Abstract
We reported an-80-year-old female patient with pellagra due to insufficient food intake. One month ago she noticed erythema on the dorsum of her hands. No favorable response was observed with topical corticosteroid ointment prescribed at her former clinic. She had not been able to eat enough food for two years because of a heartburn symptom due to gastroesophageal reflux disease and had lost about 10 kg of weight. General fatigue，drift，and diarrhea continued for several months. When she visited our hospital，sharply-defined reddish-brown erythema with scales，crusts and erosion，characteristic of pellagra，were observed on the dorsum of the hands. Serum nicotinic acid level was at lower limits of normal value，and gastrointestinal symptoms，general fatigue and drift indicated the diagnosis of pellagra. After the oral administrations of nicotinic-acid amide，the eruption disappeared in approximately ten days，and her other symptoms improved in a few days. Among triad of pellagrous symptoms，dermatitis is extremely important for the diagnosis，while dementia and diarrhea have low specificity. Nowadays pellagra is only rarely observed in dermatological clinics. However，it is necessary to include pellagra as one of the possible diagnoses of dermatitis occurred on the exposed skin areas. Also，patients of pellagra are often under a hypoalimentation state combined with vitamins and/or zinc deficiency. After checking overall nutritional status in relation to pellagra，it is important to improve the alimentary condition with food，supplemented with vitamins，zinc and nicotinic acid.
