English: This photograph depicts the hands of a patient displaying dermotologic symptoms due to a condition known as alcoholic pellagra. Note the swollen, roughened, and mottled pigmentation of the skin, all due to a niacin deficiency brought on by malnutrition, which was exacerbated by this patient’s poor nutritional intake. Pellagra is the deficiency of niacin and/or tryptophan, usually in combination with lack of other amino acids and micronutrients. Inadequate intake of either niacin or tryptophan is most common in areas where corn is the primary constituent of the diet. In addition, pellagra occurs in areas of South Asia where people eat millet with a high leucine content, which may contribute to pellagra. Secondary deficiency may occur due to diarrhea, cirrhosis, or alcoholism.