Question:easy
The image shows a skin finding on the neck (Casal's Necklace). What are the associated features of this deficiency disorder?
The image shows a skin finding on the neck (Casal's Necklace). What are the associated features of this deficiency disorder?
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The necklace-like skin rash on the neck is a classic sign of a specific vitamin deficiency -- recall its systemic manifestations.
Updated On: Jun 23, 2026
- History of diarrhoea & dementia associated with cognitive impairment
- Bitot's spots
- Angular stomatitis
- Loss of muscle coordination
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The Correct Option is A
Solution and Explanation
Image finding: Casal's Necklace -- hyperpigmented, scaly skin around the neck in a collar-like distribution on sun-exposed skin.
Diagnosis: Pellagra (Niacin/Vitamin B3 deficiency)
The 4 D's of Pellagra:
1. Dermatitis: Photosensitive, symmetrical, hyperpigmented rash in sun-exposed areas. Casal's necklace (neck), Gauntlet dermatitis (hands)
2. Diarrhoea: GI mucosal inflammation causing watery diarrhoea
3. Dementia: Neuropsychiatric manifestations -- confusion, cognitive impairment, disorientation
4. Death: Pellagra is unique -- death is included as a cardinal feature
Why not the others?
- Bitot's spots: Vitamin A deficiency
- Angular stomatitis: Riboflavin (B2) or iron deficiency
- Loss of muscle coordination: Vitamin B12 or Vitamin E deficiency
Treatment: Nicotinic acid (niacin) supplementation
\[\boxed{\text{Diarrhoea and dementia with cognitive impairment (4 D's of Pellagra)}}\]
Diagnosis: Pellagra (Niacin/Vitamin B3 deficiency)
The 4 D's of Pellagra:
1. Dermatitis: Photosensitive, symmetrical, hyperpigmented rash in sun-exposed areas. Casal's necklace (neck), Gauntlet dermatitis (hands)
2. Diarrhoea: GI mucosal inflammation causing watery diarrhoea
3. Dementia: Neuropsychiatric manifestations -- confusion, cognitive impairment, disorientation
4. Death: Pellagra is unique -- death is included as a cardinal feature
Why not the others?
- Bitot's spots: Vitamin A deficiency
- Angular stomatitis: Riboflavin (B2) or iron deficiency
- Loss of muscle coordination: Vitamin B12 or Vitamin E deficiency
Treatment: Nicotinic acid (niacin) supplementation
\[\boxed{\text{Diarrhoea and dementia with cognitive impairment (4 D's of Pellagra)}}\]
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