What is pellagra treatment. Pellagra - symptoms, photos, causes and treatment of pellagra

The name of the disease pellagra comes from the phrase "pelle agra", which means "rough, rough skin" in Italian.

The disease is one of the varieties of beriberi, and is caused by insufficient intake of B vitamins - nicotinic acid and tryptophan.

In the past, pellagra was common in areas where the main food was corn, since in this cereal the 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 into the body. This may be due to:

• With insufficient or unbalanced nutrition. It is for this reason that pellagra is massively found during periods of famine, wars, and natural disasters. The disease develops if the diet is low in protein foods, whole grains and green vegetables.
• Violation of the process of absorption of vitamins due to diseases of the digestive tract. Pellagra can develop against a background of peptic ulcer, gastroenteritis in chronic form, hyperacid gastritis, etc.
• Often, pellagra develops in alcoholics who have had irreversible changes in the liver.
• The formation of carcinomas malignant neoplasms), which affect the ability to absorb vitamins.
• Chronic stress and severe physical overwork.

Clinical picture

Pellagra is characterized by a stable triad of symptoms - dermatitis (skin changes), dementia (neurological symptoms), diarrhea (indigestion).

Changes in the skin are observed in 80% of patients with pellagra. Usually, skin symptoms are the most early signs diseases. However, they may be preceded by general disorders - weakness, sleep disturbances, lack of appetite, emotional instability, memory loss, etc.

Most often, skin changes with pellagra are observed in open areas and in areas that are often traumatized (rubbing, shaving, etc.).

As a rule, the first changes appear on the face, hands and forearms, feet and shins, neck. On the skin are formed sensitive to light. Early in 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 area of ​​\u200b\u200bthe joints, etc.

Skin lesions are usually symmetrical. characteristic symptom diseases - "pellagroid gloves" and "pellagroid boots", that is, the hands, as well as the lower parts of the forearms and shins. Often there is a lesion of the skin at the lateral surfaces of the neck with the transition to the chest, this symptom is called "Casal's collar".

With pellagra in the lesion, the skin is dry, observed, the surface is covered with small scales. Sometimes cracks and ulcerations appear on the affected skin.

The degree of skin damage in pellagra can be different. In the acute course of the disease, vesiculo-bullous manifestations may occur, that is, the formation of blisters. With pellagra, the blisters usually have a transparent content, but with the addition of secondary infections, they can become purulent. Bubbles in pellagra form more often on the legs than on the arms or neck.

The lesion of 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, while, in addition to erythematous skin lesions, blisters, crusts and hyperpigmented spots can form.

Facial skin lesions are especially common 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. Around the eye sockets are formed dark spots, forming "pellagroid glasses".

The fingers of patients with pellagra thicken, the skin on the palms becomes yellowish, there are phenomena of hyperkeratosis. Wide white stripes appear on the nails, the nail plates themselves thicken, becoming like watch glasses.

Injuries to the skin in patients with pellagra can lead to the appearance of lesions in other parts of the body. Mucous membranes may also be involved in the process. With pellagra, lesions around the anus are often observed, which are similar in clinical manifestations and symptoms.

In addition, there is swelling of the lips, tongue, manifestations of glossitis, stomatitis,.

Neurological symptoms pellagra is diverse. 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, weight loss.

Neurological and gastrointestinal symptoms may be observed simultaneously with skin rashes or later.

Diagnostic methods

Diagnosis of pellagra is based on the study clinical picture and performing blood tests. It must be said that pellagra is quite rare in civilized countries and this can create difficulties in making a diagnosis.

Treatment

Patients with pellagra are recommended to be hospitalized. For treatment, nicotinic acid preparations are prescribed in the form of injections. Also, it is necessary to take group B, ascorbic acid. For the treatment of acute skin manifestations pellagra, corticosteroid ointments may be prescribed.

If a patient with pellagra has acute neurological disorders, tranquilizers, neuroleptics and antidepressants can be prescribed.

Patients with pellagra are prescribed a special diet with a predominance of protein products 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 folk methods

The following can be used to treat pellagra folk recipe.

It is necessary to take 50 grams of soybeans, rinse and place in a saucepan. Add water so that the beans are covered by two fingers. Add 100 grams of pork liver to the pan 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. The drug should be used daily for two weeks.

Forecast and prevention

Prevention of pellagra disease is to ensure a complete and varied diet with sufficient protein content in the diet. In addition, it is necessary to limit alcohol and treat diseases of the digestive tract in a timely manner.

The prognosis for pellagra depends on the timeliness of detection of the disease and the adequacy of therapy. With timely treatment, 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.

Pellagra develops as a result of a deficiency in the body of nicotinic acid, other vitamins of the B complex and tryptophan. Pellagra can be primary (against the background of malnutrition) or secondary, in the pathogenesis of which absorption disorders in the gastrointestinal tract play a role, caused by various diseases of the latter (enterocolitis, dysentery, dysbacteriosis, condition after surgical interventions etc.). A number of additional factors are also important (alcoholism, pregnancy, severe physical exercise and etc.). Inadequate intake and / or absorption of vitamin PP and tryptophan, which are involved in the main metabolic processes, cause degenerative and neurotrophic disorders in many organs, of which the skin, gastrointestinal tract and central nervous system are the most vulnerable. The decisive factor in the development of skin pathology is intense or chronic exposure to UV radiation. As with some other photodermatoses, hypersensitivity to them, apparently, is determined by porphyrins, the exchange of which is disturbed in pellagra.

Clinic. Allocate acute and protracted forms of pellagra.

Acute form of pellagra occurs suddenly with the rapid development of the main symptoms, which are preceded by general phenomena: weakness, fatigue, headache, dizziness, irritability, memory impairment.

The initial symptoms of damage to the digestive system with pellagra are a decrease in appetite, sometimes a complete aversion to food, a perversion of taste sensations, dry mouth, accompanied by a burning sensation and soon replaced by increased salivation. The mucous membranes of the oral cavity are edematous, hyperemic, sometimes only the tongue is affected, which acquires a bright red or crimson hue. Its papillae are smoothed out, deep transverse cracks appear, imprints of teeth on the lateral surfaces. The chair is liquid, becomes more frequent up to 7-12 times a day and does not give in drug therapy, but sometimes spontaneous remissions can occur lasting 2-3 weeks.

Pellagrozny dermatitis develops in open areas skin(face, neck, rear of the hands), although in some cases closed areas are involved (forearms, shins, perineum, genitals). It is characterized by a distinct demarcation of the foci, mild edema and hyperemia of the skin with a peculiar cherry-red hue, later turning into reddish-brown. In foci located in the perianal region and on the genitals, maceration may occur. In cases that are especially acute, in some patients, blisters with serous or bloody contents appear on an erythematous background, and a secondary infection is possible. Like diarrhea, dermatitis may occasionally resolve. Repeated relapses entail some thickening of the skin, loss of elasticity, development of pigmentation and atrophy. In place of opening blisters, slowly healing superficial ulcers sometimes form. Subjective sensations in dermatitis, as a rule, are absent.

Changes from the central nervous system with pellagra, often defined as dementia (the third "D"), in reality they turn out to be depression. Dementia develops only in the later stages of aggressive pellagra. Psychosis occurs after 3-5 months from the onset of the disease. They are preceded by paresthesia, adynamia, neurasthenia phenomena, against the background of which amentia, a delirious state, manic-depressive psychosis, or other disorders later occur. There are also polyneuritis, polyradiculoneuritis, the intensity of which depends on the severity of the underlying process.

Pellagra is characterized by hyperchromic anemia of the macrocytic type, slight leukopenia with a slight shift to the left, hypoproteinemia, a decrease in the content of albumins and an increase in globulins, a decrease in acidity. gastric juice(ahilia is extremely rare).

lingering form characterized by a very slow development of the same symptoms, but less pronounced and more benign flowing. Cases that manifest only dermatitis with a moderately manifest clinic are interpreted by some authors as "pellagroid" or "pellagroid dermatitis".

Differential diagnosis of pellagra: solar dermatitis, erysipelas, Hartnup syndrome, porphyria.

Pellagra treatment. Parenteral administration of nicotinic acid in doses corresponding to the severity of the process, but not less than 100 mg per day, upon reaching the effect, the dosage is gradually reduced. A protracted form requires many months of use of the drug. Be sure to prescribe other B vitamins, especially B2, B6 and B12. Hydrochloric acid, enzyme preparations (panzinorm, etc.), hepatoprotectors, therapy of diseases pathogenetically causing pellagra are shown. A balanced diet is essential. Treatment of neurological and mental disorders in consultation with the relevant specialists.

Such a rare disease as pellagra is not familiar to everyone, and its first signs are so similar to minor skin problems that people are in no hurry to medical care. 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 diseases of the chronic form of the course.

History reference

In the 18th century, doctors were generally sure 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 performed by doctors - microscopic particles of the biomaterial of 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 just a few years after this discovery, a medicine was found that could completely cure pellagra. Nicotinic acid has become such a drug.

It is extremely rare that the disease under consideration is diagnosed in residents of developed countries, in which there is a high level of medicine and education. But in the countries of Africa and South America, there are really a lot of cases of diagnosing pellagra. And one more nuance - most often the pathology under consideration occurs against the background of 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 amounts of vitamin B3, as well as vitamins B1, B2, B6 and tryptophan. In turn, the following factors can lead to this:

• • stressful condition, which is in a chronic course;
  
  
  • previously diagnosed diseases of the digestive system - for example, gastritis, hepatitis, peptic ulcer, pancreatitis;
  • progressive tumors of a malignant nature - they are able to convert the tryptophan entering the body into serotonin;
  • malnutrition - this refers to 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 to the skin of ultraviolet rays - this also applies to lovers of solariums;
  • progressive infectious diseases - for example, dysentery or tuberculosis.

What happens in the body with a lack of nicotinic acid

Many are amazed that the lack of just one vitamin can lead to the development of a real disease. But it is not in vain that doctors constantly talk about the need to maintain their own body, about the additional intake of certain vitamin complexes - the consequences are really very serious. Judge for yourself what processes in the body are violated only with a lack of nicotinic acid:

• • the formation of hemoglobin and red blood cells;
  • redox reactions;
  • secretion of gastric juice and bile;
  • the formation of sex hormones;
  • synthesis of pancreatic and thyroid hormones;
  • control of blood glucose levels;
  • functioning of the central nervous system;
  • the processes of reducing the level of "bad" cholesterol in the blood.

And that is not all! If a lack of nicotinic acid is present in a pregnant woman, then 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, the lack of nicotinic acid in the body leads to violations of all metabolic processes, pathological changes develop in cardiovascular system, the blood formula worsens, irreversible disturbances in the hormonal balance occur, 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.

Later, as pellagra progresses, the patient reveals pathological changes in the work of the cardiovascular, endocrine and musculoskeletal systems.

As a rule, the first signs of the disease in question appear in the hot season - dermatitis develops under ultraviolet rays (solar). And then at the end of winter, the patient begins to experience disturbances in 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 taken even by qualified doctors for nervous or mental disorders.

Pellagra can occur in an acute and / or chronic form - in the first case, the symptoms begin suddenly and always with great intensity, but chronic course The disease is characterized by a gradual increase in symptoms.

Dermatitis

Most often, it is the changes on the skin that disturb 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:

1. 1. On exposed skin surfaces (legs, arms, face and neck) red, slightly swollen spots appear, sometimes they are blisters containing a cloudy liquid. With progression, these spots become brown, brown, and can develop into long-term non-healing ulcers.
   
   
   2. Hyperpigmentation appears, which is in the nature of "glasses", "gloves" and / or "socks". A person becomes sensitive to the sun's rays - they cause him a feeling of burning and burning of the skin.
   3. Separate areas of the skin may begin to peel off, and subsequently they become keratinized. The skin takes on a gray tint.
   4. The mucous membranes become inflamed - this process affects the oral cavity, the genitals, and the 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 spots in the form of a crescent, around the eyes and on the bridge of the nose, areas with brown and flaky skin may appear. Specifically, the so-called Casal collar may appear on the neck - the skin area in this place is covered with a narrow red spot that descends from the neck to the chest.

Also, the skin around the wrists and ankle joint is often affected - the appearance of red and slightly swollen "bracelets" in these places is often noted.

Pellagra can also be manifested by rashes on the legs and thighs - they will have the form of papules with liquid contents, areas of hemorrhages appear around such rashes.

If pellagra was not diagnosed at the stage of development of dermatitis, then the progression of the disease leads to impaired 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 there is always a taste of salt and a burning sensation;
  • lips and tongue swell periodically, 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 acquires 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 work 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 peristalsis, and the absence of hydrochloric acid in gastric juice may be detected.

Neuromuscular Disorders - Dementia

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

• • total loss sensitivity of the skin in some parts of the body (usually they can be clearly localized);
  • increased fatigue;
  • apathy towards oneself, work, others;
  • memory impairment;
  • sleep disorders;
  • polyneuritis;
  • irritability arising unreasonably;
  • paresthesia;
  • depression.

If pellagra proceeds 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 clouding of 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's disease.

The patient must undergo a full range of examinations. In the urine of such a patient, an active release 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 also noted on the mucous membranes of these sections of the gastrointestinal tract.

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

Note:if pellagra was provoked by some internal pathological process, then it is imperative to prescribe the patient and his treatment.

Highly important point in therapy against the disease in question is the observance of a special diet.

Patients are assigned a specially designed menu, which contains foods rich in vitamins A, B, C and protein. These include:

All products are prepared in accordance with the fact that digestive system needs support, that is the best option stewing, boiling, steaming, baking. Eating should be carried out in small portions, but often enough - at least 5 times a day. The calorie content of dishes increases gradually - for example, in the first week it will be enough for the patient to receive 2500 Kcal.

Possible Complications

Sometimes pellagra occurs in an acute form and then all the symptoms described in the article in the patient appear 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, is chronic, then its complications may appear in the form typhus, scurvy or dysentery. If pellagra lasts for years, with exacerbations only in summer period, then the patient develops dementia, he becomes disabled.

Prevention of pellagra

To prevent the development of the disease in question, you need to remember only a few rules for prevention. These include:

• • reception in the spring 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.

Pellagra is a fairly rare but still occurring disease. Doctors give variable forecasts 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 is fatal.

Pellagra - what is this disease?

- a disease caused by acute deficiency in the body of nicotinic acid (vitamin PP) for a long time. In other words, pellagra is avitaminosis PP (nicotinic acid, nicotinamide, niacin, vitamin B3).

Another substance, with insufficient intake of which pellagra develops, is protein, especially tryptophan.

AT modern world When a variety of food allows you to get the necessary amount of vitamins and microelements for the normal functioning of the body, vitamin deficiency PP, like other types of vitamin deficiencies, is quite rare, so pellagra is not familiar to many people, and has become a predominantly historical disease for them. However, in some countries in South Africa and South America, as well as among people dependent on alcohol (alcoholics), pellagra can still occur.

Development of pellagra

With a deficiency in the body (hypovitaminosis) of nicotinic acid, the following disorders occur:

• • • functions of hematopoiesis, in the video of 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 disease heart and other diseases of the cardiovascular, endocrine, musculoskeletal and other systems;
    • functions of the secretion of bile and gastric juice, necessary for normal digestion and assimilation 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 function;
    • normal development of the fetus;
    • skin, hair and nails also lose their health.

But all of the above processes develop only with a partial deficiency of vitamin PP in the body, i.e. - hypovitaminosis. Now imagine what will happen complete lack this substance in man, i.e. - avitaminosis?

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 "three D disease". However, some foreign doctors add here the fourth "D" - death (eng. Death).

Other symptoms of pellagra include:

• • • Photodermatosis and other skin lesions;
    • Alopecia (baldness, baldness);
    • edema (increased accumulation of fluid);
    • Increased fatigue, muscle weakness;
    • Ataxia (impaired coordination of movements due to a disorder in the functioning of the muscular system);
    • Paralysis of the limbs;
    • Dilated cardiomyopathy (DCMP);
    • Aggression, apathy, neurosis, depression, confusion, dementia, insomnia;
    • Headaches, dizziness;
    • Peripheral neuritis;
    • Glossitis, stomatitis, cheilitis;
    • Constipation followed by diarrhoea.

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 (after 5-8 years, if nothing is done).

main cause of pellagra – acute insufficiency 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.

To beriberi B3 (PP) lead to:

• • • The predominance in the daily diet of little-useful and harmful food, in which there are no vitamins and microelements necessary for the normal functioning of the body;
    • Metabolic disorders, especially protein;
    • Frequent stay in stressful situations, depressive states;
    • Diseases of the gastrointestinal tract: gastritis, pancreatitis, duodenitis, stomach and duodenal ulcers, hepatitis, etc.;
    • The progressive development of some infectious diseases- tuberculosis, dysentery and others;
    • The presence of malignant neoplasms (cancer);
    • Abuse of alcoholic beverages (alcoholism);
    • Abuse of sunbathing (solariums, beach);
    • Chronic physical fatigue with malnutrition;
    • The period of pregnancy and lactation.

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 of pellagra begins with an accurate diagnosis and differentiation of the disease from erysipelas and other diseases with similar symptoms.

Treatment for pellagra usually includes the following:

1. Peace;
2. Medical treatment;
3. Diet;
4. Preventive measures.

Important! Before using drugs, be sure to consult your doctor!

1. Peace

A patient with pellagra must be provided with absolute peace, not only physical, but also emotional, mental. This item 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, the state of rest minimizes the additional consumption of vitamins and microelements, which at the beginning will slow down the development of pellagra, and then contribute to a speedy recovery.

2. Drug treatment (drugs 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. The daily dosage is prescribed by the doctor based on the 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, the basis of which is nicotinic acid, one can distinguish: "Nicotinic acid", "Nicotinamide".

Important! In the presence of peptic ulcers of the digestive system, nicotinic acid preparations should be taken with caution!

Additionally, vitamins B1, B2, B6, B12, C and protein are prescribed.

Antibacterial agents are sometimes prescribed for diarrhea 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 normal microflora intestines, necessary for the normal functioning of the digestive organs, as well as the transformation and absorption of useful substances by the body. For these purposes, probiotics are used - "Linex", "Bifiform".

With dermatitis, treatment often consists in treating the affected skin with ointments based on corticosteroids (hormones), among which are Hydrocortisone (1%), Clobetasol, Prednisolone, after treating the skin with anti-inflammatory and antibacterial drugs- "Levomycetin", "Erythromycin".

With neurological disorders, sedatives are prescribed - Valerian, Diazepam, Persen, Tenoten.

With strong mental disorders appoint tranquilizers - "Tranquilan", "Relanium".

With severe exhaustion of the body, the patient is prescribed a blood transfusion.

If there are any internal diseases that caused pellagra, their treatment is carried out in parallel.

Important! With pellagra, avoid exposure to the skin of sunlight!

The pellagra diet 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), cornmeal and bran, oats, whole grains, sage, nettle, horsetail, ginseng, peppermint, chamomile, yeast, black seeds.

Products are best consumed raw and steamed, because. when steam cooking, they lose the least amount of vitamins. It is also allowed to stew and bake.

It is necessary 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. Further, the calorie content of food is gradually increased.

Treatment of pellagra folk remedies

Pellagra treatment folk remedies implies the use of food enriched with vitamins B3 (PP), B1, B2, B6, B12, as well as protein. More details about this are written in the paragraph a little higher - “Diet for pellagra”.

Prevention of pellagra

Prevention of pellagra is an integral part of the overall course of treatment of the disease and includes the following recommendations:

• • • In the daily diet, try to give preference to food enriched with vitamins and microelements;
    • Remember, when cooking food by boiling and frying, foods lose their vitamin value, because. many vitamins under the influence high temperatures and the waters are simply annihilated;
    • Food is best consumed raw (vegetables, fruits, berries) or steamed, baked;
    • Give up drinking alcohol, smoking;
    • In the autumn-winter-spring period, additionally take vitamin complexes;
    • Do not leave various diseases to chance, especially of the gastrointestinal tract, so that they do not become chronic;
    • Avoid stress, if necessary, change jobs, or learn to overcome them;
    • Do not abuse the services of a solarium, and 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 contact 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, it is the damage to the organs of the digestive system that has the greatest pathogenetic significance, 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 the presence 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 of the small intestine.

In addition, at severe forms pellagra, it acts as an accompanying pathology for acute infectious diseases that are localized in the intestines, the most common of which are dysentery and intestinal tuberculosis. In the case of prolonged alcohol abuse, conditions also arise for the violation 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 starvation.

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 a violation of the metabolic process of microelements vital for the body, especially carbohydrates, which are exchanged at the cellular level. But the trigger in the development of typical clinical signs pellagra favors insufficient content of the amino acid tryptophan in the human body.

In the case of progression in a person, the disease begins to develop irreversible processes in the skin and structures of the nervous system, which are of a degenerative nature. In situations where pellagra begins to develop in absolutely healthy person as a result of malnutrition, it is necessary to mean the primary variant of the pathology. If the occurrence of symptoms was provoked pathological changes in internal organs, which are chronic, then it is worth talking about the presence of a secondary variant of pellagra.

Given the fact that pellagra is accompanied by severe malnutrition 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 covers.

Symptoms of the disease

In the case of the development of a detailed clinical picture of the pathology, patients who suffer from the manifestations of pellagra have a wide range of symptoms. Given the large list of patient complaints, it is quite difficult to make a correct diagnosis at the initial contact, but the availability of detailed anamnestic data allows us to make assumptions about the presence of this particular pathology. Most often, the initial visit to the doctor is based on the presence of the patient various signs dyspeptic clinical picture (perversion of taste preferences, burning and dryness in the oral region, lack of appetite, and in some cases even a complete aversion to food). As the disease progresses, the patient complains of functional disorders intestines and the presence of alternating periods of diarrhea and constipation.

With an increase in the toxic syndrome, the patient may notice increasing weakness and the inability to perform habitual actions, lack of interest in life, and dizziness. In most cases, patients with pellagra take a passive position - lying on their backs.

The diagnosis of pellagra largely depends on the primary objective examination of the patient, which is accompanied by the determination of a number of pathognomonic symptoms that allow an accurate diagnosis. A visual examination of the patient's oral cavity shows pronounced hyperemia 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 echophagosteroscopy.

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 feces, which can be identified when analyzing fecal occult blood.

Anemia in pellagra is quite pronounced and is accompanied by all clinical manifestations that are characteristic of this state.

The primary criterion for determining the damage to the nervous system (its structures) in the presence of pathology is the occurrence of signs of polyneuritis of various localizations. First of all, it is accompanied by a violation of sensitivity without a pronounced pain component. With the progression of pellagra, 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 the endocrine structures are damaged, the patient develops polyglandular insufficiency, which manifests itself in the form of a tendency to:

• • • arterial hypotension;
    • osteoporotic bone disease;
    • polyuria;
    • progressive muscle weakness;
    • adynamia.

Violation of vitamin and protein metabolism is more pronounced in the results laboratory research and is 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 acute and lingering course, each option has character traits. For the formation of an acute form, a pronounced alimentary insufficiency of external origin should act as a trigger. The debut of pathology in such a situation is manifested by a sharp increase and weakening of the stool, the frequency of the urge to defecate can reach 20 times during the day. After a few days, the patient begins to develop neuropsychiatric disorders, which significantly aggravate the patient's condition. With continued vitamin deficiency, a person begins to experience 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 neuropathologists for a long time due to sluggish polyneuritis. As a result, symptoms of a psychoneurotic nature are added, which do not differ in particular specificity. And only when the skin clinic begins to appear - the pathology follows the classical version of the course.

The primary skin lesion 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, and 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 extremities, which occurs as a result of exposure to ultraviolet radiation, looks quite contrasting. The classic sign of erythema in such cases is the sharpness of the contours that act as a boundary between intact and affected parts of the skin. If there is an acute clinical variant course of the disease, the changes listed above can manifest themselves 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 cicatricial deformities.

The change in the skin on the face in the presence of pellagra is accompanied by characteristic pathognomonic changes in the form of the formation of the "collar of Casal" (band-like erythema on the chest and neck) and "pellagrozny glasses" (brown hyperpigmentation of the eyelids and peeling).

In the presence of pellagra, secondary skin changes may appear 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, the diagnosis of pathology is extremely difficult, since the patient has a lightning-fast increase in neurological manifestations, which sometimes cannot be distinguished from other intracerebral pathologies:

• • • trismus of masticatory muscles;
    • vomit;
    • visual hallucinations;
    • rigidity of the limbs;
    • severe impairment of consciousness;
    • convulsive readiness;
    • increased tendon reflexes.

In such cases, reliable diagnosis is possible only after examination of the sectional material.

Patients diagnosed with pellagra must necessarily 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 the substitution treatment with Amida Nicotinic acid”, 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 sensation of painful heat, severe hyperemia of the upper body and itching of the skin, although it is worth recognizing that this option for introducing the drug is much more effective.

Considering pathogenetic mechanism formation of pellagra, replacement therapy should be enriched with preparations from B vitamins in parenteral form (Pyridoxine, Riboflavin, Thiamine). The indication for the appointment of vitamin B12 is the presence of signs of hyperchromia, glossitis, macrocytosis. In the presence of a pronounced anemic syndrome, the position is stopped by fractional blood transfusions of 100 ml every 5 days.

During the eradication period acute manifestations diseases against the background of the applied replacement therapy it is necessary to conduct a conversation with the patient regarding the correction of the diet. The main criterion proper nutrition in such cases, the menu is saturated with products that contain a significant amount of B vitamins, nicotinic and ascorbic acid, as well as protein foods.

Pellagra is a disease resulting from a deficiency that can occur in a chronically relapsing form, dragging on with temporary improvements for many years. An exacerbation is usually observed at the end of winter - early spring, lasts throughout the summer, and by autumn, digestive disorders and skin changes disappear. But if the diet is not enriched with anti-pellagric vitamin PP and complete proteins, then by the next spring the disease recurs. The patient from year to year is becoming more and more emaciated, striking in his thinness, literally resembling an Egyptian mummy.

The name of the disease with a lack of vitamin PP is pellagra - a word of Italian origin: "pelle agra" - "rough skin".

Pellagra: symptoms

Skin lesion

One of the most common leading symptoms of pellagra disease is dermatitis. It manifests itself in the fact that the skin turns red, becomes rough, covered with blisters, ulcerations remain in the places of bursting blisters. Dark brown pigment spots and cracks form on the skin. These changes affect the exposed surfaces of the body exposed to solar radiation. It seems that the hands are dressed in brown gloves, the neck is dressed in a collar of the same color, and a huge brown butterfly is located on the cheeks. Skin manifestations of pellagra are very typical, but they do not develop in all patients. Especially often a disease without skin manifestations (as they say, "pellagra without pellagra") is observed in northern latitudes.

Damage to the digestive organs

Another group of pellagra symptoms is severe disorders of the digestive system. Inflammation of the mucous membrane of the oral cavity and tongue develops, the latter becomes covered with plaque, cracks, then the plaque disappears, and the tongue becomes bright red, shiny, as if varnished. Persistent diarrhea appears, hydrochloric acid ceases to be produced in the stomach, severe exhaustion sets in.

Damage to the nervous system

The third system affected by pellagra is the nervous system, its disorders in severe cases end in a mental illness with memory loss, delirium, dementia.