Severe pellagra masked by concurrent plaque psoriasis: A case report of a hidden diagnosis

Elizabeth A. Wang, Jason Kao, Michelle Y. Cheng, Chelsea Ma, Soneet Dhillon, Thomas Konia, Emanual Michael Maverakis, Cynthia Chambers

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Despite characteristic features, psoriasis can mimic other dermatologic conditions, such as seborrheic dermatitis, lichen simplex chronicus, and certain nutritional deficiencies such as pellagra. We present a patient with a longstanding history of severe plaque psoriasis who presented with disfiguring scaly plaques involving greater than 80% body surface area. The patient’s disease was minimally responsive to multiple therapies. Repeat punch biopsies demonstrated parakeratosis, psoriasiform hyperplasia, and dilated blood vessels consistent with psoriasis. Given atypical clinical features and overall poor treatment response additional work up was obtained. A serum nutritional panel was consistent with niacin deficiency and the patient later revealed extensive alcohol intake. A diagnosis of concurrent pellagra was made and the patient was started on niacin supplementation and instructed to reduce alcohol intake, while continuing adalimumab and high potency topical steroids. Within two weeks, his disease had markedly improved. Pellagra presents characteristically with a photosensitivity dermatitis that may appear clinically and histologically similar to psoriasis. It is important to maintain an index suspicion for a secondary pathology in treatment-resistant psoriasis.

Original languageEnglish (US)
Article number11
JournalDermatology Online Journal
Issue number5
StatePublished - 2017


  • Nutritional deficiency
  • Pellagra
  • Photosensitivity
  • Psoriasiform
  • Psoriasis

ASJC Scopus subject areas

  • Dermatology


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