Virtual Doctors Work

Found at the south eastern foot of a range of granite hills Kafue sits on the north bank of the Kafue river from which it takes its name. The district hospital covers the Kafue district an area of over 9000 square kilometres with a population of over 280,000.

Virtual Doctors support 7 rural health centres throughout Kafue district including the district hospital in town.

Kafue Ferry Crossing

Kafue Ferry Crossing

During a busy clinic in November one of the Kafue based clinical officers saw a 42 year old lady. She had an itchy, painful rash around her neck and on her arms, hands and feet. This had been troubling her for 3 months and despite treatment was no better. The rash looked dry, peeling and was much darker than her normal skin. She was known to be HIV positive too.

The clinical officer sent off a patient file with some very helpful photos to Virtual Doctors. The Volunteer Virtual doctor felt this was likely to be a case of Pellagra. The reply was sent giving clear explanation and treatment advice.  Education was also given to help with ongoing learning and to improve treatment of other cases.

So, what is Pellagra? (“rough skin” from the Italian pelle agra)

Pellagra is a vitamin deficiency most often caused by a lack of niacin in the diet (Vitamin B3) and is characterised by the 4 D’s:  diarrhoea, dermatitis (skin rash), dementia and death.

First described by Gasper Casal in 1762 in Spain. He described the rash that he saw, particularly the hallmark rash around the neck which mimics a necklace and this is known as Casal’s necklace which you can see in the picture above (although slightly out of focus).


In the UK pellagra is rare but it is still common in Africa and particularly when untreated corn products are the main food source. In the 2000s there was outbreak of Pellagra in Zimbabwe. Other causes of Pellagra can be from alcohol abuse or medications particularly those used to treat tuberculosis. Patients with HIV infection can also develop a pellagra-like state. This may make it look like an easy diagnosis to make but the signs and symptoms evolve over time making the pattern harder to see.

Treatment is relatively simple with oral niacin (nicotinamide) which reverses the problems caused by the vitamin deficiency, the rash improving quickly. It is worth remembering that these patients may be malnourished and have other vitamin deficiencies so need a high protein diet and all B vitamins for a complete recovery.

Given the high incidence of HIV and TB in Zambia, Pellagra and pellagra- like states always need to be considered!

Dr Minnie Lacamp