PELLAGRA

PELLAGRA is a disease caused by inadequate intake or incomplete absorption of nicotinic acid (vitamin PP).

It occurs with an unbalanced diet with a predominance of carbohydrates in food, as well as alcoholism, enteritis, liver cirrhosis and other diseases of the digestive system, especially manifested by the syndrome of impaired intestinal absorption.

Clinical manifestations of pellagra are diverse and can be combined with signs of other hypovitaminosis. Dermatitis, ulcers in the oral cavity, diarrhea and mental disorders (in children - dementia) are characteristic. Their appearance in adults is preceded by weakness, fatigue, apathy, decreased efficiency, lack of appetite, weight loss, dizziness , irritability. Diarrhea, changes in the skin and mucous membranes often appear towards the end of winter. The chair is watery, with putrefactive odor, without any admixture of blood and mucus. After a while, patients complain of burning in the mouth and strong salivation. Lips, especially the lower ones, swell, cracks appear on them. The mucous membrane of the mouth is sharply hyperemic, on the gums and under the tongue - ulceration. Characteristic changes in language. In the beginning, its back is covered with a touch of black-brown color, the edges and tip are bright red. Gradually the redness passes to the entire surface of the tongue, it shines like a varnished one. Filiform and fungal papillae hypertrophied and protrude in the form of red dots. The tongue is swollen, at the edges of it are visible the imprints of teeth, the epithelium is slouched. Then the acute phenomena subsided, the mucous membrane pales, the papillae atrophy. Deep furrows sometimes appear on the surface.

Changes in the skin appear mainly in its open areas in the form of erythema, usually located symmetrically on the face, around the lips, on the nose, cheeks, on the neck and forehead, on the back of hands and feet, less often on the chest, forearms and lower legs. The affected skin is dark red, swollen, itchy. Erythema is often accompanied by the formation of blisters that burst and leave the wetting areas. After a few days, there is a pungent peeling, at the end of which skin areas are found either with intense dark-brown pigmentation, or pigmentless, reminiscent of vitiligo . The body weight of patients decreases; In severe cases, cachexia develops.

All patients with manifestations of pellagra are subject to hospitalization. The main treatment is the use of nicotinic acid or nicotinamide inside after eating 100 mg 2 to 3 times a day for 15 to 20 days. In addition, a protein diet without bread, including liver, kidneys, lean beef and veal, passed through a meat grinder and fried, low-fat fish, is prescribed; Then meat broth (200-400 ml per day), 2 - 3 soft-boiled eggs, dairy products, primarily sour milk, kefir, cottage cheese. Prevention is to ensure a balanced diet.