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Redness of the skin
Diarrhea
Red when exposed to the sun
Skin has moles or spots of different colors
Fatigued
My skin is dry
Red spots on skin
Not seeing your symptoms? No worries!
What is Pellagra?
Pellagra is a systemic disease caused by a severe deficiency of vitamin B3 (Niacin). A mild deficiency might go unnoticed, but a chronically low or Niacin-free diet can result in symptoms. The primary symptoms include diarrhea, skin inflammation, inflammation of the mucous linings (inside the mouth), mental confusion, and weakness. If untreated, it can lead to death.
Typical Symptoms of Pellagra
- Whole body pain
- Redness in sun-exposed areas of skin
- Black/blue/brown spots or moles, on the skin and lining of the mouth
- Dry and flaky skin
- Seizure
- Itchy skin
- A lump or bump in the mouth
- Dark spots on skin
Diagnostic Questions for Pellagra
Your doctor may ask these questions to check for this disease:
- Do you have pain all over your body?
- Do you have redness on sun-exposed skin?
- Are there black, blue, or brown spots on your skin? (Including moles)
- Do you have dry and flaky skin?
- Have you experienced any seizures?
Treatment of Pellagra
Pellagra is treated with dietary changes and supplementation of niacin or nicotinamide (another form of vitamin B-3). These vitamins can be given orally or injected intravenously. With early treatment, many people fully recover and begin to feel better within a few days of starting treatment.
Reviewed By:
Saqib Baig, MD, MS (Pulmonology, Critical Care, Internal Medicine)
Dr. Baig graduated from Army Medical College (NUST) Pakistan in 2007. He did his internal medicine training from Baltimore, Maryland, USA during the years 2009-2013. He joined the internal medicine faculty practice at Medical College of Wisconsin in USA for 2 years before pursuing advanced training. He completed his pulmonary disease and critical care medicine fellowship from Rutgers Robert Wood Johnson Medical School from 2015-2018. | | During his fellowship, Dr. Baig completed his master's in health care services management through Rutgers Business School. He currently serves as the medical director of respiratory therapy and pulmonary function lab and the clinical director of the COPD program at the Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University. He holds the Assistant Professor of Medicine rank at Sidney Kimmel Medical College at Thomas Jefferson University. Dr. Baig's interests lie in respiratory physiology, airways disease, and data science.
Yukiko Ueda, MD (Dermatology)
Dr. Ueda graduated from the Niigata University School of Medicine and trained at the University of Tokyo Medical School. She is currently a clinical assistant professor at the Department of Dermatology, Jichi Medical University, and holds several posts in the dermatology departments at Kyoto Prefectural University of Medicine, Komagome Hospital, University of Tokyo, and the Medical Center of Japan Red Cross Society.
Content updated on May 13, 2024
Following the Medical Content Editorial Policy
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- My whole body aches and I feel weak
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- Increase in dandruff
- Whole body aches no fever
- My body is jerking
- My whole body hurts
- Black, blue, or brown spots on the skin or elsewhere
- Whole body pain
- Skin peeling
- Moles or spots of different colors on skin or lining of the mouth
- Twitching
- Dry flaky skin
- Fever seizures (with fever of >100.4°F / 38°C)
- Scaly skin
See full list
Symptoms Related to Pellagra
Diseases Related to Pellagra
FAQs
Q.
Always Tired? Why Your Brain is Starving + Medically Approved Vitamin B1 Steps
A.
Persistent fatigue, brain fog, and irritability can stem from low vitamin B1, a key nutrient your brain uses to turn carbs into energy; deficiency is more common with high processed-carb diets, alcohol use, diabetes, gut issues, older age, or certain meds, and is treatable with doctor-guided steps like increasing B1-rich foods, appropriate supplementation, reducing alcohol, and balancing other B vitamins. There are several factors to consider. See below for red flag symptoms that need urgent care, detailed food and supplement options with typical forms and doses, who should be tested or seek medical advice first, and other conditions your clinician may check if fatigue persists.
References:
* Magistretti PJ, Allaman I. Brain Energy Metabolism in Health and Disease. J Exp Biol. 2015 Jan 15;218(Pt 2):242-6. doi: 10.1242/jeb.107018. PMID: 25420352.
* Morris G, Anderson G. Mitochondrial dysfunction and fatigue: An update. Mitochondrion. 2017 May;34:106-118. doi: 10.1016/j.mito.2017.02.002. Epub 2017 Feb 18. PMID: 27956272.
* Lonsdale D. Thiamine Deficiency: An Update on the Biochemical, Physiological, and Clinical Aspects. Adv Nutr. 2016 May 15;7(3):499-513. doi: 10.3945/an.116.012580. PMID: 27242409.
* Lu J, Jiang Q, Li C, Ding J, Zhang J, Li C. Thiamine deficiency and neurological disorders. Biomed Pharmacother. 2020 Aug;128:110242. doi: 10.1016/j.biopha.2020.110242. Epub 2020 May 16. PMID: 32709292.
* Geng J, Zhou L, Zhang S, Ding J, Wang X, Hu X, Li C, Lu J. Thiamine metabolism and deficiency in metabolic diseases. J Neurochem. 2022 Jul;162(2):166-180. doi: 10.1111/jnc.15645. Epub 2022 Apr 21. PMID: 35463768.
Q.
Always Tired? Why Your Body Lacks B2 and Medically Approved Next Steps
A.
Feeling constantly tired can be caused by low vitamin B2 riboflavin, which your body needs to turn food into energy. Watch for fatigue with mouth corner cracks, a magenta tongue, skin or eye irritation, and higher risk if you have a restrictive diet, low dairy intake, gut disease, heavy alcohol use, are pregnant, or are older. Medically approved next steps include adding B2 rich foods like dairy, eggs, lean meats, almonds, mushrooms, spinach, and fortified cereals, seeing a clinician for persistent fatigue with labs such as CBC, iron, B12, folate, thyroid, and riboflavin status, and using 5 to 25 mg supplements only if advised. There are several factors to consider that can change your next move; see below for the complete guidance and important red flags.
References:
* Suwannasri W, et al. Riboflavin (Vitamin B2) Deficiency. 2023 Jan. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32491629.
* Powers HJ. Riboflavin and health. PLoS One. 2013 Sep 13;8(9):e72652. doi: 10.1371/journal.pone.0072652. PMID: 24066092; PMCID: PMC3773121.
* Thakare SN, et al. Riboflavin Deficiency: Clinical Presentation, Diagnostic Approaches, and Therapeutic Implications. J Clin Med. 2023 Mar 15;12(6):2274. doi: 10.3390/jcm12062274. PMID: 36983758; PMCID: PMC10057068.
* Prabhu V, et al. Role of Riboflavin in Health and Disease. Nutrients. 2020 Aug 17;12(8):2454. doi: 10.3390/nu12082454. PMID: 32824341; PMCID: PMC7468922.
* Sadeghzadeh R, et al. Vitamins and Minerals in the Treatment of Fatigue: A Systematic Review. Nutrients. 2022 Jul 25;14(15):3063. doi: 10.3390/nu14153063. PMID: 35956272; PMCID: PMC9369970.
Q.
Vitamin B3 (Niacinamide): Why Women 65+ Need It for Brain & Skin Health
A.
For women 65+, vitamin B3 in the niacinamide form helps maintain brain energy and memory, supports nerves, and strengthens aging skin by improving barrier function, hydration, tone, and repair. Many older adults may not get enough due to reduced intake or absorption; about 14 mg/day from food or a low-dose supplement can meet needs, with niacinamide preferred and higher doses only with medical guidance. There are several factors to consider. See below for food sources, signs of deficiency, safety and medication interactions, and when to speak with a doctor to decide on testing or supplementation.
References:
* Park KY, Hwang IS, Kim SM, Park HJ, Han SM, Kim BJ, Kang CN. The Effect of Niacinamide on the Skin and Brain: From Preclinical Evidence to Clinical Implications. Int J Mol Sci. 2023 Sep 26;24(19):14589. doi: 10.3390/ijms241914589. PMID: 37785233; PMCID: PMC10573902.
* Braidy N, Liu Y. Niacin in the treatment of Alzheimer's disease: preclinical and clinical evidence. Curr Alzheimer Res. 2017 Dec 29;15(1):1-10. doi: 10.2174/1567205014666171120124846. PMID: 29283973.
* Gehring W. Niacinamide: A Topical Vitamin with Broad Skin Benefits. J Clin Aesthet Dermatol. 2021 Jun;14(6):6-9. PMID: 34267440; PMCID: PMC8219662.
* Draelos ZD. Topical nicotinamide: a review of its use in cosmetic dermatology. J Clin Aesthet Dermatol. 2013 Dec;6(12):13-7. PMID: 24213791; PMCID: PMC3871992.
* Braidy N, Grant R, Chung RS, Sachdev P, Guillemin GJ. Therapeutic potential of nicotinamide for the treatment of neurodegenerative diseases. Curr Top Med Chem. 2008;8(10):802-8. doi: 10.2174/156802608784961556. PMID: 18598797.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Viljoen M, Bipath P, Tosh C. Pellagra in South Africa from 1897 to 2019: a scoping review. Public Health Nutr. 2021 Jun;24(8):2062-2076. doi: 10.1017/S1368980021001336. Epub 2021 Mar 26. PMID: 33769244.
https://www.cambridge.org/core/journals/public-health-nutrition/article/pellagra-in-south-africa-from-1897-to-2019-a-scoping-review/5D2EC1BADFCB0360609534C552D232AFPELLAGRA. JAMA. 2020 May 26;323(20):2100. doi: 10.1001/jama.2019.13455. PMID: 32453356.
https://jamanetwork.com/journals/jama/article-abstract/2766404Li P, Lou Y. The Pellagra Problem. JAMA. 2021 Aug 10;326(6):573. doi: 10.1001/jama.2020.18074. PMID: 34374730; PMCID: PMC8709778.
https://jamanetwork.com/journals/jama/article-abstract/2782875