absolute rest, not only physical, but also emotional and mental. This point is necessary for the body to accumulate the protective functions and forces necessary to prevent the development of clinical manifestations of the disease. In addition, a state of rest minimizes the additional consumption of vitamins and microelements, which will initially slow down the development of pellagra, and then contribute to a speedy recovery.
2. Drug treatment (medicines for pellagra)
Pellagra occurs when there is an acute deficiency of vitamin B3 (PP) in the body, therefore, drug therapy is aimed at introducing high doses of nicotinic acid into the body. Daily dosage prescribed by a doctor based on diagnosis. At the beginning of the course of treatment, nicotinic acid is usually administered intravenously and intramuscularly, after which tablets are prescribed.
Among the drugs based on nicotinic acid are: “Nicotinic acid”, “Nicotinamide”.
Important! In the presence of peptic ulcers digestive organs, nicotinic acid preparations should be taken with caution!
Additionally, vitamins B1, B2, B6, B12, C and protein are prescribed.
For diarrhea, a dose is sometimes prescribed antibacterial agents if the cause is a bacterial infection. To prevent diarrhea, you can take Mezim Forte, Smecta, Imodium, Hilak Forte.
When using antibiotics, it is necessary to restore the normal intestinal microflora necessary for the normal functioning of the digestive organs, as well as the transformation and absorption by the body useful substances. For these purposes, probiotics are used - “Linex”, “Bifiform”.
For dermatitis, treatment often consists of treating the affected skin with ointments based on corticosteroids (hormones), among which are Hydrocortisone (1%), Clobetasol, Prednisolone, having previously treated the skin with anti-inflammatory and antibacterial drugs- “Levomycetin”, “Erythromycin”.
For neurological disorders prescribed sedatives- “Valerian”, “Diazepam”, “Persen”, “Tenoten”.
For severe mental disorders, tranquilizers are prescribed - “Tranquilan”, “Relanium”.
At severe exhaustion body, the patient is prescribed a blood transfusion.
If there are any internal diseases, which caused pellagra, their treatment is carried out in parallel.
Important! If you have pellagra, avoid exposing your skin to sunlight!
The diet for pellagra is focused on eating foods enriched primarily with vitamins B3 (PP), B1, B2, B6, B12 and protein.
In addition, for a speedy recovery, you need vitamins A, C, and other B vitamins.
Products that meet the above requirements include:
Food of animal origin: liver, kidneys, fresh fish (especially fatty varieties– salmon, etc.), cheese, kefir, fermented baked milk, sour cream, milk, eggs;
Food plant origin: nuts (walnuts, peanuts, almonds, etc.), vegetables (potatoes, carrots, tomatoes, legumes, broccoli, cabbage, fennel, parsley, sorrel, green vegetables), fruits and berries (pomegranate, peach, melon, avocado, sea buckthorn, prunes, rose hips), corn flour and bran, oats, whole grains, sage, nettle, horsetail, ginseng, peppermint, chamomile, yeast, black seeds.
Products are best consumed raw and steamed, because... When steamed, they lose the least amount of vitamins. Stewing and baking are also allowed.
You need to eat fractionally, in small portions, 5-6 times a day.
The calorie content of food at the initial stage of treatment is 2500 kcal/day. Next, the caloric content of food is gradually increased.
Treatment of pellagra with folk remedies
Treatment of pellagra folk remedies implies the consumption of food enriched with vitamins B3 (PP), B1, B2, B6, B12, as well as protein. This is described in more detail in the paragraph just above - “Diet for pellagra.”
Prevention of pellagra
Prevention of pellagra is an integral part of the general course of treatment of the disease and includes the following recommendations:
- In your daily diet, try to give preference to foods enriched with vitamins and microelements;
- Remember, when preparing food by boiling and frying, foods lose their vitamin value, because... many vitamins are simply destroyed under the influence of high temperatures and water;
- Food is best consumed raw (vegetables, fruits, berries) or steamed, baked;
- Stop drinking alcohol and smoking;
- In the autumn-winter-spring period, take additional vitamin complexes;
- Do not leave various diseases to chance, especially those of the gastrointestinal tract, so that they do not become chronic;
- Avoid stress, change jobs if necessary, or learn to overcome them;
- Do not abuse the services of a solarium, or even better, refuse it, because... It is quite difficult to monitor the quality and life of special UV lamps, and therefore, for many people, a trip to the solarium ended rather badly.
Which doctor should I consult for pellagra?
- Dermatologist
- Gastroenterologist
- Nutritionist
Pellagra - video
Causes of pellagra
In the development of signs of pellagra, as a key manifestation of a deficiency in the body of the main subgroups of vitamin B and nicotinic acid, the greatest pathogenetic significance is precisely the damage to the organs of the digestive system, due to the fact that the majority of diseases that have a gastroenterological profile are accompanied by vitamin deficiency. In most cases the disease small intestine leads to the manifestation of signs of pellagra, since it is this section of the digestive tract that is responsible for the absorption of vitamin B and nicotinic acid, as well as most other groups of vitamin-like substances and vitamins. Background pathologies that provoke the development of pellagra are:
- formation of a gastrointestinal fistula;
- chronic enteritis;
- resection thin section intestines.
In addition, when severe forms Pellagra is an accompanying pathology for acute infectious diseases that are localized in the intestines, the most common of which are dysentery and intestinal tuberculosis. In case of prolonged alcohol abuse, conditions also arise for disruption of the absorption function of the small intestine, which leads to the development of vitamin deficiency of certain groups of vitamins.
As with any other form of vitamin deficiency, pellagra can develop not due to a lack of B vitamins, but due to their excessive consumption, which is possible even under conditions of normal pregnancy and lactation, as well as against the background of increased physical activity, which is combined with fasting.
If we consider the pathogenetic mechanisms of the formation of pellagra, then a key role in the development of damage to internal organs, skin, and structures of the nervous system is played by disruption of the metabolic process of microelements vital for the body, especially for carbohydrates, the exchange of which occurs at the cellular level. But the trigger for the development of typical clinical signs of pellagra is the insufficient content of the amino acid tryptophan in the human body.
As a person progresses, the disease begins to develop irreversible processes in the skin and structures of the nervous system, which are degenerative. In situations where pellagra begins to develop in absolutely healthy person as a result of malnutrition, one must assume the primary variant of the pathology. If the appearance of symptoms was provoked pathological changes in internal organs that are chronic in nature, then it is worth talking about the presence of a secondary variant of pellagra.
Considering the fact that pellagra is accompanied pronounced violations nutrition and metabolism in the body, its pathomorphological manifestations are quite wide. Degenerative changes observed in tissues of various origins:
- organs of the digestive tract;
- structures of the nervous system;
- skeletal muscles;
- endocrine organs;
- skin.
Symptoms of the disease
In case of development of a full-blown clinical picture Pathology Patients who suffer from manifestations of pellagra have a wide range of symptoms. Considering the large list of patient complaints, it is quite difficult to make a correct diagnosis during initial contact, but the presence of detailed anamnestic data allows us to make assumptions regarding the presence of this particular pathology. Most often, the initial visit to a doctor is based on the presence of various signs of a dyspeptic clinical picture in the patient (perversion of taste preferences, burning and dryness in the mouth, lack of appetite, and in some cases even a complete aversion to food). With further progression of the disease, the patient complains of functional disorders intestines and the presence of alternating periods of diarrhea and constipation.
As the toxic syndrome increases, the patient may notice increasing weakness and the inability to perform usual actions, lack of interest in life, and dizziness. In most cases, patients with pellagra take a passive position - lying on their back.
Diagnosis of pellagra largely depends on an initial objective examination of the patient, which is accompanied by the identification of a number of pathognomonic symptoms that allow an accurate diagnosis. Upon visual examination of the patient’s oral cavity, pronounced hyperemia is noted not only of the tongue itself, but also of the mucous membranes of the cheeks and gums with small ulcerations, which may be a sign of hemorrhagic impregnation. Similar changes in the mucous membranes are also observed in the projection of the esophagus and stomach, but their visualization requires echophagogasteroscopy.
With a prolonged course of pellagra, the occurrence of many small bleeding erosions in the small and large intestines is also noted, which can provoke the appearance of blood impurities in the stool, which can be identified when performing an analysis for occult blood in the feces.
Anemia with pellagra is quite pronounced and is accompanied by all the clinical manifestations that are characteristic of this condition.
The primary criterion for determining damage to the nervous system (its structures) in the presence of pathology is the appearance of signs of polyneuritis in various localizations. First of all, it is accompanied by a violation of sensitivity without a pronounced pain component. As pellagra progresses, degenerative processes begin to affect the brain, as a result the patient begins to experience focal and cerebral neurological symptoms:
- hearing impairment;
- memory;
- vision;
- vomit;
- lack of coordination;
- headache.
When endocrine structures are damaged, the patient experiences polyglandular insufficiency, which manifests itself as a tendency to:
- arterial hypotension;
- osteoporotic bone lesions;
- polyuria;
- progressive muscle weakness;
- adynamia.
Violations of vitamin and protein metabolism are more pronounced in the results of laboratory tests and are accompanied by the development of hypoproteinemia as a result of a decrease in the albumin fraction.
It is also necessary to take into account the fact that pellagra can have both an acute and protracted course, each of the options has characteristic features. For the formation of an acute form, the trigger must be a pronounced nutritional deficiency of external origin. The debut of pathology in such a situation is manifested by a sharp increase and weakening of stools; the frequency of the urge to defecate can reach 20 times during the day. A few days later, the patient begins to develop psychoneurological disorders, which significantly aggravate the patient’s condition. With continued vitamin deficiency, a person begins to develop skin manifestations characteristic of pellagra.
The protracted course of the disease is difficult for early diagnosis, since this category of patients has been observed by neurologists for a long time due to sluggish polyneuritis. As a result, symptoms of a psychoneurotic nature are added, which are not particularly specific. And only when the skin clinic begins to appear does the pathology follow the classical course.
The primary damage to the skin is increased dryness and a change in its color towards a gray color. To a greater extent, the manifestations listed above are localized on the surface of the back and lateral surfaces of the abdomen; the extensor surface of the limbs is also affected. Against the background of these changes, the redness of the skin in the upper part of the body, as well as on the distal parts of the extremities, which occurs as a result of exposure to ultraviolet radiation, looks quite contrasting. A classic sign of erythema in such cases is the clarity of the contours, which act as a boundary between the unchanged and affected parts of the skin. If there is acute clinical variant course of the disease, the changes listed above may appear in the form of blisters with hemorrhagic contents. The healing process of such inflammatory elements is characterized by a long period and is accompanied by the formation of massive scar deformations.
Changes in the skin on the face in the presence of pellagra are accompanied by characteristic pathognomonic changes in the form of the formation of the “Casal collar” (stripe-like erythema on the chest and neck) and “pellagros glasses” (brown hyperpigmentation of the eyelids and peeling).
In the presence of pellagra, secondary manifestations may occur skin changes in the form of follicular papules, which are localized in the projection of the thigh and lower leg and have a clear hemorrhagic rim.
Complications of pellagra consist in the transition of the pathology to an acute form, which quite often ends in the death of the patient. In such a situation, diagnosing the pathology is extremely difficult, since the patient experiences a lightning-fast increase in neurological manifestations, which sometimes cannot be distinguished from other intracerebral pathologies:
- trismus of masticatory muscles;
- vomit;
- visual hallucinations;
- limb rigidity;
- severe disturbances of consciousness;
- convulsive readiness;
- increased tendon reflexes.
In such cases, reliable diagnosis is possible only after examining sectional material.
Patients diagnosed with pellagra must undergo treatment in a hospital in compliance with the conditions of complete psycho-emotional and physical rest. The only pathogenetically substantiated direction of pharmacological therapy is replacement treatment with the drug "Nicotinic acid amide", which is used orally or parenterally. The saturating daily dose of the drug should be 0.3 g for a course of at least 6 weeks, after which they switch to maintenance doses, which are 50 mg of the drug when taken orally.
Intramuscular administration of Nicotinic Acid Amide is limited to a number of adverse reactions in the form of a feeling of painful heat, severe hyperemia of the upper body and itching of the skin, although it is worth recognizing that this option of administering the drug is much more effective.
Considering the pathogenetic mechanism of pellagra formation, replacement therapy should be enriched with preparations of B vitamins in parenteral form (Pyridoxine, Riboflavin, Thiamine). The indication for prescribing vitamin B12 is the presence of signs of hyperchromia, glossitis, and macrocytosis. In the presence of severe anemic syndrome, the situation is treated with fractional blood transfusions of 100 ml every 5 days.
During the elimination period acute manifestations diseases against the background of the used replacement therapy you need to have a conversation with the patient regarding the correction of the diet. The main criterion for proper nutrition in such cases is the saturation of the menu with foods that contain a significant amount of B vitamins, nicotinic and ascorbic acid, as well as protein foods.
Pellagra is rare disease, ignoring the symptoms of which can lead to death. The problem is that the human body does not receive enough vitamins B3, B1, B6 and B2, as well as nicotinic acid. In addition to the main source of the disease, clinicians have identified a fairly wide list of predisposing factors. These include poor nutrition, addiction to bad habits, the occurrence of gastrointestinal diseases and other reasons.
The disease has specific symptoms because it leads to changes in the skin, hair and nail plates. It can also manifest itself as dizziness, upset bowel movements and frequent mood swings.
Diagnosis is carried out by a dermatovenerologist, who is based on data obtained during a physical examination. In addition, laboratory and instrumental examinations are carried out.
The disease can be treated using conservative methods, namely by taking medications and following a gentle diet. However, despite the success of therapy, such pathology leads to the development of undesirable complications.
Etiology
The main cause of pellagra is an acute deficiency in the human body of the following substances:
- vitamin B3, which is also called nicotinic acid, vitamin PP and nicotinamide;
- vitamin B1 or thiamine;
- vitamin B2 or riboflavin;
- vitamin B6 or pyridoxine;
- tryptophan.
This type of vitamin deficiency can result from:
- poor nutrition, namely the predominance of the menu fatty foods;
- metabolic disorders, especially protein;
- frequent or prolonged effects stressful situations, as well as being in depression;
- diseases of the digestive system, in particular of any nature, and, or;
- progression of infectious diseases such as or;
- prolonged exposure to direct sunlight on the body;
- abuse of alcoholic beverages and smoking cigarettes;
- chronic fatigue combined with poor nutrition;
- the presence of oncological tumors of any location;
- the period of bearing a child or breastfeeding a baby.
The pathogenesis of the disease lies in the fact that when there is a lack of the above substances in the body, a violation occurs:
- formation of hemoglobin and red blood cells;
- redox reactions;
- secretion of bile and gastric juice;
- blood sugar control;
- functioning of the central nervous system;
- synthesis of pancreatic hormones and thyroid gland;
- processes responsible for reducing the amount of “bad” cholesterol in the blood;
- formation of the fetal nervous system - when pellagra occurs in an pregnant woman;
- concentration and memory in children.
Symptoms
This disease manifests itself in three main signs:
- diarrhea and other symptoms of improper functioning of the gastrointestinal tract;
- formation of ulcers on the mucous membrane oral cavity– in gastroenterology, such a manifestation is called;
- constant burning in the mouth;
- periodic occurrence of a salt taste in the mouth;
- the appearance of cracks in the corners of the mouth - it is noteworthy that it is impossible to get rid of them even with specially designed medications;
- change in the shade of the tongue - it becomes crimson and has a shiny surface;
- the tongue is coated with a white coating, causing teeth marks to be visible on it;
- alternating diarrhea and;
- prolonged nausea ending with vomiting;
- increase in abdominal size.
Most often, it is changes in the condition of the skin that force people to seek qualified help. Symptoms of pellagra according to the type of dermatitis are presented:
- the appearance of red spots on the skin of the limbs, face and neck. In some cases, swelling is noted, and even less often, the formation of bubbles containing a cloudy liquid on the affected area. As the disease progresses, such neoplasms acquire a brown or brown tint, and ultimately transform into non-healing ulcers;
- unhealthy redness of the skin like “socks”, “gloves” or “glasses”;
- burning of the skin, which occurs during prolonged exposure to direct sunlight;
- peeling of individual areas of the skin, which subsequently leads to keratinization. Because of this, the skin becomes gray;
- inflammation of the mucous membranes of the genitals, mouth and sinuses;
- Kasal’s “collar” - in this case, the skin around the neck is covered with a narrow red spot that goes down to the chest;
- formation of red and swollen “bracelets” around the wrist and ankle.
Dementia or neuromuscular dysfunction is expressed in:
- complete loss of sensitivity of the skin in some areas of the body;
- increased fatigue and decreased performance;
- And depressed state;
- impaired memory and concentration;
- sleep disorders;
- unreasonable irritability;
- a feeling of numbness and tingling not only of the limbs, but of the whole body;
- auditory and visual hallucinations;
- psychomotor agitation;
- paranoid delusions, which is also called;
- cloudiness of consciousness;
- increased tone muscles;
- loss of control over the sucking or grasping reflex.
Less common symptoms that pellagra may present with include:
- baldness or baldness;
- paralysis of limbs;
- deformation or separation of the nail plates;
- intense headaches and dizziness;
- dementia.
It is worth noting that the exacerbation of clinical signs is seasonal. This most often occurs in the summer, when it is almost impossible to avoid skin contact with ultraviolet radiation, and also in winter, against the background of the fact that a person does not have the opportunity to eat fresh fruits and vegetables.
Diagnostics
To make a correct diagnosis and carry out differential diagnosis it is necessary to implement a whole range of measures. Thus, for pellagra the following diagnostic measures will be required:
- study by a dermatovenerologist of the patient’s medical history and life history - this will help clinicians establish the most likely etiological factor;
- conducting a thorough physical examination with mandatory examination of the condition of the skin, hair and nails, as well as palpation of the anterior wall abdominal cavity;
- a detailed survey of the patient - to determine the severity of symptoms and compile a complete picture of the course of such a disease;
- general clinical blood test - to determine changes in its composition;
- blood biochemistry - to detect signs of leakage pathological process in organism;
- general urine analysis will show the presence of nicotinic acid and vitamin B complex;
- endoscopic procedures– to assess the condition of the internal surface of the digestive tract. Thanks to this procedure, it is possible to determine the presence of atrophy of the mucous membrane or bleeding ulcers;
- Ultrasound, CT and MRI - to detect the presence of malignant neoplasms, which may have different localizations;
- radiography both with and without contrast agent.
The disease pellagra must be differentiated from:
- solar dermatitis;
- Hartnup's disease;
Treatment
Given that such a pathology develops against the background of acute vitamin B deficiency, during therapy in the vast majority of cases, patients are advised to take medications containing nicotinic acid.
Often complex treatment takes place in a hospital setting and is based on several principles:
- complete rest - patients need to avoid not only physical, but also emotional and mental stress. This is necessary for the body to restore its protective functions and independently prevented the progression of symptoms. In addition, ensuring rest minimizes the additional consumption of vitamins - at first this will lead to a slowdown in the course of pellagra, after which it will contribute to the rapid recovery of the patient;
- use of medications;
- maintaining a nutritious diet.
Drug therapy is aimed at:
- intramuscular administration of drugs containing nicotinic acid;
- oral administration vitamins B1, B12, B6, B2 and C, as well as protein;
- use of antibacterial and antidiarrheal agents;
- treating affected areas of the skin with ointments containing corticosteroids;
- taking sedatives or tranquilizers;
- Blood transfusion is necessary in case of severe exhaustion of the body.
If during the diagnosis any internal pathologies, then in parallel with the treatment of pellagra, their elimination is carried out.
A diet for pellagra involves enriching the diet with the following ingredients:
- offal;
- fatty fish;
- milk products;
- eggs in any form, except fried;
- cheese and nuts;
- dried fruits and bran;
- pomegranate and peaches, avocado and melon;
- legumes and cabbage, tomatoes and potatoes, carrots and greens;
- whole grains.
In addition, the following rules must be observed:
- prepare dishes by steaming, but stewed and baked food is allowed several times a week;
- frequent and fractional food consumption;
- daily allowance energy value should be no more than 2500 kilocalories;
- abundant drinking regimen - more than 2 liters per day.
Possible complications
Pellagra is a rather dangerous disease, since ignoring the symptoms and lack of treatment can lead to the development of serious consequences, which include:
- scurvy and encephalopathy;
- dysentery and;
- peripheral
Prevention and prognosis
The development of the disease can be prevented by following simple rules, namely:
- lifelong renunciation of addictions;
- good nutrition and eating plenty of raw fruits and vegetables;
- taking vitamin complexes during the cold season - to strengthen the immune system and enrich the body necessary substances;
- eliminating stress if possible;
- usage protective equipment when exposed to direct sunlight for a long time, this is the main preventive condition;
- timely elimination of gastrointestinal ailments and infectious diseases;
- regular preventive examinations at a medical institution.
Pellagra is a disease that manifests itself with a large number of pronounced and specific symptoms; some people prefer to ignore it or fight it on their own. This leads to the fact that the lack of treatment is fraught not only with the development of complications, but also leads to death - often this happens approximately eight years after the first expression of symptoms. However, early diagnosis and comprehensive treatment leads to complete recovery.
Pellagra manifests itself in the following classic triad: dermatitis; disruption of the gastrointestinal tract (diarrhea); neuromuscular activity (dementia). Pellagra is mainly observed in spring and summer. Initial Clinical signs Pellagra appears as dermatitis on exposed areas of the body exposed to sunlight. Dermatitis is manifested by swelling of the skin, erythema, which have sharp and clear boundaries. Subjectively, patients are bothered by severe itching and burning. Erythema, located on the lateral side of the palm or foot, fingers and hand, ends in a straight line. This clinical symptom resembles gloves (glove symptom). The erythema and border of the swollen lesion on the skin of the neck also rises somewhat, as if separating it from the surrounding skin (symptom of the “Kozal collar”). Newly appeared pathological lesions are dark red, the color of red cherry, and old ones are brown, red-brown in color. Subsequently, peeling begins in the center of the pathological focus, which continues along the periphery of the lesion. The skin is dry, its surface is rough and atrophied, gradually infiltrating. If pellagra is severe, blisters containing cloudy or hemorrhagic fluid appear on the hyperemic skin. The tongue, like a raspberry, is red, swollen, and teeth marks are visible on its side. The tongue papillae are flat or disappear entirely. This type of tongue damage is called glossitis.
In patients who have pellagra, appetite disappears or decreases, the stomach is painful, and diarrhea is observed. Disturbance of neuromuscular activity occurs in the form of pellagrosous polyneuritis, depression, fear and dementia, accompanied by paresthesia and decreased sensitivity of the skin. At mild flow disease, if there are no disorders of the gastrointestinal activity, the psyche of the patient and the disease manifests itself only as dermatitis, this condition is called pellagroid erythema, or pellagroderma. Pellagra can last for years, is accompanied by severe diarrhea and clinically resembles scurvy. At very severe course she can feign illness typhoid fever. Patients die quickly.
Few people know about a disease such as pellagra. Most often, only those who have experienced it know why it arises and what consequences it can lead to. However, to prevent the occurrence of the disease, you need to know as much as possible about it. After all, anyone can face this. In this article we will talk about what pellagra is, the symptoms and treatment of the disease.
This mysterious disease occurs due to poor nutrition or insufficient amounts of substances in the body. Pellagra develops when the body is sorely lacking riboflavin, folic acid, thiamine and some other substances.
Causes of pellagra
Not only a deficiency of vitamins and nutrients can trigger the development of this disease. Very often pellagra occurs due to:
- pathological conditions of the digestive system, in which the process of absorption of nutritional elements from food is disrupted (for example, chronic enteritis);
- infectious diseases (tuberculosis and dysentery);
- increased insolation;
- chronic alcoholism;
- natural conditions in the body, when the body's need for nicotinic acid increases (during pregnancy and lactation, with poor nutrition, as well as with severe physical exertion).
The trigger for the development of the disease is a violation of metabolism and oxygen respiration of cells in the body due to a lack of nicotinic acid.
Symptoms of pellagra
During pellagra, the skin, digestive and nervous systems are affected. If the disease is not detected in time and treated, it begins to suffer. endocrine system, skeletal muscles and heart.
In the first stages of the disease, weakness, decreased or complete absence of appetite, burning sensation in the mouth, profuse salivation, abdominal pain, stool upset. Also, over time, paresthesia begins to appear - this is a condition when a person begins to experience strange sensations in places where peripheral nerves. This may manifest itself as tingling, goosebumps, tingling, or numbness.
First of all, degenerative transformations of the skin appear, as well as symptoms of disorders of the digestive system. Over time, they become associated with nervous exhaustion, which leads to mental problems.
How does the skin react to pellagra?:
- redness appears on the skin (pathological erythema);
- at severe cases bubbles with cloudy contents appear inside (most often they appear on the arms, face, neck and legs);
- damage to the skin with hyperkeratosis (keratinization) appears;
- the skin changes color - it becomes grayish;
- By suits the body strong pigmentation;
- over time, the damaged areas undergo sclerosis, atrophy and begin to peel off;
- Many people experience severe inflammation of the mucous membranes of the eyes, nose, mouth and genitals.
With pellagra, the gastrointestinal tract also suffers:
- the surface of the gastrointestinal tract is bright red and smooth;
- achlorhydria of gastric juice appears;
- bloating;
- ulcerative stomatitis;
- is decreasing physical activity stomach;
- diarrhea alternates with constipation;
- vomiting occurs.
Destructive mental disorders are manifested by the following symptoms:
- memory impairment;
- depression and apathy;
- dizziness and headache;
- hallucinations and psychosis.
With pellagra, blood counts change: slight leukopenia and anemia are noted. Sometimes polyneuritis develops. In spring, the disease most often worsens due to increased solar activity.
Pellagra can be suspected in children if they often suffer from diarrhea that does not go away after special therapeutic diets, as well as after taking medications. In children, pellagra manifests itself with the same symptoms as in adults. Also, skin rashes may be accompanied by severe itching. There are frequent mood swings and increased irritability.
What complications may arise
Pellagra is a serious disease that requires treatment. It can torment a person for years and worsen in warm weather, and then fade away again. The main complication that may arise is that the disease will become acute and lead to death. In the acute form, destructive disturbances in the functioning of the central nervous system are observed. The attacks occur suddenly and have symptoms similar to a stroke. Such attacks are accompanied by severe vomiting, nausea, diarrhea, hallucinations, convulsions, and stiffness of the legs and arms. Tendon reflexes also sharply arise, the temperature of the whole body rises, swelling and ascites appear. In this case, changes in the skin characteristic of the disease are weakly expressed or absent altogether.
How is the disease diagnosed?
If the symptoms of pellagra are pronounced, then an experienced specialist can easily make the correct diagnosis. As a rule, to make a diagnosis it is enough to see the patient has dermatitis, diarrhea and dementia. The patient also needs to undergo a urine test, which will show the presence of B vitamins and niacin in the body.
Treatment of the disease
If you consult a doctor in time, the disease can be treated successfully. The patient is admitted to the hospital or treated as an inpatient. Each person is assigned individual nutrition, which includes all the necessary quantities. The patient’s diet must include: fish, yeast, buckwheat, meat, peanuts, liver, bread.
The patient is also prescribed drug treatment. It consists of taking Nicotinamide or nicotinic acid. If the patient has problems with the gastrointestinal tract, then vitamins are administered intravenously or intramuscularly. The course of treatment lasts on average one and a half months. Along with nicotinic acid, the patient is prescribed to take B vitamins.
In addition, drugs to support the pancreas and hydrochloric acid are prescribed. At heavy salivation atropine is prescribed. Skin changes are treated systematically. If the patient is severely exhausted, it is recommended to do this. For the entire duration of treatment, the patient is given mental and physical rest. To prevent relapse, the patient must quit smoking forever and avoid direct sunlight.
Prevention of pellagra
The best prevention of this disease is proper nutrition. Make sure that your diet contains all the necessary vitamins and substances. If necessary, take a course of multivitamin complexes.
To never encounter this disease, eat foods every day that contain nicotinic acid and B vitamins. A lot of nicotinic acid is found in wheat and yeast, liver, salmon, pork, beef, and lamb. You also need to drink milk. It contains almost no niacin, but it does contain tryptophan, which helps synthesize niacin in the body.
If symptoms of the disease appear, consult a doctor immediately. Timely treatment guarantees you fast recovery and a minimum of side effects from the disease.
The name pellagra comes from the phrase “pelle agra,” which translated from Italian means “rough, rough skin.”
The disease is one of the types of vitamin deficiencies, and is caused by insufficient intake of B vitamins – nicotinic acid and tryptophan – into the body.
In the past, pellagra was common in areas where corn was the main food product, since in this cereal B vitamins are in a bound state and are poorly absorbed by the body.
Reasons for development
The main reason leading to the development of pellagra is insufficient intake of B vitamins in the body. This may be due to:
- With insufficient or unbalanced nutrition. It is for this reason that pellagra occurs in large numbers during periods of famine, war, and natural disasters. The disease develops if the diet is low in protein foods, whole grains and green vegetables.
- Violation of the absorption of vitamins due to diseases of the gastrointestinal tract. Pellagra can develop against the background peptic ulcer, chronic gastroenteritis, hyperacid gastritis, etc.
- Pellagra often develops in alcoholics who have had irreversible changes in the liver.
- Formation of carcinomas (malignant neoplasms), which affect the ability to absorb vitamins.
- Chronic stress and severe physical fatigue.
Clinical picture
A lack of B vitamins in the body provokes the development of pellagra.Pellagra is characterized by a stable triad of symptoms - dermatitis (skin changes), dementia (neurological symptoms), diarrhea (digestive disorders).
Changes in the skin are observed in 80% of patients with pellagra. Usually, skin symptoms are the earliest signs of the disease. However, they may be preceded by general disorders - weakness, sleep disturbances, lack of appetite, instability of the emotional background, weakening of memory, etc.
Most often, skin changes with pellagra are observed in open areas and in areas that are often subject to trauma (rubbing, shaving, etc.).
As a rule, the first changes appear on the face, hands and forearms, feet and legs, and neck. Sensitive to light forms on the skin. At the beginning of the process, the lesion may resemble sunburn, but then the erythema quickly turns into red-brown spots. In some patients, it appears in closed areas of the skin - in the perineum, in the joint area, etc.
Skin lesions are usually symmetrical. Characteristic symptom diseases - “pellagroid gloves” and “pellagroid boots”, that is, of the hands, as well as lower parts forearms and shins. Skin lesions are often observed on the lateral surfaces of the neck with a transition to the chest; this symptom is called the “Casal collar”.
With pellagra, the skin at the affected area is dry, the surface is covered with small scales. Sometimes cracks and ulcerations appear on the affected skin.
The extent of skin damage with pellagra can vary. At acute course The disease may cause vesiculobullous manifestations, that is, the formation of blisters. With pellagra, the blisters usually have clear contents, but when secondary infections occur, they can become purulent. Pellagra blisters form more often on the legs than on the arms or neck.
The lesion on the skin of the face with pellagra may resemble the lesion, as a rule, has the shape of a butterfly. The face of patients with pellagra often becomes like a mask, and in addition to erythematous skin lesions, blisters, crusts and hyperpigmented spots can form.
Damage to the skin of the face is especially often observed in women and children with pellagra, while skin changes in other parts of the body can be very mild.
With pellagra, erymatous rims often form on the eyelids, which look like fresh bruises. Pigment spots form around the eye sockets, forming “pellagroid glasses”.
The fingers of patients with pellagra thicken, the skin on the palms becomes yellowish, and hyperkeratosis is observed. Wide white stripes appear on the nails, and the nail plates themselves thicken, becoming like watch glasses.
Skin injuries in patients with pellagra can lead to the appearance of lesions in other areas of the body. The mucous membranes may also be involved in the process. With pellagra, lesions around the anus are often observed, which clinical manifestations symptoms are similar.
In addition, there is swelling of the lips, tongue, manifestations of glossitis, stomatitis, etc.
The neurological symptoms of pellagra are varied. Patients experience insomnia, asthenic syndrome, irritability, depression, psychosis, memory impairment, etc. Pellagra can become a provoking factor for the development of schizophrenia.
Digestive disorders are characterized by persistent diarrhea, vomiting, and weight loss.
Neurological and gastrointestinal symptoms may occur simultaneously with skin rashes or later.
Diagnostic methods
Diagnosis of pellagra is made based on the study of the clinical picture and blood tests. It must be said that in civilized countries pellagra is quite rare and this can create difficulties in making a diagnosis.
Treatment
Nicotinic acid preparations are used for treatment. Patients with pellagra are recommended to be hospitalized. For treatment, nicotinic acid preparations are prescribed in the form of injections. Also, group B intake is required, ascorbic acid. For the treatment of acute skin manifestations For pellagra, corticosteroid ointments may be prescribed.
If a patient with pellagra experiences acute neurological disorders, tranquilizers, antipsychotics and antidepressants may be prescribed.
Patients with pellagra are prescribed a special diet with a predominance of protein foods and vitamins. The diet should include fish, meat products, whole grains, a variety of green vegetables. Additionally, you can take brewer's yeast.
Treatment with traditional methods
The following can be used to treat pellagra: folk recipe.
You need to take 50 grams of soybeans, rinse and place in a saucepan. Add water until the beans are covered by two fingers. Add 100 grams to the pan pork liver and cook everything together over very low heat for two hours. At the end of cooking, you can add a little salt. Eat everything, along with the resulting broth. Medicine apply daily for two weeks.
Prognosis and prevention
Prevention of pellagra disease involves providing a nutritious and varied diet with sufficient protein content in the diet. In addition, it is necessary to limit alcohol and promptly treat diseases of the gastrointestinal tract.
The prognosis for pellagra depends on the timeliness of detection of the disease and the adequacy of therapy. When treatment is started on time, it is almost always possible to achieve a good result. If left untreated, pellagra can lead to the death of the patient within 4-5 years.
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