Scurvy is a rare condition that occurs when a person doesn't have enough vitamin C in their diet.

Vitamin C is vital for the body as it needs it to make a substance called 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).

The body needs to regularly produce collagen. 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
• tiredness
• the appearance of red dots on the skin
• bleeding and swelling of the gums, which can lead to teeth falling out

Vitamin C

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; specifically fresh fruit and vegetables (see box, left).

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 with a dependency on alcohol or drugs

Treating scurvy

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 other healthcare professionals, such as a dietician, social worker or mental healthcare professional may be required to prevent further episodes of scurvy or other problems linked to malnutrition.

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 in your legs

The first noticeable symptom of scurvy is the appearance of reddish-bluish bruise-coloured spots on your skin. They develop where individual hairs grow out of the skin, 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 spongy and vulnerable to bleeding; badly affected gums may no longer be able to hold your teeth in place
• severe pain in your joints caused by bleeding inside the joints – the pain can be so severe that you may be unable to walk
• extreme shortness of breath, particularly after periods of physical activity
• vision problems, such as blurred vision, which are caused by bleeding inside your eyes; you may also become more sensitive to light and your eyes may feel sticky
• redness and swelling in recently healed wounds; new wounds may fail to heal

Left untreated, scurvy can enlarge the muscles in your heart and cause bleeding inside your heart, both of which can result in sudden death.

Scurvy in children

In children, the initial symptoms of scurvy include:

• lack of appetite
• irritability
• poor weight gain
• diarrhoea
• high temperature 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 child very upset when they're having their nappy changed
• as with adults, the appearance of reddish-bluish spots on the skin
• bleeding inside the bones of their legs – the blood can pool and is often noticeable to the touch
• 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.

Collagen is a type of protein found in many different types of tissue in the body, including in 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. For example, cases of scurvy have been reported in:

• people with a dependency on alcohol or drugs
• homeless people
• people with complex mental health conditions, such as severe depression or schizophrenia
• elderly people who are unable or, in some cases, unwilling to maintain a healthy diet; elderly men who have recently been widowed and have little experience cooking for themselves can sometimes develop scurvy
• people having treatments such as chemotherapy, which causes nausea as a side effect; this can result in the person losing their appetite
• people who have conditions that affect their ability to digest food, such as Crohn’s disease or ulcerative colitis; both of these conditions cause inflammation inside the digestive system
• people who are on ‘fad diets’
• people with 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

In England, scurvy in children is very rare. It usually occurs through a combination of parents having little knowledge of nutrition and being on a very low income. For example, in 2009, a case of scurvy was reported in a child whose diet only consisted of bread and jam. 

Your doctor can usually diagnose scurvy by:

• asking you about your recent diet
• asking you about your symptoms
• carrying out a blood test to measure the level of vitamin C in your blood

X-rays may also be used to check for changes in the normal structure of your bones as thinning of the bones can often occur in cases of scurvy.

If there's a lack of vitamin C in your diet, it's likely that your diet also lacks other nutrients, such as:

• iron – can lead to iron deficiency anaemia, a condition that causes the symptoms of tiredness, shortness of breath and a lack of energy
• vitamin B12, which can lead to vitamin B12 deficiency and cause a range of symptoms such as mouth ulcers and disturbed vision

Therefore, you may have additional blood tests to measure the nutrient levels in your blood.

Vitamin C supplements are used in the initial stage of treating scurvy. Once treatment begins, you should notice your symptoms starting to improve significantly.

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.

Read more about preventing scurvy by eating a healthy diet.

Referral to a specialist

You may 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 dietician if you have scurvy that was caused by a very unhealthy diet and there were no other underlying factors
• a social worker or occupational therapist if your scurvy was caused by an inability to cook for yourself due to disability or poor health; an occupational therapist helps people to carry out day-to-day tasks such as cooking
• a gastroenterologist – a doctor who specialises in treating digestive conditions, such as Crohn’s disease if your scurvy has been 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.

Recommendations

It's recommended that:

• infants (children under two years old) need around 30-40mg of vitamin C a day
• children and adults need around 40mg of vitamin C a day (smokers and heavy drinkers of alcohol may require a slightly higher dose)
• pregnant women need 70mg of vitamin C a day
• breastfeeding mothers need around 90-95mg of vitamin C a day

Consuming more than the amounts of vitamin C outlined above isn't harmful. You would only suffer adverse effects, such as nausea and vomiting, if you were regularly eating more than 2000mg of vitamin C a day, which would be the equivalent of eating 30 oranges in one sitting.

It's very easy to reach your daily amount of vitamin C. 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.

Sources of vitamin C

Good sources of vitamin C include:

• oranges
• lemons
• limes
• grapefruits
• blackcurrants
• kiwi fruits
• tomatoes
• broccoli
• asparagus
• cabbage
• green peppers
• sprouts
• sweet potatoes

Other good sources of vitamin C include:

• fresh milk
• liver
• kidney
• fish

Eating at least five portions of fresh fruit and vegetables a day provides you with more than enough vitamin C to remain healthy. For more information see:

• the Health A-Z topic about Vitamins and minerals
• the Live Well topics about Healthy Eating, Food and Diet and the Eatwell Plate