This child has the casal collar skin rash around the neck associated with<unk> . Man with<unk>  with typical skin lesions The classic symptoms of<unk>  are diarrhea, dermatitis, dementia, and death ("the four Ds"). A more comprehensive list of symptoms includes: * Sensitivity to sunlight * Dermatitis (characteristic "broad collar" rash known as casal collar) * Hair loss * Swelling * Smooth, beefy red glossitis (tongue inflammation) * Trouble sleeping * Weakness * Mental confusion or aggression * Ataxia (lack of coordination), paralysis of extremities, peripheral neuritis (nerve damage) * Diarrhea * Dilated cardiomyopathy (enlarged, weakened heart) * Eventually dementia J. Frostigs and Tom Spies—according to Cleary and Cleary—described more specific psychological symptoms of<unk>  as: * Psychosensory disturbances (impressions as being painful, annoying bright lights, odors intolerance causing nausea and vomiting, dizziness after sudden movements), * Psychomotor disturbances (restlessness, tense and a desire to quarrel, increased preparedness for motor action), as well as * Emotional disturbances Independently of clinical symptoms, blood level of tryptophan or urinary metabolites such as 2-pyridone/N-methylniacinamide ratio <2 or NAD/NADP ratio in red blood cells can diagnose<unk> . The diagnosis is confirmed by rapid improvements in symptoms after doses of niacin (250–500 mg/day) or niacin enriched food.
Pellagra
Pemphigus
Koilonychia
Kwashiorkor
Melanonychia
Porphyria
Crepitus
Photodermatitis