Sign of the day
CASAL COLLAR
CASAL NECKLACE
Distinctive skin lesion found in patients suffering from PELLAGRA, a disease caused by a severe deficiency of NIACIN ( Vit D3).
APPEARANCE
It starts looking like a severe sunburn, but progresses into rough, dry, scaly, deeply pigmented , broad, sharply demarcated plaque.
It’s highly photosensitive, it’s triggered or worsened by SUNLIGHT EXPOSURE.
The band usually forms on the neck ( affecting C3 & C4 dermatomes & often extends downward over the upper chest ( known as a CRAVAT) or onto the back.
The area is extremely itchy, painful, and prone to blistering.
The 4 Ds of Pellagra
Dermatitis,
Diarrhoea ,
Dementia , & potentially
Death.
It is closely related to other manifestations of Niacin deficiency- PELLEGROUS GLOVE and BOOT( rash on the hands & feet)
The sign is named after the Spanish Physician
Don Gasper Casal, who first identified it among peasants in 1735.
Dr. Prabhakar k
Prof of Medicine
SDUMC, Kolar.