Author: Ms Christa Maria Joel Department of Dermatology Father Muller Medical College 2nd Year MBBS (2014-2015)

1. Cutaneous Manifestations
of Vitamin C Deficiency
CHRISTA MARIA JOEL

2. Introduction
• Vitamin C also known as ascorbic
acid is a highly heat labile and
water soluble vitamin.
• It is a reducing agent
• Co factor for several enzymes like
proline hydroxylase which helps in
the collagen synthesis.
• Has a key role in the formation of
stratum corneum.
• Along with vitamin E it helps in
reducing the UV radiation induced
damage.

3. • Has a role in amino acids like phenylalanine and tyrosine and carbohydrate
metabolism, synthesis of certain hormones and in reduction of folic acid to
folinic acid.
• Increases absorption of iron from gut.
• Plays a role in osteoid formation.
• Also influences prostaglandin synthesis.
• Sources- orange, lemon, tomatoes, green leafy vegetables, sprouted grains
and amla.

4. Scurvy
• Scurvy is a condition characterized by general weakness, anemia, gingivitis
and skin hemorrhages caused by a prolonged deficiency of vitamin C.
• WHO SUFFERS FROM SCURVY?
- Bottle fed infants and those weaned on diets poor in ascorbic acid are likely
to develop this deficiency.
- An inadequate diet devoid of fresh vegetables and fruits results in scurvy.
- Elderly men who live alone on a low budget, the mentally incapacitated and
alcoholics also develop this deficiency.
- Also common in gastrointestinal diseases especially in patients on ulcer diet,
in diarrhea, achlorhydria, malignancy and Crohn’s disease.
- Pregnacy, lactation and thyrotoxicosis, stress, extremes of temperature and
strenuous activity increase its requirement.

5. Clinical manifestations of scurvy- skin and
mucous membrane
Follicular hyperkeratosis with
perifollicular hemorrhage is
characteristic. It is seen on the
anterior aspect of the forearms,
abdomen and posterior aspect of the
thighs. Hairs are curled in follicles
and capped by keratotic plugs.

6. Corkscrew hairs due to reduced
disulphide bonds are seen.
Gingival hypertrophy with enlarged
purple friable gums is seen.

7. Petechiae and ecchymoses may
occur on any part of the body
independent of hair follicles but
occur most commonly on areas
subjected to even trauma or
pressure.
The feet and ankles are involved
early with woody edema and
discolouration.This is called woody
leg.

8. Musculoskeletal manifestations
• Depression of osteoblastic activity in vitamin C deficiency leads to failure of
bone matrix formation and increased bone resorption.
• This results in pain, weakness or pseudo paralysis.
• In infants dental development is impaired.
• Joint swelling and hemarthroses (extravasation of blood into a joint or its
synovial cavity).

9. Radiologic
manifestations
• Subperiosteal hemorrhage
(beneath the periosteum)
• Bulbous enlargement of
costochondral junction (rosary
beads formation)
• Transverse banding of metaphyses
• Fractures
• Osteoporosis

10. Psychiatric
manifestations
• Emotional lability- neurologic
disorder characterized by
uncontrollable episodes of crying
and/ or laughing or other
emotional displays.
• Depression (feeling of dejection)
• Hypochondriasis- excessive fear or
preoccupation with a serious illness
despite medical testing.
• Hysteria (exaggerated emotion)
Constitutional
symptoms
• Fatigue
• Weight loss

11. Laboratory symptoms
• Anemia- normocytic normochromic
• Lowered serum vitamin C level
• Raised ESR.

12. Rare manifestations of
scurvy
• Epistaxis
• Hematemesis and bloody diarrhea.
• Xerostomia (dryness of mouth)
• Keratoconjunctivitis - thickening
and drying of the corneal
epithelium, itching and burning
sensation of eye.
• Enlarged submandibular salivary
glands
• Sjogren’s syndrome- auto immune
disorder with symptoms of dry
eyes and mouth.

13. Lab diagnosis
• In serum assay, vitamin C is less than 0.1mg which indicates deficiency.
• In leucocyte assay, vitamin C is less than 7 mg/dl which indicates deficiency.
• Capillary fragility test is usually positive
• Bleeding, coagulation and prothrombin times are normal.
• Normocytic normochromic anemia is common.
• A prompt response to vitamin C therapy is usually enough to confirm
diagnosis.

14. Histopathology
• Skin biopsy of petechial lesions
shows perifollicular hemorrhages,
hyperkeratosis and mild
lymphocytic infiltrate.
• The hair follicles may show
infundibular dilatation with
hyperkeratosis and coiled hair
shafts.

15. Treatment
• The recommended daily allowance
for adults is 200 mg/day and for
infants 25 mg/day.
• Deficiency symptoms are
prevented by a dose of 60 mg/day.
• Therapeutic dose ranges from 300-
1000 mg/day orally.
• Protein rich diet is advised.

16. THANKYOU