# Scurvy and Vitamin C Deficiency

> Scurvy for NEET-PG Medicine: perifollicular haemorrhage, corkscrew hairs, the collagen hydroxylation defect, Frankel lines and rapid response to vitamin C.

- Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/scurvy-and-vitamin-c-deficiency
- Exam / course: NEET-PG · Subject: Medicine
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Harrison's Principles of Internal Medicine; Davidson's Principles and Practice of Medicine; ICMR Nutrient Requirements for Indians
- How to cite: "Scurvy and Vitamin C Deficiency", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/scurvy-and-vitamin-c-deficiency

## Direct answer

Scurvy is the clinical syndrome of vitamin C (ascorbic acid) deficiency. Impaired hydroxylation of procollagen makes collagen unstable, causing bleeding from small vessels, poor wound healing and gum disease. Perifollicular haemorrhage and corkscrew hairs are its hallmark signs, and a rapid response to vitamin C usually settles the diagnosis in practice.

## What you must remember

- **Mechanism:** ascorbic acid is the cofactor for prolyl and lysyl hydroxylases, so collagen is unstable and capillaries bleed; humans cannot synthesise it.
- **Hallmark signs:** perifollicular haemorrhage, corkscrew (coiled) hairs, spongy and bleeding gums, and bruising on the legs.
- **Skeletal signs:** subperiosteal haemorrhage, painful joints with haemarthrosis, and pseudoparalysis of the limbs in infants.
- **Radiology:** Frankel lines, dense white metaphyseal lines, and Trümmerfeld zones on long bone films are classic in children.
- **Iron link:** vitamin C reduces ferric iron for absorption, so scurvy commonly coexists with iron-deficiency anaemia.
- **Causes:** poor diet in the elderly or isolated, alcohol use, restrictive diets, and infants fed boiled milk without fruit or juice.
- **Diagnosis:** low plasma ascorbate supports the diagnosis, but clinical features and a dramatic response to vitamin C often decide it.
- **Treatment:** a course of high-dose vitamin C lasting weeks (regimens differ) followed by maintenance, with dental and wound care; improvement is often visible within days.

## Worked example: bleeding gums in a man living alone

A 67-year-old widower living alone presents with bleeding gums, bruising on his shins and aching knees. He has eaten little fresh food for months and drinks daily.

1. **Look for the classic signs:** Examination shows spongy, bleeding gums and perifollicular haemorrhages around the hair follicles of the thighs, and corkscrew hairs are seen.
2. **Check the platelets and clotting:** Haemoglobin is low, but platelet count and prothrombin time are normal, which moves the picture away from immune thrombocytopenia and clotting factor defects.
3. **Take a diet history:** A bleeding screen with normal platelets and coagulation tests should prompt a dietary history rather than more haematology.
4. **Send vitamin C and treat:** Plasma vitamin C is sent, and oral vitamin C at high dose is started and continued for several weeks (regimens differ), followed by maintenance, with a multivitamin and iron once iron deficiency is confirmed.
5. **Review teeth and counsel:** Dental review follows, since loosening of teeth can occur, and he is counselled about fruit, vegetables and alcohol.
6. **Expect a response:** Within days the gums settle and the bruising starts to fade.

The same logic applies to a ten-month-old infant on boiled cow's milk who is irritable and holds the legs flexed. There, the trap is the differential with fracture and osteomyelitis, and subperiosteal bleeding on radiology distinguishes scurvy.

## Where the bleeding history misleads

Four traps recur in examiner questions on this topic.

- **Trap:** treating scurvy as a primary bleeding disorder — **Correct:** platelets and clotting studies are normal in scurvy, so the examiner expects the classic physical signs first, perifollicular haemorrhage and corkscrew hairs, with gum change next.
- **Trap:** reading the infant radiograph as osteomyelitis alone — **Correct:** Frankel lines and subperiosteal haemorrhage must be separated from osteomyelitis and non-accidental injury.
- **Trap:** forgetting the daily requirement — **Correct:** the older ICMR RDA for adults was 40 mg a day, while ICMR-NIN 2020 raised it to about 80 mg for men and 65 mg for women, so check which edition a stem follows.
- **Trap:** answering with the cause when the stem asks for the cure — **Correct:** James Lind's citrus experiment in the eighteenth century is the historical anchor, and a stem about sailors or prisoners often asks for the cure rather than the cause.

## Frequently asked questions

### Which signs are the hallmarks of scurvy?

Perifollicular haemorrhage and corkscrew hairs are the hallmarks of scurvy, alongside spongy, bleeding gums and bruising. Perifollicular haemorrhage appears as small haemorrhages around hair follicles, most often on the lower limbs.

### Why does scurvy cause bleeding and poor wound healing?

Scurvy causes bleeding and poor wound healing because vitamin C is needed for prolyl and lysyl hydroxylation of procollagen. Without it, collagen fibres are weak and capillary walls are fragile, so small vessels bleed and wounds fail to close.

### Which radiographic signs suggest scurvy in an infant?

Frankel lines, dense white metaphyseal lines and Trümmerfeld zones on long bone radiographs suggest scurvy in an infant. Subperiosteal haemorrhage is a further clue that helps separate scurvy from osteomyelitis in a child with limb pain.

### How does scurvy relate to iron-deficiency anaemia?

Scurvy relates to iron-deficiency anaemia because vitamin C reduces dietary ferric iron to the ferrous form, which is absorbed in the duodenum. Patients with scurvy therefore often have coexisting anaemia, and iron stores should be checked alongside treatment.

### Why do normal platelet counts and clotting tests help distinguish scurvy?

Normal platelet count and prothrombin time are expected in scurvy, which helps distinguish it from thrombocytopenia and clotting factor defects. Bleeding with normal platelet and coagulation studies should prompt a dietary history and a search for vitamin C deficiency.