Scurvy (severe vitamin C deficiency)
Scurvy is a severe, long-standing lack of vitamin C. Most people think of it as the sailors' disease from old books, and that is exactly why it gets missed…
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Medicines commonly prescribed for Scurvy (severe vitamin C deficiency)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: INJECTABLE, 1g ascorbic acid / 5mlActive substance: ascorbic acid (vit C)Manufacturer: Bayer Hispania S.L.Prescription requiredDosage form: INJECTABLE, 100 mg/mlActive substance: ascorbic acid (vit C)Manufacturer: Laboratorios Basi Industria Farmaceutica S.A.Prescription required
Scurvy is a severe, long-standing lack of vitamin C. Most people think of it as the sailors' disease from old books, and that is exactly why it gets missed today: doctors rarely have it in mind, and patients do not connect bleeding gums and bruises on the legs with what they eat. Yet scurvy has not gone away. It turns up in people whose diet has become very narrow, and it has one valuable feature: it is one of the few severe conditions that reverses completely, with clear improvement within days of starting treatment.
Why scurvy still happens
The body cannot make vitamin C and does not store it for long, so it has to arrive with food fairly regularly. Reaching the point of scurvy takes months on end with almost no fruit or vegetables. That happens more often than people expect:
- a very monotonous diet, for instance nothing but bread, pasta, tea and processed food, with nothing fresh. This pattern shows up both when money is short and simply out of habit;
- alcohol dependence: drink displaces food, and absorption of vitamins is poorer as well;
- eating disorders and severely restrictive diets, including extreme food selectivity in children and teenagers with autism;
- older people living alone who have stopped cooking, so meals shrink to whatever needs no preparation;
- conditions in which food is not absorbed or cannot be eaten: after stomach or bowel surgery, in inflammatory bowel disease, with the nausea of chemotherapy, or when chewing hurts because of poor dental and gum health;
- smoking, which does not cause scurvy on its own but raises the requirement for vitamin C and adds to the other causes;
- severe mental illness and dementia, when a person simply stops eating.
A separate case is babies fed for long periods on boiled cow's milk alone or on unsuitable formula: boiling destroys vitamin C.
What breaks down without vitamin C
Vitamin C is needed for the body to build collagen, the protein that makes up the walls of small blood vessels, the skin, the gums, the ligaments, the cartilage and bone tissue. Without it the collagen comes out weak, and that explains the whole picture at once: blood vessels become fragile, hence the bruises and bleeding; gums become spongy and bleed; fresh wounds heal badly and old, long-healed scars can break open again. In a child the growing bone is affected too, which is why scurvy looks quite different in childhood.
What it actually looks like
It starts non-specifically, and that is why the diagnosis is late. Typically there are several weeks of mounting tiredness and weakness, irritability and low mood, with aching muscles and joints. All of that is easily put down to overwork, depression or age. Then come the signs that make scurvy recognisable:
- the gums: swollen, spongy, purplish-red, bleeding when teeth are brushed and when hard food is eaten; in advanced cases teeth loosen and fall out. In someone with no teeth this sign may be missing altogether;
- bruises from the slightest pressure: from the edge of a table, the elastic of a sock, the strap of a bag; they are usually more numerous on the shins and thighs;
- corkscrew hairs: the hairs on the thighs, abdomen and lower legs coil up and fail to emerge, and around each follicle there is a small red spot of bleeding and a rough little bump. This is the most recognisable sign of scurvy, and it can be found simply by looking at the skin of the legs in good light;
- poor healing: cuts and grazes that do not close for weeks, surgical wounds that reopen;
- red or bluish spots and patches on the skin, usually on the lower legs and feet; on brown or black skin they are harder to see, so it is worth looking at the palms, the soles and the lining of the mouth;
- anaemia, and with it pallor and breathlessness on exertion;
- swelling of the legs, bleeding into the white of the eye and blood in the urine, all signs that things have gone a long way.
Scurvy in a child: when they stop walking
In children scurvy presents in a way that suggests almost anything except a vitamin deficiency. Bleeding occurs beneath the lining of the long bones, and it is extremely painful. The child:
- complains of leg pain, limps, and then refuses to walk or stand at all;
- cries when picked up or changed, because having their legs touched hurts;
- lies in a characteristic position with the legs bent and turned outwards, and screams at any attempt to move them;
- becomes irritable and pale, loses appetite and may run a low fever.
Such a child is usually investigated at length for rheumatological disease, bone infection or cancer, and rightly so, because those must be excluded. But if the child's diet consists of a very narrow set of foods, say so to the doctor plainly: one sentence about eating can cut weeks off the road to the diagnosis.
When to see a doctor and when it is urgent
Arrange an appointment within the next few days if you or your child are in one of the risk situations and you notice bleeding gums, bruises without knocks, wounds that will not heal or that reopen, or persistent weakness and leg pain.
Emergency help, meaning an ambulance on the single European number 112, which works in Spain, Italy, Portugal, Poland and Ukraine, is for a different set of situations:
- bleeding that cannot be stopped: from the gums, from the nose, in the stools or in the urine;
- sudden weakness, dizziness, fainting, breathlessness at rest, chest pain or marked pallor;
- a child who is limp, not responding as usual, or difficult to wake.
One distinction matters here. The small red spots of scurvy also fail to fade when a glass is pressed against them, but they appear slowly, over weeks, against a background of long-standing weakness. If instead a non-fading rash comes on within hours, together with a high temperature, headache, a stiff neck and a rapidly deteriorating condition, that is not scurvy but suspected meningococcal infection or sepsis, and there the count is in minutes.
How it is confirmed, and what it gets mistaken for
What settles the diagnosis is not a test but a conversation about what the person has actually been eating over recent months, rather than what they eat "normally". The doctor will look at the gums and the skin of the legs and ask about weight, alcohol, stomach and bowel surgery, and who cooks at home and how. Vitamin C can be measured in blood, but the test is not available everywhere and reflects recent intake more than stores, so treatment is often started on the clinical picture. Blood is usually checked at the same time for anaemia and other deficiencies: vitamin C is rarely short on its own, and B vitamins, vitamin D, iron and protein tend to be low alongside it.
Scurvy is most often mistaken for vasculitis, a clotting disorder or a rheumatological illness, and in children for arthritis, bone infection or leukaemia. One thing sets it apart: once treatment begins, everything improves quickly.
Treatment: better within days
This is the hopeful part. Scurvy reverses completely, and recovery starts sooner than in almost any other condition with such dramatic signs. The treatment is vitamin C itself, also called ascorbic acid, in a treatment course decided by the doctor, together with ordinary fresh food coming back onto the plate.
How the improvement unfolds:
- within the first day or two the listlessness and low mood lift and appetite returns;
- within a few days the pain in legs and joints settles and a child begins to stand again;
- the gums stop bleeding over roughly one to two weeks;
- bruises, the bleeding around hair follicles and the skin changes fade over several weeks;
- wounds start to heal normally.
Vitamin C is water-soluble and the excess leaves in the urine, so treatment doses are well tolerated; if you have a history of kidney stones, mention it to the doctor in advance.
How to stop it happening again
What matters most comes afterwards: working out why the deficiency arose at all. If the reason is alcohol, an eating disorder, isolation, poverty or bowel disease, tablets alone will not fix it and scurvy will come back. That is why treatment almost always includes help with the underlying cause, and sometimes other professionals as well.
Prevention itself needs no numbers: there is enough vitamin C if fresh fruit and vegetables appear every day in any of their usual forms, such as citrus, berries, kiwi, peppers, tomatoes, cabbage and broccoli, leafy greens and potatoes. Vitamin C is destroyed by long cooking and by storage in a warm place, so it is useful to have some vegetables raw or cooked briefly. Frozen fruit and vegetables are no worse at all than fresh. Anyone eating that way needs no supplements; in pregnancy and while breastfeeding, any supplement is worth discussing with a doctor or midwife.
Online consultation
Scurvy is precisely the kind of problem where a conversation settles a great deal. An Oladoctor doctor will ask about diet and circumstances in a way that makes clear whether there is a risk of deficiency; help you work out whether your bleeding gums, your bruising or your child's leg pain point to scurvy or to something else; explain which tests are worth doing; and advise on food and on whether supplements are needed if you are recovering from stomach surgery or caring for an elderly relative. If your account shows that a face-to-face examination or urgent care is needed, you will be told straight away.
This material is for information only and does not replace medical advice.
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