History: A middle-aged woman with a chronic gastrointestinal problem (malabsorption) presented with a scaly erythematous well-demarcated dermatitis-like reaction on the acral parts (hands and feet) and extensor surface of the knees. The lesions were bilateral symmetrical and associated with burning sensation. Initiating therapy with multivitamins containing 100 mg niacin three times daily resulted in marked improvement within few days.