The combined excretion of N- methylnicotinamide and pyridone of less than 1.5 milligrams in 24 hours indicates severe niacin deficiency. As patients often are malnourished and suffer from other vitamin deficiencies, provision of a high protein diet and B-complex vitamins is needed for complete restoration of health. The addition of meats, milk, peanuts, green leafy vegetables, whole or enriched grains, and brewers' dry yeast can enhance the niacin intake. In patients with oral dysphagia secondary to glossitis, a liquid or a semisolid diet may be required. Long-term inclusion of milk, meat, and eggs in the diet ensures dietary adequacy of proteins essential for recovery.
Bed rest is mandatory in treatment of severe cases of pellagra.
Patients with severe glossitis require a liquid or a soft solid diet to overcome the dysphagia. Ensure a balanced diet rich in protein and niacin. Topical management of skin lesions with emollients may reduce discomfort. Avoid sun exposure during active phase of the disease. Close dietary follow-up of the patient upon recovery helps prevent recurrence of pellagra.