Dumitrescu C, Lichiardopol R
Clinic of Diabetes, Nutrition and Metabolic Diseases, Hospital N. Malaxa, Bucharest, Romania.
Rom J Intern Med. 1994 Apr-Jun;32(2):165-70.
The follow-up of an important number of patients during the last three decades has shown a substantial difference between the clinical description of pellagra in the 40's (the triad: dermatitis, diarrhea, dementia) and its clinical aspects today: sun-exposed teguments revealing erythema and rapidly becoming pigmented and parchment like, dried, parched lips, angular stomatitis, lead like sclera fine cornea vascularization; gastro-intestinal disturbances: constipation, unjustified diarrhea, strange migratory abdominal feelings accompanied by ubiquitous dysesthesias. Other characteristics of this form of disease are: unexpressive look, continuously concerned, thoughtful, anxious or frowning, labile mind, headaches, insomnia. Villager's neurosis sometimes may be considered, in an appropriate clinical context, as a facet of nutritional deficiency. It is considered that the "classical" features of pellagra have changed due to: protein ingestion slightly below the lowest normal limit, decrease of strenuous physical activity and some associated diseases (frequently gastrointestinal disorders, chronic alcoholism).
在过去三十年中，对大量患者的随访显示，40年代糙皮病的临床描述（三联征：皮炎、腹泻、痴呆）与其如今的临床症状存在显著差异：暴露于阳光下的皮肤出现红斑，迅速色素沉着并变得如羊皮纸般干燥，嘴唇干裂、口角炎，巩膜呈铅灰色、角膜血管轻度增生；胃肠道紊乱：便秘、不明原因的腹泻、伴有全身感觉异常的奇怪游走性腹部不适。这种疾病形式的其他特征包括：表情淡漠、持续担忧、若有所思、焦虑或皱眉、情绪不稳定、头痛、失眠。在适当的临床背景下，村民的神经症有时可被视为营养缺乏的一个方面。人们认为，糙皮病的“经典”特征发生了变化，原因如下：蛋白质摄入量略低于正常最低限度、剧烈体力活动减少以及一些相关疾病（通常为胃肠道疾病、慢性酒精中毒）。
