```html

Scurvy – Complete Medical Guide

Overview

Scurvy is a disease caused by a severe deficiency of vitamin C (ascorbic acid). Vitamin C is essential for collagen synthesis, antioxidant protection, and iron absorption. When intake falls below the body’s requirement (≈10 mg/day for adults), the structural integrity of connective tissue deteriorates, producing the classic signs of scurvy.

Although historically associated with sailors and explorers, scurvy can affect anyone with poor dietary intake of fresh fruits and vegetables. In modern high‑income nations it is rare, but it still occurs in certain vulnerable groups.

• In the United States, an estimated 2–4 % of the population has sub‑optimal vitamin C status, but clinically manifest scurvy is far less common—≈1 case per 100 000 people per year.<sup>[1] CDC, 2022</sup>
• Higher prevalence is reported in low‑income regions of sub‑Saharan Africa and South Asia, where up to 30 % of children have biochemical evidence of deficiency.<sup>[2] WHO, 2020</sup>
• At‑risk groups include: the elderly, people with alcohol use disorder, individuals with malabsorption syndromes, patients on restrictive diets (e.g., some vegan or “paleo” diets lacking fresh produce), and those with severe psychiatric illness.

Symptoms

Symptoms develop after 1–3 months of inadequate vitamin C intake. They can be grouped by system:

Dermatologic

• Easy bruising – Capillary fragility leads to petechiae and ecchymoses, especially on the lower legs.
• Corkscrew hairs – Coiled, brittle hair shafts that break easily.
• Poor wound healing – Ulcers and hemorrhagic spots around wounds or surgical sites.
• Perifollicular hemorrhages – Small red or purple spots around hair follicles, often on the arms and thighs.

Musculoskeletal

• Joint pain and swelling (arthralgia) due to sub‑chondral bleeding.
• Muscle tenderness and weakness.

Oral & Dental

• Gingival swelling, bleeding, and eventual recession.
• Loose teeth or tooth loss.
• Dry, rough tongue (glossitis).

General

• Fatigue, malaise, and irritability.
• Fever without an obvious source (low‑grade).
• Weight loss due to loss of appetite.

Cardiovascular

• Edema and hypotension in severe cases, secondary to plasma leakage.

Causes and Risk Factors

Primary cause

Inadequate intake of vitamin C (<10 mg/day) over weeks to months. Vitamin C is not synthesized by humans and must be obtained from diet.

Key risk factors

• Dietary restrictions – Very low fruit/vegetable consumption (e.g., “carnivore” or “zero‑carb” extreme diets).
• Alcoholism – Poor nutrition and impaired absorption.
• Elderly living alone – Reduced appetite, dental problems, or limited access to fresh produce.
• Malabsorption – Crohn’s disease, ulcerative colitis, bariatric surgery, or short bowel syndrome.
• Psychiatric illness – Schizophrenia or severe depression can lead to self‑neglect.
• Renal dialysis – Loss of water‑soluble vitamins during the procedure.
• Pregnancy & lactation – Increased vitamin C requirements (≈85 mg/day pregnant, 120 mg/day lactating).

Diagnosis

Diagnosis is clinical but supported by laboratory testing.

Clinical assessment

• History of inadequate dietary vitamin C intake.
• Physical exam showing characteristic skin, gum, and musculoskeletal findings.

Laboratory tests

• Plasma vitamin C level – <10 µmol/L (≈1.8 mg/L) confirms deficiency; 10–23 µmol/L indicates low status.<sup>[3] NIH Office of Dietary Supplements, 2021</sup>
• Complete blood count – May reveal anemia (often normocytic, sometimes microcytic if iron deficiency co‑exists).
• Coagulation profile – Generally normal, but bleeding time may be prolonged.

Differential diagnosis

Conditions that mimic scurvy include:

• Vasculitis (e.g., Henoch‑Schönlein purpura)
• Platelet disorders (e.g., idiopathic thrombocytopenic purpura)
• Other nutritional deficiencies (e.g., vitamin K, zinc)
• Connective‑tissue diseases (e.g., Ehlers‑Danlos syndrome)

Treatment Options

Vitamin C repletion

• Oral supplementation – 300–500 mg three times daily for the first week, then 100–200 mg daily for 2–4 weeks.
• Intravenous (IV) vitamin C – 1–2 g daily for 3–5 days in patients unable to tolerate oral intake (e.g., critically ill, vomiting).

Symptoms usually improve within 24–48 hours; skin changes resolve over 1–2 weeks.<sup>[4] Cleveland Clinic, 2023</sup>

Supportive care

• Analgesics for joint pain (acetaminophen or NSAIDs if not contraindicated).
• Wound care for ulcerations – sterile dressings, antibiotics only if secondary infection is evident.
• Correction of co‑existing deficiencies (iron, folate, B‑12) when present.

Lifestyle & dietary counseling

• Incorporate at least 75 mg of vitamin C daily (≈1 orange, ½ cup of strawberries, or 1 cup of cooked broccoli).
• Educate on food preparation that preserves vitamin C (raw or lightly cooked, avoid prolonged boiling).

Living with Scurvy

Once repleted, most patients recover fully, but long‑term vigilance is essential.

Practical daily tips

• Meal planning – Keep a fruit or vegetable portion in your bag; frozen produce is a convenient, nutrient‑preserving option.
• Cooking methods – Steam or stir‑fry vegetables for ≤5 minutes; add citrus juice after cooking to boost vitamin C.
• Supplements – A daily multivitamin containing at least 90 mg of vitamin C is safe for most adults.
• Regular monitoring – If you have a chronic condition affecting absorption, have plasma vitamin C checked annually.

Psychosocial aspects

Address underlying issues such as depression, loneliness, or substance use that may hinder proper nutrition. Referral to a dietitian, social worker, or mental‑health professional can improve adherence.

Prevention

• Balanced diet – Aim for 5 – 9 servings of fruits and vegetables per day, as recommended by the USDA MyPlate guidelines.
• Fortified foods – Some breakfast cereals and juices are fortified with vitamin C; check nutrition labels.
• High‑risk groups – Provide nutrition education in nursing homes, addiction centers, and psychiatric facilities.
• Travelers – When travelling to regions with limited fresh produce, carry a vitamin C supplement (500 mg) and dried fruit.

Complications

If left untreated, scurvy can lead to serious, sometimes life‑threatening conditions:

• Severe hemorrhage – Intracranial or gastrointestinal bleeding due to fragile vasculature.
• Infection – Open skin lesions serve as portals for bacterial invasion; secondary cellulitis is common.
• Cardiovascular collapse – Massive plasma leakage can cause hypotension and shock.
• Pseudotumor cerebri – Rarely reported in prolonged deficiency.
• Permanent dental loss – Chronic gum disease may result in irreversible tooth loss.

When to Seek Emergency Care

---

References

1. Centers for Disease Control and Prevention. “Vitamin C Deficiency (Scurvy).” 2022. https://www.cdc.gov/nutrition/micronutrient-malnutrition/vitamin-c-deficiency.html
2. World Health Organization. “Micronutrient Deficiencies.” 2020. https://www.who.int/health-topics/micronutrients
3. National Institutes of Health, Office of Dietary Supplements. “Vitamin C Fact Sheet for Health Professionals.” 2021. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
4. Cleveland Clinic. “Scurvy – Symptoms, Causes, and Treatment.” 2023. https://my.clevelandclinic.org/health/diseases/21654-scurvy

```