Various health issues may arise within the course of alcohol addiction. Here we describe pellagra as possible complication of alcohol use disorder (AUD). Pellagra is a disease caused by deficiency of vitamin B3 (niacin) or its precursor tryptophan. There are several factors contributing to exacerbation of pellagra within the course of AUD: reduced intake of niacin or tryptophan, malabsorption, diarrhea, and liver insufficiency. The classic syndrome of “3D” in pellagra consists of “dermatitis” (dermatological symptoms), “diarrhea” (gastrointestinal symptoms) and “dementia” (neuropsychiatric symptoms); “death” can be added to these symptoms, creating the syndrome of “4D”. Diagnosis of pellagra is based on the recognition of the symptoms mentioned above, while history of chronic alcohol use can be informative, too. The diagnosis can be confirmed by positive therapeutic response to niacin in a patient with typical symptoms. If untreated, pellagra leads to death in the horizon of several years. The treatment consists of long-term supplementation of niacin and management of the underlying condition that causes its deficit (including the long-term therapy of AUD). It is advisable to supplement the entire spectrum of B-vitamins as well as magnesium and zinc. A diet consisting of meals prepared from ingredients such as yeast, meat, fish, milk, eggs, green vegetables, legumes and cereals is important in the prevention of pellagra.

Key words: alcohol – niacin – vitamin B3 – tryptophan – pellagra