Scurvy (Vitamin C Deficiency)

Why vitamin C matters

Humans cannot make vitamin C and store only a limited amount. It is needed to:

• Make and stabilize collagen, the protein that holds together skin, blood vessel walls, gums, tendons and bone
• Absorb iron from plant foods
• Support immune function and act as an antioxidant

With little or no intake, body stores run low within about a month, and signs of scurvy usually appear after 1 to 3 months.

Who gets scurvy today

Scurvy is uncommon in high-income countries but is still diagnosed, and is easily missed. People at risk include:

• Children and adults with very selective eating, including some with autism spectrum disorder or avoidant/restrictive food intake disorder (ARFID)
• Alcohol use disorder, with poor diet and impaired absorption
• Older adults living alone, on a "tea and toast" diet
• Eating disorders such as anorexia nervosa
• Malabsorption: Crohn disease, celiac disease, weight-loss surgery
• Kidney dialysis, which removes vitamin C
• Smokers, who need more vitamin C
• Food insecurity, homelessness and extreme fad diets
• Infants fed only cow's milk without formula or other sources

Scurvy symptoms

Early signs of scurvy

• Fatigue, weakness and lack of energy
• Irritability, low mood
• Loss of appetite and weight loss
• Aching muscles and joints

Later signs

• Skin: tiny red, blue or purple spots around hair follicles (perifollicular hemorrhages), usually on the shins; rough, bumpy skin; corkscrew hairs that are coiled and break easily
• Bruising: large bruises after minor knocks, especially on the legs (easy bruising)
• Gums: swollen, purple, spongy gums that bleed easily; loose teeth (only in people with teeth)
• Wounds: slow healing, old scars breaking open
• Joints and bones: painful bleeding into joints and under the bone lining, leg swelling; children may refuse to walk
• Anemia: from bleeding and poor iron absorption (iron deficiency anemia)
• Eyes: dryness and bleeding under the conjunctiva

Untreated scurvy can be fatal from bleeding, infection or heart complications.

Diagnosis

Scurvy is often diagnosed from the combination of a very poor diet and typical signs. Tests may include:

• Plasma vitamin C level: a very low level confirms deficiency, ideally taken before supplements start
• Blood count and iron studies: anemia and iron deficiency often coexist
• Other nutrient tests: vitamin D, B vitamins and zinc deficiencies frequently occur alongside
• X-rays or MRI in children with leg pain may show typical bone changes
• Clotting tests are normal, which helps distinguish scurvy from bleeding disorders

Scurvy can mimic vasculitis, leukemia, bleeding disorders or bone infection in children, so diet history is essential.

Treatment

• Vitamin C supplements: high-dose vitamin C by mouth daily for several weeks, at a dose your doctor recommends, then a maintenance intake from diet.
• Diet: daily fruits and vegetables. A dietitian can help selective eaters find acceptable sources.
• Treat coexisting problems: iron, vitamin D and other deficiencies, alcohol use, eating disorders and malabsorption.
• Support for selective eating: feeding therapy and behavioral support in children with autism or ARFID, to prevent recurrence.

How fast treatment works

• Fatigue, mood and pain often improve within 1 to 2 days
• Bruising and gum bleeding settle within 1 to 2 weeks
• Most signs resolve within about 3 months; joint and bone changes may take longer

Preventing scurvy

Adults need 90 mg of vitamin C a day (men) and 75 mg (women), plus 35 mg more for smokers. That is easy to reach with food:

Vitamin C is destroyed by long cooking and storage, so raw or lightly cooked produce provides more. A daily multivitamin is a reasonable safety net for people with very limited diets.

Frequently asked questions

What are the first signs of scurvy?

The first signs are vague: tiredness, weakness, irritability, poor appetite and aching legs or joints, often after 1 to 3 months of very low vitamin C intake. Bruising, tiny bleeding spots around hair follicles, corkscrew hairs and swollen, bleeding gums usually follow a few weeks later.

Can you still get scurvy today?

Yes. Scurvy is still diagnosed in the US and other wealthy countries, particularly in children with extremely selective diets, people with alcohol use disorder, older adults with poor diets, people with malabsorption or on dialysis, and those facing food insecurity. It is often mistaken for other conditions at first.

How long does it take to get scurvy?

Signs typically appear after 1 to 3 months of eating almost no vitamin C, as body stores run out. The exact time depends on starting stores, smoking, illness and how little vitamin C is eaten. Even small amounts, around 10 mg a day, prevent classic scurvy.

How quickly does vitamin C cure scurvy?

Tiredness and pain often improve within a day or two of starting vitamin C. Bleeding gums and bruising usually improve within 1 to 2 weeks, and most people recover fully within about 3 months. Long-term prevention depends on fixing the diet or continuing a supplement.

Is scurvy contagious?

No. Scurvy is a nutritional deficiency, not an infection. It cannot spread between people. Family members may be affected at the same time only if they share the same very limited diet.