Pellagra: Symptoms and Treatment

Such a rare disease as pellagra is not familiar to everyone, and the first signs of it are so similar to small skin problems that people do not rush for medical help.As a rule, the disease under consideration develops due to a violation of the assimilation of vitamins and other substances, several factors may provoke it - for example, inadequate nutrition, internal diseases of chronic form of the course.

Table of contents: Historical background Causes of pellagra development What happens in the body with a deficiency of nicotinic acid Symptoms of pellagra

Historical background

In the 18th century, doctors were generally confident that pellagra is an infectious disease, especially since in those yearsThe disease most often affected the poor.But in 1916 this opinion successfully refuted the experiments set by the doctors - microscopic particles of the biomaterial of sick people( for example, skin scales) were mixed in absolutely healthy people - no cases of the disease were found.And just a few years after this discovery, a medicine was found that could completely heal from pellagra.Nicotinic acid became such a medicine.

Pellagra is considered quite a dangerous disease for a person, but only if no therapeutic measures are taken - after a maximum of 8 years, this disorder leads to a fatal outcome.

Very rarely considered disease is diagnosed in people in developed countries, where a high level of medicine and education.But in countries of Africa and South America, there are many cases of diagnosing pellagra.And one more nuance - most often the considered pathology arises against the background of chronic alcoholism - this is a proven fact.

Causes of the development of pellagra

The main reason for the development of this disease is the intake of vitamin B3 in small amounts, as well as vitamins B1, B2, B6 and tryptophan. In turn, the following factors can lead to this:

• stress state, which is in a chronic current;
• previously diagnosed diseases of the digestive system - for example, gastritis, hepatitis, peptic ulcer, pancreatitis;
• progressive malignant tumors - they are able to convert the incoming tryptophan into serotonin;
• malnutrition - it means both a violation of the diet, and a violation of the regime;
• period of pregnancy and lactation;
• chronic physical fatigue against a background of malnutrition;
• alcoholism;
• permanent effect on the skin of ultraviolet rays - this applies to fans of solariums;
• progressive infectious diseases - for example, dysentery or tuberculosis.

What happens in the body when there is a lack of nicotinic acid

Many people are amazed that the lack of only one vitamin can lead to the development of a real disease.But after all doctors knowingly constantly speak about necessity of maintenance of own organism, about additional reception of some vitamin complexes - consequences really very serious. Judge for yourself, what processes in the body are violated only with a lack of nicotinic acid:

• formation of hemoglobin and erythrocytes;Redox reactions;
• ;
• secretion of gastric juice and bile;
• formation of sex hormones;
• synthesis of pancreatic and thyroid hormones;
• blood glucose monitoring;
• functioning of the central nervous system;
• processes to reduce the level of "harmful" cholesterol in the blood.

And that's not all!If the lack of nicotinic acid is present in a pregnant woman, then the processes of the intrauterine formation of the neural system of the unborn child are disrupted, and in some cases this condition leads to memory loss and disruption of certain zones of the brain even in absolutely healthy people.

In general, the lack of nicotinic acid in the body leads to violations of all metabolic processes, pathological changes in the cardiovascular system are developing, the blood formula is deteriorating, irreversible disorders occur in the hormonal balance, the condition of joints and skin changes dramatically for the worse.

Symptoms of pellagra

Symptoms of the disease under consideration include the main triad of symptoms:

• dermatitis;
• diarrhea;
• dementia.

Afterwards, as the pellagra progresses, the patient is diagnosed with pathological changes in the cardiovascular, endocrine, and musculoskeletal systems.

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 disorders in the digestive system( diarrhea), weakness, decreased appetite, increased drowsiness and chronic fatigue.In some cases, these symptoms develop so slowly that the lack of vitamin B3 in the body is accepted even by 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, the changes on the skin worry the patient - they appear almost immediately after exposure to sunlight and manifest as dermatitis, and the mucous membranes are also affected.

The following changes in the skin and mucous membranes will occur with pellagra:

1. Red, slightly swollen spots appear on the exposed skin surfaces( legs, hands, face and neck), sometimes they are bubbles with a cloudy liquid content.With progression, these spots become brown, brown, can develop into long, non-healing ulcers.
2. Appears hyperpigmentation, which has the character of "glasses", "gloves" and / or "socks".The person becomes sensitive to the sun's rays - they cause him a burning sensation and burning of the skin.
3. Individual areas of the skin may begin to peel off, and subsequently they become angry.The skin becomes gray.
4. Mucous membranes become inflamed - this process affects both the oral cavity, and the genitals, and nasal passages / sinuses.

Most often, changes in the skin of pellagra are localized in the face and neck area.Patients can mark the appearance of red spots in the form of a crescent, around the eyes and on the bridge of nose can appear areas with brown and flaky skin.Specifically, on the neck can appear the so-called collar of Kasal - a patch 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 is also often affected - often there are red and slightly edematous "bracelets" in these places.

Pellagra can also be manifested by rashes on the lower leg and thighs - they will have the form of papules with liquid contents, hemorrhage zones appear around such rashes.

Dysfunction of the digestive system

If the pellagra was not diagnosed during the development stage of dermatitis, the progression of the disease leads to disruption of the functioning of the digestive system. This is manifested not only by diarrhea, but also by other syndromes:

• , whitish sores appear on the oral mucosa - stomatitis is diagnosed;
• in the mouth is always present taste of salt and burning sensation;
• lips and tongue periodically swell, but not too intensively;
• cracks appear in the corners of the mouth, which do not heal for a long time even with the use of specific drugs;
• language gets crimson color and becomes "lacquered", it clearly shows the prints of teeth.

Note: during pellagra diarrhea always alternates with constipation, and in some cases, such abnormalities in the intestine are accompanied by a prolonged nausea, resulting in vomiting.

When a patient with similar symptoms is examined by a doctor, bloating, a decrease in gastric motility and the absence of hydrochloric acid in gastric juice can be detected.

Neuromuscular disorders - dementia

Nervous and psychiatric disorders can also be a consequence of a lack of nicotinic acid and tryptophan in the body. In this case, the patient will have the following syndromes:

• complete loss of sensitivity of the skin in some parts of the body( usually they can be clearly localized);
• increased fatigue;
• apathy to yourself, work, others;
• memory corruption;
• sleep disorders;
• polyneuritis;
• irritability arising without basis;
• paresthesia;
• depression.

If the pellagra proceeds in a neglected form, the patient does not undergo treatment, then in the future he may develop hallucinations, psychomotor agitation, paranoid nonsense - this condition is classified by doctors as psychosis.Often, on the background of neglect of the disease under consideration, encephalopathy develops, which is accompanied by a clouded consciousness, lack of control over sucking and grasping reflexes, hypertension of muscles.

How is

diagnosed with pellagra? As a rule, a diagnosis of pellagra is made if the patient has a described triad of symptoms.The disease in question must necessarily be differentiated from porphyria, erysipelas, solar dermatitis and Hartnap's disease.

The patient must undergo a complete examination.In the urine of such a patient, an active release of nicotinic acid and B vitamins will be revealed. When the digestive system is examined by an endoscope, the doctor will detect atrophy of the stomach and intestinal mucosa, and in some cases bleeding ulcers on the mucous membranes of these parts of the gastrointestinal tract are noted.

Treatment of pellagra

Treatment of the disease in question is always carried out in hospital, the doctor will prescribe a comprehensive therapy and will constantly monitor the patient's condition. As a rule, the therapy for pellagra is as follows:

• absolute rest to the patient - both physical( bed rest) and mental;
• the affected areas of the skin are treated with corticosteroid preparations( ointments);
• in high doses are prescribed to receive nicotinic acid preparations - the dosage is selected in a strictly individual order, at the very beginning of treatment such drugs are injected intramuscularly or intravenously, and then the dosage is reduced and the patient switches to taking the tablets;
• is assigned vitamin B12, riboflavin, thiamine and pyridoxine;
• for diarrhea appoint a course of antibacterial drugs( antibiotics);
• the patient must necessarily drink a course of Nystatin and multivitamin complexes if there was antibiotic treatment;
• eliminates skin contact with ultraviolet rays;
• , in case of obvious exhaustion, the patient is assigned blood transfusion with fractional "portions";
• if the disease is already accompanied by mental disorders, then tranquilizers are prescribed.

Note: if the pellagra was triggered by any internal pathological process, then it is necessary to appoint the patient and his treatment.

A very important aspect in therapy against the considered disease is the observance of a special diet.

Diet for pellagra

Patients are assigned a specially developed menu in which foods rich in vitamins of groups A, B, C and protein are present. These include:

• liver and kidney;
• fresh fish and meat of fatty varieties;
• any nuts - walnuts, almonds, peanuts and so on;
• cornmeal and wheat bran;
• all dairy products, including kefir, fermented baked milk, sour cream;
• any vegetables;
• all fruits and berries, especially useful for pellagra will be sea buckthorn, pomegranate, melons and peaches;
• potatoes and beans;
• rose hips;
• fennel;
• spicy greens.

All products are prepared taking into account that the digestive system needs support, that is, the best option is quenching, cooking, steaming, baking.Food intake should be done in small portions, but often enough - at least 5 times a day.Caloric content of foods increases gradually - for example, in the first week the patient will receive enough 2500 Kcal.

Possible complications

Sometimes the pellagra proceeds in acute form and then all the symptoms described in the article are manifested immediately and intensively - often doctors confuse this condition with developing stroke.In this case, the pellagra always ends in a fatal outcome.

If the disease under consideration proceeds at a normal rate is chronic, then its complications may occur as typhus, scurvy or dysentery.If the pellagra proceeds for years, with exacerbations only in the summer period, the patient develops dementia, he becomes disabled.

Pelagra prophylaxis

To prevent the development of the disease under consideration, it is necessary to remember only a few rules of prevention. These include:

• reception in the spring period of multivitamin complexes;
• a 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;
• prevention of stress and depression development.

Pellagra is a rare, but still common, disease.Forecasts for this pathology doctors give variative - if treatment is started on time, and carried out in full, then the forecast is extremely favorable.But if the pellagra is "in free form", the patient does not take specific medications and has not undergone the necessary examinations, then the doctors give the forecast unfavorable - after 5-8 years, the pellagra leads to death.

Tsygankova Yana Aleksandrovna, medical reviewer, therapeutist of the highest qualification category