Topically applied niacinamide in isoniazid-induced pellagra

Area of Science:

• Dermatology
• Neurology
• Pharmacology

Background:

• Tuberculous meningitis is a serious infection requiring treatment with isoniazid.
• Isoniazid can cause adverse effects, including skin reactions.
• Pellagra is a condition caused by niacin (vitamin B3) deficiency.

Observation:

• A patient undergoing isoniazid treatment for tuberculous meningitis developed a pellagra-like skin eruption.
• The patient's rash and mood symptoms (depression, apathy) showed improvement after topical application of niacinamide (nicotinamide).

Findings:

• Topical niacinamide application led to rapid resolution of the skin rash.
• The patient experienced significant improvement in mood disturbances concurrently with rash resolution.
• These clinical improvements suggest that percutaneous absorption of niacinamide may be effective.

Implications:

• Topical niacinamide could be a viable treatment for isoniazid-induced pellagra-like eruptions.
• Percutaneous niacinamide absorption may offer therapeutic benefits for both dermatological and neurological symptoms.
• This case highlights a potential management strategy for specific isoniazid side effects.