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These three patients had the same disease.
All three images show numerous plugs of inspissated sebum projecting from dilated orifices of sebaceous glands. “Dyssebacia”—thename coined to describe this finding—appears in about one-fifth of pellagrins and constitutes a fifth D of pellagra. The other four are dermatitis, diarrhea,dementia, and death.
On palpation, these plugs feel like sharkskin or sandpaper. They first appear on the alae nasi, then spread over the nose, and inadvanced cases involve the forehead, lips, and chin. With niacin therapy, the sebaceous plugs fall out within several days, and the lesions clear completelywithin a week or so.
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