Reflections on pellagra, the then and the now

Abstract

By the mid-20th century, pellagra had virtually been eradicated from the USA and Europe. In contrast, outbreaks of pellagra, as diagnosed by skin lesions, today still occur in sub-Saharan Africa. We argue that outbreaks of pellagra in sub-Saharan regions are not only maintained by food insecurity, but that it is further aggravated by the burden of communicable diseases and excessive alcohol consumption. In addition, we argue from a historical point of view, that the prevalence of pellagra is underestimated when based only on dermatological symptoms.