Scurvy is a disease that results from a severe and chronic deficiency of vitamin C, also known as ascorbic acid. Vitamin C is an essential nutrient, meaning the human body cannot produce it on its own and must obtain it regularly from dietary sources. This vitamin plays a critical role in many of the body’s most important functions, but its most crucial job is in the synthesis and maintenance of collagen.

Collagen is the most abundant protein in the human body. It is the primary structural protein that makes up all of our connective tissues.

• A helpful analogy is to think of collagen as the body’s “superglue” and “steel cables.”
• It is the essential material that gives strength, structure, and integrity to our skin, blood vessels, bones, tendons, ligaments, cartilage, and gums.
• To make strong, stable collagen, the body’s cellular “construction workers” (enzymes) need a critical tool: vitamin C. Vitamin C acts as a vital cofactor, or helper molecule, that allows these enzymes to properly weave and cross-link individual collagen fibers into strong, durable cables.

In scurvy, a person has been deprived of vitamin C for a prolonged period (typically at least one to three months).

• In this state, the body’s construction workers have run out of their essential tools. They can still produce the raw collagen fibers, but they cannot properly link them together to form strong cables.
• The result is the production of weak, fragile, and unstable collagen throughout the body. The body’s “superglue” fails.
• This is why in scurvy, things literally begin to fall apart. The walls of the blood vessels become fragile and begin to leak, the gums become spongy and bleed, old wounds can reopen, and teeth can loosen in their sockets.

In my experience, many people assume scurvy is a historical disease, but I still encounter it occasionally especially in patients with restricted diets or severe malnutrition.

The sole cause of scurvy is a severe and prolonged dietary deficiency of vitamin C.

The human body, unlike many other animals, cannot synthesize its own vitamin C. It also cannot store large amounts of it. Therefore, we rely on a regular intake of vitamin C from the foods we eat to replenish our supply. If a person consumes little to no vitamin C for an extended period, the body’s small reserve is depleted, the production of healthy collagen halts, and the signs and symptoms of scurvy begin to appear.

Clinically, the primary cause is inadequate intake of vitamin C over time, commonly seen in individuals with alcohol use disorder, eating disorders, or limited access to fresh fruits and vegetables.

A person develops scurvy by consuming a diet that is almost completely devoid of fresh fruits and vegetables for at least one, and more often three, months. Scurvy is not contagious.

In the modern world, where fresh produce is widely available, scurvy is very rare. When it does occur, it is seen only in specific at-risk populations. These include:

• The Elderly: Particularly those who are isolated, live alone, or are institutionalized and have a very poor or unvaried diet (sometimes referred to as a “tea and toast” diet).
• Individuals with Alcoholism or Substance Abuse Disorders: These conditions are often associated with severe self-neglect and malnutrition.
• Individuals on Extremely Restrictive Diets: People who follow very restrictive fad diets that completely eliminate all fruits and vegetables.
• People with Severe Mental Illness, such as severe depression or schizophrenia, which may affect their ability to maintain a healthy diet.
• Individuals with Malabsorption Syndromes: Conditions like Crohn’s disease, celiac disease, or those who have had certain types of gastric bypass surgery may have difficulty absorbing nutrients from their food.
• Infants who are fed only evaporated or boiled cow’s milk, which does not contain vitamin C, without proper supplementation.

In my experience, I’ve seen scurvy in elderly patients living alone, those with autism or psychiatric illnesses who have selective eating habits, and even in children on highly restrictive diets.

The signs and symptoms of scurvy develop gradually after a long period of vitamin C deprivation. Early symptoms are often vague and non-specific.

Early Symptoms (after 1-3 months of deficiency)

• Fatigue, weakness, and a general feeling of being unwell (malaise).
• Irritability and sadness.
• Loss of appetite and unintentional weight loss.
• Aching pain in the legs and joints.

Classic Symptoms of Advanced Scurvy

As the deficiency becomes more severe, the classic and more recognizable signs of scurvy appear, primarily related to the breakdown of collagen and fragile blood vessels.

• Hemorrhagic Signs (Bleeding):
  • Petechiae: Pinpoint-sized red or purple dots on the skin. A very characteristic sign is perifollicular hemorrhage, where these tiny bleeds occur around the hair follicles, particularly on the legs and buttocks.
  • Ecchymoses: The development of large, spontaneous bruises, especially on the legs.
  • Bleeding Gums: This is a hallmark sign. The gums become swollen, spongy, purple, and bleed with even the slightest touch.
  • Bleeding into the joints (hemarthrosis) or muscles, causing severe pain.
• Skin and Hair Changes:
  • Hyperkeratosis: The skin can become rough, scaly, and bumpy.
  • “Corkscrew” Hairs: The body hairs can become fragmented and twisted into a corkscrew shape due to abnormal follicle development.
• Dental Problems: In addition to bleeding gums, the teeth can become loose in their sockets and may eventually fall out due to the breakdown of the ligaments that hold them in place.
• Poor Wound Healing: New wounds will fail to heal properly, and old, previously healed scars may break down and reopen.
• Anemia: Anemia is common due to bleeding and because vitamin C is also important for the absorption of iron.

If left untreated, scurvy is a fatal disease. Death can occur suddenly from bleeding into a critical organ, such as the brain, or from heart failure.

Clinically, I look for classic signs like corkscrew hairs, petechiae, poor wound healing, and perifollicular hemorrhage, which are strong clues to vitamin C deficiency.

In the modern era, scurvy is so rare that it is often a diagnostic challenge, as many doctors have never seen a case.

• Clinical Diagnosis: A diagnosis of scurvy is often suspected by an astute physician based on the patient’s clinical signs (especially the combination of skin hemorrhages and bleeding gums) and, most importantly, a detailed dietary history that reveals a profound lack of intake of fresh fruits and vegetables.
• Ruling Out Other Conditions: A doctor will perform blood tests, including a complete blood count and coagulation studies, to rule out other causes of bleeding, such as a platelet disorder or a clotting factor deficiency.
• Plasma Vitamin C Level: The diagnosis can be definitively confirmed with a blood test that measures the level of ascorbic acid in the plasma. A very low level confirms a state of severe deficiency.
• Imaging: X-rays of the bones, particularly in children, can show characteristic abnormalities at the growth plates that are suggestive of scurvy.

In my experience, I avoid unnecessary workups if the presentation is typical and the patient improves rapidly with vitamin C repletion.

The most remarkable aspect of scurvy is that this devastating and once-fatal disease is completely curable with one of the simplest, safest, and most inexpensive treatments available: vitamin C.

1. Vitamin C Supplementation

• Treatment is simply to replace the missing vitamin C.
• This is typically done with oral vitamin C (ascorbic acid) supplements. A doctor will prescribe a dose that is much higher than the normal daily requirement for a period of time to rapidly replenish the body’s depleted stores.
• In very severe cases or if a person cannot take oral medication, vitamin C can be given intravenously.

The Dramatic Response to Treatment

The improvement in symptoms after starting vitamin C supplementation is often rapid and dramatic.

• General symptoms like fatigue, pain, and irritability often begin to improve within 24 to 48 hours.
• The bleeding from the gums and skin typically stops within one to two weeks.
• The bruising, skin rashes, and hair changes will resolve over several weeks.
• The gums and teeth will heal, although any teeth that were lost will not regrow.

2. Dietary Improvement

The long-term management is a commitment to consuming a balanced diet that is rich in vitamin C. Excellent dietary sources of vitamin C include:

• Citrus fruits (oranges, grapefruit, lemons)
• Berries (especially strawberries)
• Kiwi fruit
• Bell peppers
• Broccoli
• Tomatoes
• Potatoes

Clinically, I also educate patients on reintroducing vitamin C-rich foods to maintain long-term health.

Scurvy is a severe but entirely preventable disease caused by a lack of dietary vitamin C, a nutrient that is essential for building the body’s collagen and maintaining the integrity of its tissues. While it is famous as the historical scourge of sailors, it serves as a powerful modern-day reminder of the critical importance of basic nutrition. Its devastating symptoms from bleeding gums and loose teeth to poor wound healing and fatigue can be completely and rapidly reversed with one of the simplest treatments in all of medicine. Clinically, I use scurvy as a reminder to consider nutritional deficiencies in patients with vague symptoms, especially when risk factors like poor diet or isolation are present.

The National Institutes of Health (NIH), Office of Dietary Supplements. (2021). Vitamin C Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/

The World Health Organization (WHO). (n.d.). Scurvy. Retrieved from https://www.who.int/data/nutrition/nlis/info/scurvy

The Merck Manual Professional Version. (2022). Vitamin C Deficiency. Retrieved from https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-c-deficiency