Topically applied niacinamide in isoniazid-induced pellagra

Abstract

A patient with tuberculous meningitis developed a pellagra-like skin eruption after treatment with isoniazid. Administration of the drug was continued, and a topical preparation of niacinamide (nico-tinamide) was applied to one half of the face and the back of one hand. The areas treated responded rapidly, and subsequently all affected areas of the patient were treated, with almost complete resolution of the rash. At the same time, there was noticeable improvement in the patient's depression and apathy. We suggest that all of these changes could be due to percutaneous absorption of niacinamide.

A Novel Metabolite of Antituberculosis Therapy Demonstrates Host Activation of Isoniazid and Formation of the Isoniazid-NAD+Adduct

“…Thus, 4-INN formation could be a mechanism for INH-induced pellagra. In fact, individuals who develop INHassociated pellagra despite supplementation with pyridoxine respond to Nam, suggesting niacin deficiency in these individuals (4,5,7,8). Information about INH metabolism can be useful in developing strategies to minimize and manage its toxicity.…”

Photosensitivität bei Pellagroid unter tuberkolostatischer Therapie mit Pyrazinamid

“…Ein spezifische Lokaltherapie wird nicht empfohlen, lediglich unspezifisch pflegende Externa [9]. In einem Falle wurde aber über die erfolgreiche topische Anwendung von Nikotinamid im Bereich der Hautveränderungen berichtet [3]. Die Rolle von externen Lichtschutzmitteln wurde bislang noch nicht näher untersucht, jedoch spricht unser Fall mit promptem Ansprechen auf die Applikation eines Sunblockers dafür, dass diese wirksam sind und konsequent angewendet werden sollten.…”

Nicotinic acid/niacinamide and the skin

“…The complex formation between isoniazid and pyridoxal phosphate can then lead to inhibition of the synthesis of nicotinic acid from tryptophan 10 . Comaish et al 11 . were able to observe complete remission of an isoniazid‐induced pellagra following topical treatment with niacinamide 11 .…”

“…Comaish et al 11 . were able to observe complete remission of an isoniazid‐induced pellagra following topical treatment with niacinamide 11 . One per cent niacinamide was used in a macrogol ointment.…”