As time progresses, the dermatitis begins to desquamate. This process begins in the central portions of the dermatitis and spreads outward in a centrifugal manner. As the skin desquamates, it leaves behind red, eroded patches and plaques. Chronic involvement leaves permanent scarring and abnormal hyperpigmentation or hypopigmentation of the area. The epidermis over bony prominences (e.g., ulnar head) shows marked hyperkeratosis.
Mucous membrane involvement is common in all vitamin deficiency states, and pellagra is no exception. Angular cheilitis and a red, shiny, edematous tongue with atrophied papillae are seen routinely in patients with pellagra. The oral and gastrointestinal mucous membranes may be involved. Oral ulcerations are frequently seen. Patients routinely complain of a sore mouth and difficulty swallowing; these symptoms can lead to further lack of proper nutrition, exacerbating and compounding the disease.
Diarrhea is commonplace and is caused by the effect of niacin deficiency on the gastrointestinal tract. The diarrhea is watery and further complicates the patient’s nutritional status and electrolyte and fluid balances. Blood and purulence may be present in the watery diarrhea as a result of ulceration and abscess formation. Ulcerations can be seen throughout the gastrointestinal tract, as can cystic dilation of the mucous glands. The colon may show small submucosal abscesses.
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