Author: Charlotte Davies / Codes: SLO1 / Published: 22/12/2020

If I mention scurvy to most people, they think of sea dogs, and Pirates, and archaic health complaints. Indeed, scurvy was thought to be a thing of the past, but we’re starting to diagnose it more often. I suspect, we’re missing many more – 6-8% of people in the US are thought to have scurvy. Scurvy was common in sea farers. Many of the discovery voyages had doctors on board, and it was on one such voyage with the explorer Scott (of the Antarctic) that it was discovered penguins and seals have lots of vitamin C- preventing scurvy! We’re going to dot lots of penguin pictures throughout this blog because they’re cute, and because they have so much vitamin C in them!

The original “research” looking at the treatment of scurvy has been critically appraised and is not thought to be scientifically robust, but it did pave the way for further research and interest in scurvy.
Hospital admissions for scurvy are rising – there were 6 cases in 2010, and 14 in 2014. Whether this is increased incidence, or increased diagnosis, we’ll never know.

What is it?

Scurvy is a disease caused by a lack of Vitamin C, or ascorbic acid. It is known as Barlow’s disease in infants, but they’re all the same pathological process.

Vitamin C is a sugar absorbed in the proximal ileum. It enhances dietary iron absorption and helps collagen peptides to develop and stay stable. A deficiency causes collagen structures like gums and bones to become weak. The effect on bones is greatest at the metaphysis, because the demand for type 1 collagen is greatest here. 

Humans are unable to create their own vitamin C, instead relying on maternal stores in the first few months of life, and then dietary sources. We need to consume vitamin C every day because the water soluble vitamin can’t be made or stored in the body.

A large orange provides around 80 mg of the vitamin, twice the recommended adult daily dose of 40 mg. Half a cup of raw red pepper contains more vitamin C than an orange., and half a cup of cooked Brussels sprouts or broccoli will also provide an adult’s daily requirement as long as it’s not over cooked. Not everyone eats these foods all the time – …alcoholics are frequently malnourished, as are the elderly and those with food selectivity seen in conditions such as autism. Most adults are supposed to get enough vitamin C from their diet, but cooking does reduce the available vitamin C, which is thought to be a large cause of vitamin C deficiency.


You may think that scurvy isn’t a diagnosis you should be making in the ED, and you’re probably right but looking through case reports, many diagnoses were made in the ED. Even if we don’t confirm the diagnosis (more on that later), raising the possibility of scurvy could mean treatment is started sooner (as Charlotte reaches for the vitamin C tablets).

Most of the signs and symptoms are non specific, and related to anaemia or collagen damage. Symptoms include:
Lethargy and malaise, bone pain
Bleeding tendencies – bleeding gums, and epistaxis, subungal or splinter haemorrhages. Perifollicular haemorrhage with corkscrew hair deformity – this is pathognomic of scurvy .
Orthostatic hypotension
Impaired wound healing


If you’re looking for scurvy, chances are it’s part of a bigger picture, and you’re screening for anything that might help. Scurvy is supposed to be a clinical diagnosis, so you shouldn’t need any “extra” bloods to help the diagnosis.

An FBC might show anaemia either macrocytic (from coexisting folic acid deficiency), microcytic (from iron deficiency, as its absorption depends on ascorbic acid) or normocytic (from haemorrhage into tissue or loss into the GI tract).

X-rays can show generalised osteopaenia, and some special lines. If you’re interested, have a look at Radiopedia as they explain it more efficiently than I ever could!

Vitamin C deficiency leads to decrease in chondroitin sulfate and collagen synthesis and repair

Musculoskeletal findings include joint pain, typically of the knees, ankles and wrists; as well as muscle pain and hemarthrosis.

Skin findings can include petechia centred around hair follicles, corkscrew hairs, ecchymosis and haematomas. These changes typically occur first in the legs and buttocks, because these are regions of elevated hydrostatic pressures.

Ultrasound can also help identify scurvy – apparently! 


Treatment with vitamin C leads to prompt resolution of symptoms within days. It seems like on the occasions I’ve been run down before exams, and self-diagnosed with scurvy, binged on some orange juice and got better my diagnosis may have been right- and not just a figment of my imagination!
Treatment is Ascorbic Acid 100mg TDS.

This treatment starts to work really quickly, and if skin lesions are present, complete resolution of skin lesions should occur within weeks. After treatment, we need to think about prophylaxis. People could take vitamin C tablets for ever, but it’s probably better to eat some every day.


When we’re making clinical diagnoses, I always wonder what the effect will be if we’re wrong. Luckily, it looks like it’s really hard to overtreat.
Taking large amounts (more than 1,000mg per day) of vitamin C can cause stomach pain, diarrhoea and flatulence. These symptoms should disappear once you stop taking vitamin C!

Toxbase says that Vitamin C is virtually non-toxic in a single acute OD. If you have G6PD deficiency, you may become acidotic or get a haemolytic anaemia. In chronic over dose, you may get renal failure and oxalate crystalluria. N&V, cramps, flushing of skin, headache, increase in urination have been reported with chronic use of doses >600mg / day. So I think we’re safe.

Bottom Line

Think Vitamin C deficiency (scurvy)
Consider suggesting supplements
Not all dermatological presentations have their origins in the skin!


  1. BMJ and here and here
  2. Annals
  3. Orthobullets
  4. Case Reports 1 2 3
  5. wiki Scurvy
  7. Vitamin-C
  8. Vitamin-C