Revista de informes de casos clínicos

Pellagra-Like Dermatosis: To Be or Not to Be?

Abstract

Oliveira AL, Portela J, Calixto R, Jose Vaz, Agostini P and Calixto M

Pelagra was first described in Spain in 1795, with outbreaks in Italy and France until it became epidemic in the United States in the early 1900’s. Back then, nutritional deficiencies were common as a result of misinformation and famish until it was finally associated to maize, when eaten without being processed to make niacin available in the diet. Nowadays, the wide access to a considerable nutritional variety makes this disease oblivious to most of the medical staff in the current, daily practice. We describe a case of an eighty-five-year-old woman living in a rural isolated area in the southern Portugal, brought to the urgency services of our centre with itchy, edematous dermatological lesions in her face, hands and forearms for the last three days. When observed, the lesions were coarse, ulcerated with serohematic crusts in some areas, strictly delimited in areas of prolonged solar exposure, sparing the rest of the body. The history confirmed a poor intake of nutritional variety. Despite the poor contribution of analytical parameters for the diagnosis, as well as the unspecific dermo pathologic aspects, the clinical history favoured the hypothesis of Pellagra. The patient underwent niacin therapy and hydration with emollient, topic emulsions in the affected areas, with restricted improvement. With this case report we emphasize the importance of the nutritional details in a clinical history in patients with dermatological lesions, focusing as well in the distribution and aspect of those lesions. A careful history taking is essential to suspect such disease and, given its rarity, it is important to carefully consider all the differential diagnosis.