”Hello dopamine seekers, did you know about “Casal’s Necklace”
A Brief of Pellagra
Pellagra, is a vitamin B3 (niacin) deficiency disorder caused by poor intake of dietary vitamin B3. The condition manifests as 4 “Ds” which indicate dermatitis, diarrhea, dementia, and death (if left untreated). The disease is rare and can be caused by alcoholism, drugs (Isoniazid), and malabsorption.
Dermatologic Manifestation
The most characteristic finding of pellagra is the presence of dermatitis.
First step:
- The first skin changes are erythema and edema following sun exposure, which fade with a dusky brown-red coloration.
- The location of lesion on face, neck, and dorsal surfaces of the hands, arms, and feet.
Second step:
- The lesion become hyperpigmented, hyperkerotic, and scaly with fissures and crusts (“goose-like”)
Did you know?
The diagnosis of pellagra is difficult in the absence of cutaneous findings
Casal’s Necklace
The pathognomonic sign of pellagra.
- A brief of history
The sign (casal’s necklace) is named after gaspar casal, who first described pellagra in 1902.
- Also known as
Collar necklace
- Definition
A dermatitis partly or completely encircling the lower part of the neck in pellagra
- Characteristic
The lesion begin as erythemas and progress to vesiculation and crusting in the distribution of a broad collar (dermatomes C3 and C4)
Treatments
- Prevention
- A diet adequately rich in vitamin B3 (niacin) and tryptophan can help prevent the sign and the disease, including: sweet potatoes, avocados, tuna meats, peanuts, and chicken breasts
- Non-pharmocologic
- Prescribe a vitamin B3-rich diet with adequate calories
- Patient should avoid sun exposure during the active phase of the disease
- Pharmacologic
- Niacin supplementation cause a rapid clinical response
- Using sunscreen to reduce photosensitivity
- The topical treatment of the skin lesions with topical emollients may reduce discomfort
Key Notes
- Niacin deficiency leading to pellagra continues to be a health problem
- Pellagra is clinical diagnosis and dermatitis around the neck, casal’s necklace, is the characteristic sign