Pellagra: History and Discovery

Pellagra, arising from insufficient niacin intake, derives its name from the Italian phrase "pelle agra," translating to rough skin. Originating in the Lombard dialect of Northern Italy, this term underscores the condition's most prominent clinical feature.

In 1735, Spanish physician Don Gaspar Casal identified pellagra among peasants in Spain's Asturia region, labeling it "mal de la rosa." This ailment exhibited classic symptoms like dermatitis, diarrhea, and dementia, often resulting in fatality. Casal's posthumous work in 1762 extensively elaborated on the condition, using a Spanish term that echoed the characteristic sunburn-like skin erythema associated with pellagra.

The initial documented cases of the disease in 1755 and 1762 provided an accurate description, linking it to spoiled maize. Pellagra emerged in Italy approximately 50-100 years later, persisting widely in the country during the nineteenth century, with Lombardy reporting 39,000 cases in 1862. Serbia and Southern Russia grappled with the disease in the early 20th century.

The term "pellagra" likely made its debut in 1771 in Milan, Italy, coining the name that denotes "rough skin." Frappoli in 1771 proposed the term, possibly tracing its origins to the "pellarella" documented in Milan in 1578.

In the first half of the 19th century, societal aspects of pellagra gained attention, particularly in Liberali's 1831 studies on the manic dementia linked to the condition. Pellagra vanished from Southern France around 1880, and by 1916, it had nearly disappeared in Italy for reasons that remain unclear.

In 1922, Goldberger and Tanner suggested that pellagra resulted from an amino-acid deficiency. Joseph Goldberger, an American physician and epidemiologist, is acclaimed in American clinical epidemiology for his pellagra studies in the early 20th century.

The 1937 discovery that pellagra is caused by a deficiency in niacin (nicotinic acid), a B vitamin, highlighted that the body's synthesis of this vitamin depends on the availability of the essential amino acid tryptophan, found in milk, cheese, fish, meat, and eggs.
Pellagra: History and Discovery

Pellagra

Pellagra results from a niacin and/or tryptophan deficient diet. It is still endemic in areas of Africa and Asia because of poor nutrition and intake of certain cereals such as maize and jowar (Indian millet): the staple diet.

It is rare complication that typically manifests late in the course of the disease and should be treated with low doses of niacin supplements. Pellagra was first described in 1735 by Don Gaspar Casal by the name ‘mal de la rosa’ due to the reddish and glossy rash that he noted amongst the poor of Spain.

Casal recorded all the clinical characteristics and ascribed the disease to the unbalanced diets, based on maize, of poor peasants in the Asturia region of Spain. The next description of the disease came from Italy in 1771 when pellagra was given its name, meaning "rough skin".

Pellagra is a nutritional disorder that is characterized classically with three Ds, namely dermatitis, diarrhea and dementia. Pellagra is a clinical syndrome characterized by:
(1) symmetric photosensitive skin eruptions;
(2) gastrointestinal manifestations; and
(3) neurologic and psychiatric disturbances.
Pellagra

Lack of niacin can cause pellagra

Pellagra results from a niacin and/or tryptophan deficient diet which produces psychosis and dementia, among other symptoms. Niacin, known as vitamin B3, is a water-soluble, vitamin of the B complex group of vitamins.

The earliest description of pellagra was that of the Spanish physician Don Gaspar Casal in 1763.Casal recorded all the clinical characteristics and ascribed the disease to the unbalanced diets, based on maize, of poor peasants in the Asturia region of Spain. The next description of the disease came from Italy in 1771 when pellagra was given its name, meaning "rough skin".

Pellagra mostly found in parts of India, China, and Africa where corn or maize as a staple food. The characteristic manifestations appear as dermatitis, diarrhea and dementia ("the three Ds") and can lead to death (the fourth D).

Causes of pellagra can be divided into primary and secondary. Primary pellagra is due to dietary deficiency. High leucine content in corn/maize prevents conversion of tryptophan to niacin, leading to deficiency of niacin. Secondary pellagra is due to defective absorption or metabolism of niacin/tryptophan.

Early neurological symptoms associated with pellagra include anxiety, depression, and fatigue; later symptoms include apathy, headache, dizziness, irritability and tremors. In early cases the manifestations are psychoneurotic; later, lesions affect the nerves. As the disease advances, patients become confused, disoriented, and delirious, then comatose and stuporous, and finally die.

Mental aberrations may pass to dementia: about 4-10 % of chronic pellagra patients developmental symptoms.

In the western world, it is almost eradicated due to fortification of flour with niacin.

Lack of niacin can cause pellagra 

Niacin deficiency

First documented in 1735 by a Spanish physician named Gaspar Casal the niacin deficiency disease pellagra was originally named ‘mal de la rosa,’ or ‘red sickness.’ Its due to the telltale redness that appears around the necks of people with the disease. 

Pellagra means ‘rough skin’ in Italian. The great pellagra epidemic in America’s South did not emerged until the early twentieth century. 

Because the niacin coenzymes NAD and NADP are involved in just about very metabolite pathway, niacin deficiency wreaks havoc throughout the body. It also that the depressive psychosis is assumed to be because of inadequate formation of the neurotransmitter serotonin as a result of tryptophan deficiency. 

The classical features of endemic pellagra are dermatitis, inflammation of the mucous membranes, diarrhea and psychiatric disturbances. The dermatitis often appears after exposure to sunlight and resembles sunburn. 

Pellagra condones to plaque people living in Southeast Asia and Africa however, whose diet lack sufficient niacin and protein. 

Niacin deficiency

B Vitamins – Niacin, Pyridoxine and Biotin

B Vitamins – Niacin, Pyridoxine and Biotin
Niacin (nicotinic acid) is one of vitamin B. This compound is part of an enzyme system regulating reduction reactions in the body. It is also a compound that dilates blood vessels. Deficiency of niacin causes pellagra (a disease that causes diarrhea, dermatitis, nervous disorders, and sometimes death). The requirement for niacin is about ten times that for thiamin. Beef, hog and lamb livers are excellent sources of niacin. Other organs and the musculature of these animals are good to fair sources.

Pyridoxine (Vitamin B6) is part of the enzyme system that remove CO2 from the acid group (COOH) of certain amino acids and transfers amine groups (NH2) from one compound to another in the body. It is also needed for the utilization of certain amino acids. Deficiency manifestations are dermatitis around the eyes, eyebrows, and angles of the mouth. They may so be a sensory neuritis and a decrease in certain white blood cells and increase in others. Bananas, barley, beef and beef organs, cabbage, raw carrots, yellow corn, lamb and the organs of lamb, malt ,molasses, peanuts, pork and the organs of hogs, potatoes, rice, salmon, sardine, tomatoes, tuna, wheat bran and germ, flour and yams are goods to excellent source of pyridoxine.

Biotin is reported to be a coenzyme in the synthesis of aspartic acid, which plays a part in a deaminase system and in other processes involving the fixation of carbon dioxide. Deficiency of this compound is unusual, but can be demonstrated by the feeding of raw egg white, which contains the substance, avidin, which ties up biotin. Deficiencies of biotin cause scaling skin, skin lesion and a deterioration of nerve fibers. Due to the production of biotin by microbiological flora of the intestine, the requirement for this compound is not known, Liver is an excellent source of biotin, and peanut, peas, beans, and whole cooked eggs are good sources.
B Vitamins – Niacin, Pyridoxine and Biotin