The “gauntlet” of pellagra

A 48‐year‐old alcoholic Filipino man presented to the outpatient department with a 2‐year history of an eruption in a photosensitive distribution and episodes of mild diarrhea. He was otherwise in good health. Dermatologic examination revealed a browny‐red coloration, with a sharply demarcated erythematous border, affecting both hands and lower forearms, where it was striking in its symmetry ( Fig. 1). Around the neck, it was typical of a casal's necklace. The fronts and backs of the legs and the dorsa of the feet were also erythematous. The patient showed no evidence of mental confusion. 1“Gauntlet” of pellagra, showing browny‐red discoloration with sharply demarcated erythematous border A clinical diagnosis of pellagra was made based on the morphology, and treatment with nicotinamide 500 mg daily was instituted. The eruption quickly improved and resolved in 2 weeks ( Fig. 2). 2Two weeks after treatment, showing rapid clearance of the lesions