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Scurvy - Oral Mucosal Lesion
See also in: Overview
Other Resources UpToDate PubMed

Scurvy - Oral Mucosal Lesion

See also in: Overview
Contributors: Christine S. Ahn MD, FAAD, William W. Huang MD, MPH, FAAD, Susan Burgin MD, Art Papier MD
Other Resources UpToDate PubMed

Synopsis

Scurvy is an acquired condition caused by a prolonged deficiency of vitamin C (L-ascorbic acid). Vitamin C is a water-soluble, essential vitamin that can only be obtained through the diet. It is an essential cofactor in the cross-linking and stabilization of collagen; thus, deficiency of this nutrient causes impaired collagen synthesis, leading to poor wound healing, capillary fragility, and bone abnormalities.

Scurvy is a relatively rare diagnosis in the developed world. Pathognomonic clinical findings of scurvy include gingival bleeding and perifollicular petechiae with corkscrew hairs. Other common features include vascular fragility, manifesting as purpura, petechiae, ecchymoses, and gastrointestinal bleeding. Spontaneous hemorrhage into muscles, soft tissues, and joints can cause painful hematomas and hemarthroses. Symptoms include fatigue, weakness, muscle cramping, and malaise as well as cognitive impairment and mood disturbances.

Risk factors for developing scurvy include alcohol use, low socioeconomic status, restrictive diets or dietary fads, obesity, psychiatric disease, and malabsorption due to gastrointestinal disease. Additionally, the elderly, especially those in social isolation; patients on dialysis; and individuals with increased metabolic requirements (such as pregnant or lactating individuals and patients with severe infections) are at increased risk. People who chronically abuse alcohol are particularly susceptible to scurvy not only due to poor dietary intake but also decreased ascorbic acid absorption.

Codes

ICD10CM:
E54 – Ascorbic acid deficiency

SNOMEDCT:
76169001 – Scurvy

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Oral mucosal differential:
  • Chronic gingivitis / periodontitis – these entities are common and result from inadequate oral hygiene procedures; however, severe examples may mimic the swelling and erythema of scorbutic gingivitis. Lack of systemic signs and symptoms would be characteristic.
  • Necrotizing ulcerative gingivitis – this condition is relatively common, and is usually accompanied by poor oral hygiene, inappropriate diet, and stress. Usually there are no systemic signs or symptoms.
  • Leukemic gingivitis – this condition may have a relatively sudden onset and is usually associated with myelomonocytic forms of leukemia. Systemic signs and symptoms may be similar to scorbutic gingivitis, and biopsy or CBC may be necessary.

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Therapy

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References

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Last Updated:11/22/2021
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Scurvy - Oral Mucosal Lesion
See also in: Overview
Scurvy (Initial Stage) : Diarrhea, Fatigue, Fever, Malaise, Anorexia, Tachypnea
Clinical image of Scurvy
A close-up of scattered perifollicular purpura and "corkscrew" hairs.
Copyright © 2022 VisualDx®. All rights reserved.