Dermatologic Manifestations of Pellagra Treatment & Management

Updated: May 13, 2022
  • Author: Vladimir Hegyi, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Medical Care

Oral therapy with nicotinamide or niacin usually is effective in reversing the clinical manifestations of pellagra. Because patients are often malnourished and have other vitamin deficiencies, provisions for a high-protein diet and the administration of B-complex vitamins are needed for complete recovery. [27]

Patients with acute pellagra require bedrest during the initial phase of treatment. Patients with severe glossitis require a liquid or a soft solid diet to overcome dysphagia. Ensure that the patient has a balanced diet that is rich in protein and niacin. The topical treatment of skin lesions with topical emollients may reduce discomfort.



To prevent and/or treat pellagra, prescribe a protein-rich diet with adequate calories. The addition of meats, milk, peanuts, leafy green vegetables, whole or enriched grains, and brewer's dry yeast can enhance niacin intake. In patients with oral dysphagia secondary to glossitis, a liquid or a semisolid diet may be required. The long-term inclusion of milk, meat, and eggs in the diet ensures the dietary adequacy of the proteins essential for recovery.



Primary prevention is as follows:

  • The primary prevention of pellagra involves an adequate diet.

  • Food sources of niacin and/or tryptophan include nutritional yeast, eggs, bran, peanuts, meat, poultry, fish with red meat, cereals (especially fortified cereals), legumes, and seeds.

  • The recommended daily allowance of niacin for infants is 5-6 mg; for children, 9-13 mg; for adults, 13-20 mg; for pregnant women, 17 mg; and for breastfeeding women, 20 mg.

  • Optimal supplementation is 20-30 mg daily.

Secondary prevention is as follows:

  • Patients should avoid sun exposure during the active phase of the disease.

  • Patients should follow a convenient dietary regimen.

  • Close dietary follow-up after the patient's recovery helps prevent the recurrence of pellagra.