Step 1: Concept
Deficiencies of specific water-soluble vitamins lead to distinct clinical syndromes.
Step 2: Meaning
Pellagra is characterized by the "4 Ds": Dermatitis, Diarrhea, Dementia, and Death.
Step 3: Analysis
Pellagra is caused by a deficiency of Niacin (Vitamin $B_{3}$) or its precursor, the amino acid tryptophan.
Step 4: Conclusion
Lack of Vitamin $B_{3}$ is the direct cause of pellagra.
Final Answer: (C)