Most cases of vitamin C deficiency seen in the United States are due to dietary inadequacy in older patients and patients with chronic alcohol use disorder. Patients with chronic illnesses such as cancer and chronic kidney disease and individuals who smoke cigarettes are also at risk.
Early manifestations of vitamin C deficiency are nonspecific and include malaise and weakness. In more advanced stages, the typical features of scurvy develop. Manifestations include perifollicular hemorrhages, perifollicular hyperkeratotic papules, petechiae, purpura, splinter hemorrhages, bleeding gums, hemarthroses, and subperiosteal hemorrhages. Anemia is common, and wound healing is impaired. The late stages of scurvy are characterized by edema, oliguria, neuropathy, intracerebral hemorrhage, and death.
The diagnosis of advanced scurvy can be made clinically on the basis of skin lesions in the proper clinical situation. Atraumatic hemarthrosis is also highly suggestive. The diagnosis can be confirmed with decreased plasma ascorbic acid levels, typically below 0.2 mg/dL.
Adult scurvy can be treated with ascorbic acid 300–1000 mg/day orally. Improvement generally occurs within days. Clinical trials have shown that supplemental vitamin C has no benefit on cardiovascular disease or cancer outcomes.