severe niacin deficiency or pellagra or photosensitive dermatitis in right forearm of alcoholic adult patient

4d 4ds acid adult alcohol alcoholic alcoholism asian b3 burning changes closeup cracked deficiency deficient dermatitis dorsal dorsum dusky erythema forearm glossy goose induced isoniazid lesion limb male malnourished man natural niacin nicotinamide nicotinic pain painful patient pellagra photosensitive pigmented poverty rash red reddish rough sensation skin sunburn syndrome upper vitamins