Alcoholism is still a cause of pellagra in sunny countries


  • Fatema Aljaralla Department of Dermatology, College of Medicine, University of Baghdad
  • Khalifa E. Sharquie Department of Dermatology, College of Medicine, University of Baghdad. Iraqi and Arab Board for Dermatology & Venereology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq. Email:
  • Salwa F. Taha Dermatology Center, Medical City, Baghdad, Iraq


Pellagra, alcoholism, niacin


Background Primary nutritional pellagra is still an endemic problem in many developing countries but surprisingly it had not been reported in Iraq even with the endless wars and prolonged sanctions that Iraqi people had faced. All cases of pellagra that were seen since 1978 were mostly secondary to chronic alcohol intake but not nutritional and rarely to anti tuberculosis therapy.   Objective To report and evaluate pellagra cases in regards to their triggering factors, clinical picture and therapy.   Methods This case series descriptive study was conducted in Dermatology Centre, Baghdad Medical City, Baghdad, Iraq during the period from December 2013 to January 2019. All pellagra cases were collected, documented and evaluated clinically. All triggering factors were looked for like alcohol intake, nutritional problem, drug intake or any family history of the same disease. Niacin and other B vitamins were given as therapeutic and diagnostic agents.   Results Over the period of 6 year, a total of 11 patients with pellagra were seen. All patients were males, their ages range from 5 – 65 years with mean age of 42.5 years. Seven out of eleven cases were caused by chronic alcoholism, three cases were caused by isoniazid therapy for tuberculosis and only one case was caused by Hartnup disease. But none of the cases were primary nutritional pellagra. The main clinical picture was photosensitivity as a burn like dermatosis but not Wernicke’s encephalopathy.   Conclusion Although living in a developing country with many wars and sanctions that lasted for decades, Iraqis rarely if ever suffered from primary nutritional pellagra, probably because the Iraqi cuisine depends on rice and wheat as a staple food as opposed to other developing countries that depend on corn which is a poor source of niacin. Thus, all cases of pellagra were secondary, mainly to chronic alcoholism in sunny climate. The florid burn like picture of photosensitivity, put pellagra as one of the main causes of burn like dermatosis but no obvious mainly neurological manifestation as seen in western countries.  


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How to Cite

Aljaralla F, E. Sharquie K, F. Taha S. Alcoholism is still a cause of pellagra in sunny countries. J Pak Assoc Dermatol [Internet]. 2023Mar.5 [cited 2024May20];33(1):96-100. Available from:



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