Unlike most animals, which form ascorbic acid by metabolizing glucose, huma
ns require an exogenous source. Vitamin C occurs primarily in fruits and ve
getables, and scurvy develops from inadequate consumption of these sources,
usually because of ignorance about proper nutrition, psychiatric disorders
, alcoholism, or social isolation. The earliest symptom of scurvy occurring
only after many weeks of deficient intake, is fatigue. The most common cut
aneous findings are follicular hyperkeratosis, perifollicular hemorrhages,
ecchymoses, xerosis, leg edema, poor wound healing, and bent or coiled body
hairs. Gum abnormalities, which occur only in patients with teeth, include
gingival swelling, purplish discoloration, and hemorrhages. Pain in the ba
ck and joints is common, sometimes accompanied by obvious hemorrhage into t
he soft tissue and joints. Syncope and sudden death may occur. Anemia is fr
equent, leukopenia occasional. Treatment with vitamin C results in rapid, o
ften dramatic, improvement.