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Images of Memorable Cases: Cases 58, 59 & 60

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

Cases_58_59_60-pres1-1.jpg Cases_58_59_60-pres1-2.jpg

Cases_58_59_60-pres1-3.jpg

These three patients had the same disease.

58, 59 & 60. Pellagra

All three images show numerous plugs of inspissated sebum projecting from dilated orifices of sebaceous glands. “Dyssebacia”—the name coined to describe this finding—appears in about one-fifth of pellagrins and constitutes a fifth D of pellagra. The other four are dermatitis, diarrhea, dementia, and death.

On palpation, these plugs feel like sharkskin or sandpaper. They first appear on the alae nasi, then spread over the nose, and in advanced cases involve the forehead, lips, and chin. With niacin therapy, the sebaceous plugs fall out within several days, and the lesions clear completely within a week or so.

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