What should I do?
If you think you have this condition you should see a doctor within two weeks.
How is it diagnosed?
Your doctor may suspect ascorbic acid (vitamin C) deficiency after asking about your symptoms and diet. A blood test to measure the level of vitamin C can help confirm the diagnosis.
What is the treatment?
If you are diagnosed with this condition, you should try to increase your dietary intake of vitamin C . Good sources of this vitamin include:
In addition, vitamin C supplements can be purchased at a pharmacy.
When to worry?
If you develop any of the following symptoms then you should see a doctor immediately:
- bleeding that will not stop
- chest pain
- sensation of your heart racing
- loss of consciousness.
If you develop any of the following symptoms then you should see a doctor within 48 hours:
- jaundice, or yellowing of the skin or white of the eyes
- swollen ankles, feet, hands or arms.
Scurvy is a rare condition that can develop if you don't have enough vitamin C in your diet.
Vitamin C (also called ascorbic acid) is vital for the body as it is needed to make collagen. Collagen is a type of protein found in many different types of tissue, such as skin, blood vessels, bones and cartilage (which covers the surface of joints).
Without vitamin C, collagen can't be replaced and the different types of tissue break down, leading to symptoms of scurvy, including:
- muscle and joint pain
- the appearance of red dots on the skin
- bleeding and swelling of the gums
Read more about the symptoms of scurvy.
Unlike some other types of vitamins, the human body is unable to make vitamin C. Therefore, all the vitamin C that the body needs has to come from a person’s diet.
The best way to prevent scurvy is to eat a healthy, balanced diet that contains plenty of fruit and vegetables.
Read more about preventing scurvy.
Who is affected by scurvy?
People tend to think that scurvy is a disease of the past because our diet and standard of living has improved over the years.
However, although rare, vitamin C deficiency can still be a problem for certain groups of people, including:
- elderly people who are unable to maintain a healthy diet
- people who smoke, or have a dependency on alcohol or drugs
- people on a low income
Read more about the causes of scurvy.
Your doctor can usually diagnose scurvy by examining your symptoms and asking about your diet. They may also carry out a blood test to measure the level of vitamin C in your blood.
Treatment for scurvy is relatively straightforward. It involves taking vitamin C supplements and eating food that's high in vitamin C. This should quickly reverse the harmful symptoms of scurvy.
The fact that a person has scurvy in the first place is usually a sign that they're vulnerable or living a chaotic lifestyle. Therefore, referral to a dietician, social worker or mental healthcare professional may be required to prevent further episodes of scurvy or other problems linked to malnutrition.
Read more about treating scurvy.
The symptoms of scurvy usually begin three months after a person stops getting enough vitamin C in their diet.
In adults, the initial symptoms of scurvy include:
- feeling very tired and weak all the time (fatigue)
- a general sense of feeling "out of sorts", such as feeling irritable and miserable all the time
- pain in your limbs, particularly your legs
- the appearance of small red-blue spots on your skin
These spots develop where individual hairs grow out of the skin (hair follicles), and they often occur on the shins. Hairs in affected areas usually twist around like corkscrews and break away easily. Without treatment, the spots can grow and merge to create large dark patches on your skin.
Other symptoms then follow, including:
- swollen gums, which become soft and vulnerable to bleeding (teeth may feel loose or fall out)
- severe pain in your joints caused by bleeding inside the joints
- shortness of breath, particularly after periods of physical activity
- redness and swelling in recently healed wounds (new wounds may fail to heal)
- easily bruised skin
Scurvy in infants
In infants, the initial symptoms of scurvy include:
- lack of appetite
- poor weight gain
- high temperature (fever) of 38ºC (100.4ºF) or above
As the condition progresses, additional symptoms include:
- pain and tenderness in the legs, which is often severe – this can make a young child very upset when they're having their nappy changed
- as with adults, the appearance of reddish-bluish spots on the skin
- the eyes bulging outwards
Scurvy is caused by a lack of vitamin C in your diet.
Without enough vitamin C, your body can't produce new collagen, which is a type of protein found in many different types of body tissue, including the skin and bones. Without a new supply of collagen, the body's tissue will begin to break down and deteriorate.
For people living in the developed world, even a relatively unhealthy and imbalanced diet should provide an adequate supply of vitamin C. Therefore, for scurvy to develop there are usually other contributing factors, such as:
- dependency on alcohol or drugs
- complex mental health conditions, such as severe depression or schizophrenia
- being elderly and unable to maintain a healthy diet – for example, elderly men who have recently been widowed and have little experience of cooking for themselves can sometimes develop scurvy
- treatments that cause nausea as a side effect, such as chemotherapy, can result in the person losing their appetite
- conditions that affect people's ability to digest food, such as Crohn's disease or ulcerative colitis
- anorexia nervosa, an eating disorder in which a person becomes very concerned about gaining weight and tries to control it by eating as little as possible
- fad diets
- smoking, which can reduce the amount of vitamin C absorbed by the body
- pregnancy or breastfeeding, as the body needs more vitamin C at these times
However, delayed or unsuccessful weaning of babies and toddlers to solid food can also lead to scurvy if these children are not given the recommended supplementation of vitamins A, C and D from six months of age, or if they are drinking less than 500ml of formula milk.
See [vitamins for children] for more information about this.
Scurvy is treated with vitamin C supplements, which can quickly improve your symptoms.
Some symptoms, such as joint pain, will usually resolve within 48 hours. Most people will make a full recovery within two weeks.
Once your symptoms improve, you should be able to get enough vitamin C by eating a healthy, balanced diet and you will no longer have to take supplements.
See preventing scurvy for more information.
Referral to a specialist
You may also be referred to a health or social care specialist to address the underlying reasons for developing scurvy in the first place. The type of specialist will depend on the underlying cause. For example, you may be referred to a:
- a dietitian if you have scurvy caused by a very unhealthy diet and there are no underlying factors
- a social worker or occupational therapist if your scurvy was caused by an inability to cook for yourself because of disability or poor health
- a gastroenterologist – a doctor who specialises in treating digestive conditions, such as Crohn's disease, if your scurvy is caused by this type of condition
- a psychologist if your scurvy is associated with a mental health or behavioural condition, such as depression, schizophrenia or anorexia nervosa
The best way to prevent scurvy is to eat a healthy, balanced diet that contains plenty of fresh fruit and vegetables.
This will ensure that you have enough vitamin C in your body at all times.
It's recommended that:
- babies (0-12 months old) get around 25mg of vitamin C a day
- children 1-10 years old get around 30mg of vitamin C a day
- children 11-14 years old get around 35 mg of vitamin C a day
- older children and adults get around 40mg of vitamin C a day (smokers and heavy drinkers of alcohol may require slightly more)
- pregnant women get 50mg of vitamin C a day
- breastfeeding mothers get around 70-75mg of vitamin C a day
For most people, it's very easy to get the daily recommended amount of vitamin C from your diet. For example, eating one large orange, a bowl of strawberries or a single kiwi fruit would provide you with more than enough vitamin C to meet your body's needs.
Consuming more than the amounts of vitamin C outlined above isn't harmful. You would only suffer adverse effects, such as diarrhoea and flatulence, if you were regularly eating more than 1000mg of vitamin C a day, which is the equivalent of eating about 15 oranges.
Sources of vitamin C
Fruit and vegetables are some of the best sources of vitamin C, including:
- kiwi fruits
- green peppers
- sweet potatoes
It's better to eat raw fruit and vegetables as vitamin C is easily destroyed during cooking. If you cook vegetables, it is a good idea to steam rather than boil them as vitamin C dissolves in water.
Levels of vitamin C also gradually reduce during storage, so frozen vegetables can have a higher vitamin C content than fresh vegetables that are not eaten soon after purchase.