Medicines for Scurvy

What it is

Scurvy is a condition caused by a severe and prolonged lack of vitamin C (ascorbic acid) in the diet. Vitamin C is essential for the body — it is needed to make collagen (a protein important for the skin, blood vessels, gums, and healing), for the health of connective tissues, and for other functions. The body cannot make or store vitamin C for long, so a regular dietary intake is needed; if someone gets very little vitamin C for a prolonged period (weeks to months), scurvy can develop. Historically, scurvy was famously common among sailors on long voyages without fresh fruit and vegetables, but today it is rare in countries with a varied diet. However, it still occurs, particularly in people with a very poor or restricted diet lacking fruit and vegetables — for example due to certain eating patterns, food poverty, alcohol dependence, some mental health conditions or eating disorders, older age with a limited diet, or other situations affecting diet. The symptoms of scurvy can include: tiredness and weakness; feeling irritable or low; aching joints, muscles, or legs; gum problems — swollen, bleeding, or sore gums, and, if untreated, loosening of the teeth; easy bruising; small red or purple spots on the skin (often around hair follicles), and skin that is dry or that bruises easily; slow healing of wounds; and, over time, anaemia and other effects. Because vitamin C is important for many tissues, untreated scurvy can cause significant problems, but the important and encouraging point is that scurvy is easily treated: replacing the vitamin C — through diet and/or supplements — leads to a quick improvement in symptoms, often within days to weeks. Preventing scurvy is straightforward through a diet containing enough vitamin C (found in fruit and vegetables, such as citrus fruits, berries, peppers, and many others). The key messages are that scurvy is caused by a lack of vitamin C, that it is now rare but occurs with a very poor diet, and that it is easily treated and prevented with vitamin C.

How it is treated

Scurvy is easily treated by replacing the missing vitamin C, along with addressing the underlying dietary cause, and it responds quickly to treatment. If scurvy is suspected — from the symptoms (such as tiredness, gum problems, easy bruising, and skin changes) in someone with a diet likely to be low in vitamin C — assessment can confirm it, and treatment is straightforward. Treatment involves replacing the vitamin C, usually with vitamin C supplements (at a suitable dose, as advised) and by improving the diet to include vitamin-C-rich foods; symptoms typically improve quickly, often within days for some symptoms and over a few weeks for fuller recovery. Because scurvy reflects a lack of vitamin C in the diet, an important part of management is identifying and addressing the underlying reason for the poor intake — for example supporting someone with a very restricted diet, addressing food access or poverty, managing alcohol dependence, addressing an eating disorder or mental health condition, or supporting an older person with a limited diet — so that the deficiency does not recur, and so that any other nutritional deficiencies (which can co-exist with a poor diet) are also identified and addressed. Dietary advice, and support where needed (for example from a dietitian or relevant services), help. Preventing scurvy is simple and is achieved through a varied diet containing enough vitamin C — found in fruit and vegetables such as citrus fruits, berries, kiwi, peppers, broccoli, potatoes, and many others — as part of a balanced diet. Because scurvy is now uncommon, it may not always be immediately considered, but it is worth thinking of in someone with a very poor diet and suggestive symptoms, as it is easily treated once recognised. The reassuring messages are that scurvy is caused by a lack of vitamin C, that it is easily and quickly treated by replacing the vitamin C, and that addressing the underlying dietary cause prevents it recurring — while a varied diet with enough fruit and vegetables prevents it in the first place.