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Zinc Deficiency, Pellagra, or Both?-Reply

Zinc Deficiency, Pellagra, or Both?-Reply Abstract In Reply.— The thought that our case could as well represent the uncommon but well-studied nicotinamide deficiency state is provocative and indicates the difficulty in proving any one clinical diagnosis to the exclusion of others—in this case, the diagnosis of pellagra to the exclusion of zinc deficiency, and vice versa.When the pellagra rash appears with the classic long-standing dirtybrown, rough, scaly appearance with associated diarrhea and dementia, a clinical diagnosis can frequently be made. With decreased renal excretion of N-methyl nicotinamide and 6-pyridone derivative, the measurement of which was considered but not done in this case, the diagnosis is confirmed. With resolution of symptoms after a trial of nicotinic acid supplement, which produced no change in this patient, the proof is complete.Due to the lack of diarrhea, a rash that was not suggestive of pellagra, and absent response to multivitamins on admission, the zinc therapy was attempted. This References 1. Van Vloten WA, Bos LP: Skin lesions in acquired zinc deficiency due to parenteral nutrition . Dermatologica 156:175-183, 1978.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Zinc Deficiency, Pellagra, or Both?-Reply

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Publisher
American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1979.04010040079029
Publisher site
See Article on Publisher Site

Abstract

Abstract In Reply.— The thought that our case could as well represent the uncommon but well-studied nicotinamide deficiency state is provocative and indicates the difficulty in proving any one clinical diagnosis to the exclusion of others—in this case, the diagnosis of pellagra to the exclusion of zinc deficiency, and vice versa.When the pellagra rash appears with the classic long-standing dirtybrown, rough, scaly appearance with associated diarrhea and dementia, a clinical diagnosis can frequently be made. With decreased renal excretion of N-methyl nicotinamide and 6-pyridone derivative, the measurement of which was considered but not done in this case, the diagnosis is confirmed. With resolution of symptoms after a trial of nicotinic acid supplement, which produced no change in this patient, the proof is complete.Due to the lack of diarrhea, a rash that was not suggestive of pellagra, and absent response to multivitamins on admission, the zinc therapy was attempted. This References 1. Van Vloten WA, Bos LP: Skin lesions in acquired zinc deficiency due to parenteral nutrition . Dermatologica 156:175-183, 1978.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Apr 1, 1979

References