Gauntlet-appearance in a chronic alcoholic

A 45-year-old male patient presented with well-to-ill defined, scaly, dusky erythematous to hyperpigmented, photosensitive plaques with few erosions over the extensor aspect of the forearms, and dorsum of hands in a gauntlet-like distribution [Figure 1]. He did not have any lesion over his neck. The patient was a chronic alcoholic. Based on the characteristic history and clinical presentation, we made a clinical diagnosis of pellagra and treated him with niacinamide 300 mg/day with good improvement. Pellagra is characterized by symmetric photosensitive skin eruptions, gastrointestinal manifestations, neurologic, and psychiatric disturbances. It occurs due to niacin or Vitamin B3 deficiency. The classically described four Ds of pellagra are dermatitis, diarrhea, dementia, and death. A gauntlet is a glove worn with medieval armor which extends above the wrist. In pellagra, the lesions most commonly appear in this distribution. It occurs prevalently in chronic alcoholics as a result of a nutritionally poor diet and malabsorption. Pellagra responds well to oral nicotinic acid supplementation.^[1]

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Figure 1:

Well-to-ill defined, scaly, dusky erythematous to hyperpigmented, photosensitive plaques with few erosions over the extensor aspect of the forearms, and dorsum of hands in a gauntlet-like distribution.

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