Definition

Scurvy is a clinical syndrome marked by a range of symptoms resulting from prolonged vitamin C deficiency. A person is considered deficient in vitamin C when blood levels drop below 11.4 µmol/L.

Vitamin C, or ascorbic acid, is essential for the growth, development, and repair of skin, bones, and connective tissues. It also plays a crucial role in maintaining healthy teeth and gums, among other functions.

The prevalence of scurvy varies across different countries, with about 7.1% of cases in the United States and up to 73.9% in North India. Scurvy commonly occurs when dietary intake of vitamin C is insufficient, posing a concern in regions with high rates of malnutrition.

Causes

When a person’s diet lacks vitamin C, the body’s reserves are depleted within 4 to 12 weeks. Scurvy itself is not contagious; it arises from sustained low vitamin C intake, generally over a period of at least three months. The body typically stores around 1500 mg of vitamin C, and symptoms of scurvy may develop if levels drop below 350 mg.

Although scurvy is relatively rare, as vitamin C is present in various foods, it may still occur. Vitamin C is abundant in fresh fruits and vegetables, such as oranges, grapes, potatoes, tomatoes, lemons, spinach, and broccoli. For infants, both breast milk and formula provide sufficient vitamin C. Thus, inadequate consumption of these foods is often the primary cause of deficiency.

In addition, certain medical conditions can interfere with vitamin C absorption or utilization in the body, which may also contribute to scurvy.

Risk Factor

Several factors can increase the risk of vitamin C deficiency or scurvy:

• Alcohol use, which can inhibit vitamin C absorption.
• Smoking, which increases the body’s need for vitamin C by approximately 30%.
• Diets low in vitamin C-rich foods, for instance, diets restricted to tea and bread.
• Low income, which may limit access to fruits and vegetables.
• Medical conditions, including:
• Eating disorders like anorexia nervosa, a psychological disorder causing distorted body perception and low body weight.
• Gastrointestinal conditions, such as inflammatory bowel disease.
• Hyperthyroidism, an overactive thyroid that produces excessive thyroid hormone.
• Food allergies that limit certain foods.
• Type 1 diabetes mellitus.
• Elevated iron levels, which can lead the kidneys to excrete more vitamin C.
• Older adults, who may have reduced food intake and are thus at higher risk of deficiency.
• Pregnant or breastfeeding women, who have increased vitamin C requirements.

Symptoms

Symptoms of scurvy typically emerge after 8 to 12 weeks of vitamin C deficiency. Common symptoms include:

• Emotional instability
• Reduced appetite
• Fatigue and weakness
• Muscle and joint pain
• Delayed wound healing
• Swollen gums, which may lead to tooth loss
• Red or purple spots indicating subcutaneous bleeding
• Dry, rough, and scaly skin
• Coarse, brittle hair
• Swollen legs due to fluid retention
• Spoon-shaped, outward-curving nails
• Dry eyes
• Bleeding in the sclera (whites of the eyes)
• Hair loss
• Anemia, or reduced red blood cell count
• Stunted weight gain in infants

Diagnosis

The diagnosis of scurvy is primarily based on evaluating the symptoms presented and identifying associated risk factors. Given that scurvy is a chronic condition developing over time, symptoms typically progress gradually.

In addition to discussing symptoms, the doctor will inquire about the following:

• Dietary habits
• Past medical history
• Daily activities
• Previous treatments or interventions

A thorough physical examination will then be conducted, along with blood tests to measure vitamin C levels. Additional diagnostic tests may be performed if other related symptoms or conditions are observed in scurvy patients.

In cases of scurvy, screening for other vitamin deficiencies is also common, as poor dietary intake often correlates with low levels of other essential vitamins and minerals. Deficiencies in vitamin B12, folate, calcium, zinc, and iron are frequently observed among individuals with scurvy.

Management

The primary focus of scurvy treatment is addressing the root cause of vitamin C deficiency. This involves increasing vitamin C intake through diet and supplementation. Additionally, it is crucial to discontinue alcohol use and smoking.

Upon supplementation and increased intake of vitamin C-rich foods, symptoms generally resolve within one to two weeks.

Complications

If left untreated, scurvy may worsen, potentially impacting essential organs. Severe cases of scurvy can lead to:

• Hemolysis, a condition where red blood cells are damaged and ruptured, resulting in bleeding and anemia.
• Jaundice, a clinical symptom characterized by yellowing of the skin and eyes due to liver and gallbladder dysfunction.
• Convulsions.

Prevention

The most effective prevention strategy for scurvy is maintaining adequate daily vitamin C intake. Examples of highly recommended fresh fruits and vegetables rich in vitamin C are:

• Oranges
• Lemons
• Strawberries
• Tomatoes
• Bell peppers
• Broccoli

Avoid overcooking foods, as high heat can reduce vitamin C content. Lifestyle changes to prevent scurvy include:

• Avoiding alcoholic beverages
• Not smoking
• Ensuring balanced nutrition

When to See a Doctor?

Since scurvy symptoms tend to develop gradually, it is crucial to consult a doctor as soon as any of the symptoms described above arise.

Prompt treatment can significantly improve recovery outcomes, so it is important for patients to seek medical evaluation if experiencing symptoms consistent with scurvy.

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