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Pellagra in a Malawian woman
Pelagra en una mujer malauí
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Characteristically, cutaneous features were bilateral and well defined and <span class="elsevierStyleItalic">glove</span> and <span class="elsevierStyleItalic">Casal's necklace</span> typical signs were noted (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a–c). She reported weakness, loss of appetite and irritability. A diagnosis of pellagra was made clinically, due to the lack of resources in Nkhotakota district (Malawi), where we performed our work of dermatological cooperation. She was provided with niacin-and-caloric-rich foods, a multivitamin-complex and nicotinamide (50<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h). Teledermatology and local staff cooperation were necessary to follow patient's evolution. After 60 days, the skin and systemic symptomatology resolved except for the cutaneous hyperpigmentation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>d). Pellagra is a systemic disease classically described with four cardinal clinical features: dermatitis (photosensivity), diarrhea, dementia and death (the four “D's”). It results from niacin-deficiency which still remains a problem in extreme poverty countries, especially those where diets are mainly maize-based. 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