This deficiency results from a failure of the body to convert tryptophan (a precursor) into niacin. Niacin is necessary for cell metabolism.

This deficiency occurs in areas of the world where maize (white corn) forms the major part of the diet. Niacin and, or tryptophan, is not assimilated in the intestinal tract.

The four areas that demonstrate symptoms of pellagra are mucous membranes which become inflamed; lesions on the skin which can be photosensitive; gastrointestinal symptoms of nausea, vomiting, abdominal distention, and diarrhea which can be bloody; and central nervous system (CNS) symptoms involving loss of memory, confusion, confabulation, paranoia, and depression or mania or both.

The presence of symptoms must be coordinated with a history of a diet that is lacking in niacin and tryptophan.

Niacinamide in 500 to 1000 mg doses three times a day are administered, in addition to a diet that contains all the necessary vitamins, amino acids, and minerals. Supplemental vitamins should be given. If the patient is unable to digest the vitamins, they should be given parenterally.

Older people who have had pellagra demonstrate scaly, inelastic skin that is too large for the part that it covers.

1. May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% and/or other requirements/qualifications under 38 CFR §3.350 [Special monthly compensation ratings]. Also reference 38 CFR 3.155(d)(2).

2. If the veteran is a former prisoner of war and was interned or detained for not less that 30 days, this disease shall be service connected if manifest to a degree of disability of 10 percent or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of §3.307 are also satisfied [38 CFR 3.309(c) Disease subject to presumptive service connection].