Casal's Necklace

Kiran H.S

Cite this article as: BJMP 2021;14(1):a007
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Abstract

This article presents an interesting case of Casal's necklace in a patient with Pellagra-like dermatitis and the response to treatment.

Keywords: Pellagra; Dermatitis; Casal's necklace
Abbreviations: HIV-Human Immnodeficiency Virus; ELISA - Enzyme linked immunosorbent assay

A 40 years old non-alcoholic and non-diabetic agricultural laborer presented with skin lesions around his neck, forearms and feet (sun exposed areas) along with glossitis. Pellagra was suspected because of Casal's necklace (i.e., erythematous, hyperpigmented, scaly lesions around his neck- arrow mark in figure 1). However he did not have diarrhea or neurological manifestations. Pellagra is due to Niacin (Vitamin B3) deficiency. Typical cases of pellagra are associated with 3 Ds - Dermatitis, Diarrhea, Dementia, (and if not treated, the 4th D- Death).1,2  Not many will have all the three Ds. Most commonly involved is skin – dermatitis (Pelle-skin; agra -rough). The patient belonged to poor socioeconomic status.2 His vital parameters and basic investigations were all within normal limits and HIV-ELISA was negative.

The diagnosis of a pellagra-like dermatitis was entertained.3 He was treated with multivitamin capsules which included Niacinamide.2  

The skin lesions had disappeared dramatically at the time of follow-up after one month (figure 2).


Figure 1: Casal's necklace before treatment


Figure 2: Improvement after treatment

Acknowledgements
I thank our respected Principal, HOD of Gen.Medicine and department of Dermatology.
Competing Interests
None declared
Author Details
Dr Kiran H.S; MD, PGDTSP, FAIMER fellow, Professor, Department of Internal Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India.
CORRESPONDENCE: Dr Kiran H.S; MD, PGDTSP, FAIMER fellow, Professor, Department of Internal Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India.
Email: drhskiran@gmail.com

References

  1. Hegyi, J., Schwartz, R.A. and Hegyi, V. (2004), Pellagra: Dermatitis, dementia, and diarrhea. International Journal of Dermatology, 43: 1-5. https://doi.org/10.1111/j.1365-4632.2004.01959.x
  2. Frank G-PGM, Voorend DM, Chamdula A, van Oosterhout JJ, Koop K. Pellagra: a non-communicable disease of poverty. Tropical Doctor. 2012;42(3):182-184. doi:10.1258/td.2012.120155
  3. Hendricks WM. Pellagra and pellagralike dermatoses: etiology, differential diagnosis, dermatopathology, and treatment. Semin Dermatol. 1991 Dec;10(4):282-92. PMID: 1764355. 

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