Clinical manifestation

Gingivitis, stomatitis, glossitis; photosensitivity; multiple sun exposures leading to dry, scaly, well-marginated plaques, resembling chronic eczema, affecting preferentially the forehead, cheeks, periorbital regions, dorsal surface of the hands, and other light-exposed areas; vesiculobullous eruption with exudation sometimes occurs; hypopigmentation and/or hyperpigmenta-tion that is intensified with further sunlight exposure; intermittent cerebellar ataxia with wide-based gait, spasticity, delayed motor development, and tremulousness, all reversible with niacin therapy; diarrhea; attacks sometimes provoked by a febrile illness, poor nutrition, sulfonamides, and possibly emotional stress

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