Ver el código de «Scurvy»

==Background==
{{Skin anatomy background images}}
*Nutritional deficiency of Vitamin C (Ascorbic acid)
*Vitamin C is typically found in fruits and vegetables.
*Vitamin C is a cofactor for hydroxylation of proline and lysine amino acids in procollagen molecules, which is required for cross-linking collagen's triple helix.  
*Scurvy therefore leads to unstable collagen and collagen fragility.
**Leaking of vascular structures
***Gingival bleeding
***[[Petechiae]]
***Easy bruising
*Vitamin C is also required for the disulfide bonding in hair leading to corkscrew appearance of hair.
*16th-19th century sailors with scurvy found to have developed tooth decay, bruising, lassitude, and often died from massive hemorrhage<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>

===Risk Factors===
*Eating disorders or select eating habits
*Infants who only consume pasteurized milk
*Autism
*Alcohol disorder
*Isolated elderly persons with poor nutrition

==Clinical Features==
[[File:Corkscrew hair.png|thumb|Corkscrew hair in a patient with scurvy.]] 
[[File:Petechiae.png|thumb|Petechiae in a patient with scurvy.]]
[[File: Scruvy_-_Easy_bruising.png |thumb|Bruising in a patient with scurvy.]]
[[File: Gingival_bleeding.png |thumb|Gingival bleeding in a patient with scurvy.]]
*[[Gingival bleeding]]
*Easy bruising
*[[Petechiae]]
*Corkscrew hair
*Perifollicular hemmorrhage
*Weakness, fatigue, and muscle cramping
**Vitamin C is cofactor for enzymes involved in biosynthesis of carnitine, which is essential for release of energy via transport of fatty acids into mitochondria<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>
*Mood disturbance, cognitive impairment, delusions and depression<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>
**Vitamin C is a modulator of neurotransmitter synthesis and release (e.g. Dopamine)<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>
*Anemia
**Vit C promotes intestinal absorption of Iron and prevents oxidative damage to the red-cell cytoskeleton<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>

==Differential Diagnosis==
{{Purpura DDX}}

{{Dental Problems DDX}}

{{Vitamin deficiencies DDX}}

==Evaluation==
*Guided by clinical suspicion but confirmed with laboratory analysis of vitamin C levels.

==Management==
*Vitamin C supplementation.
**1 gram of oral vitamin C daily

==Disposition==
*Depends on the manifestations of vitamin C and their severity  


==External Links==

==References==
#Kluesner, Nicholas and Miller, daniel.  “Scurvy: Malnourishment in the land of the plenty.” The journal of emergency medicine. Vol 46. no 4.  pages 530-532. 2014.
#Maltos, andre, et al.  “Scurvy in a patient with AIDS: case report.”  Revista de sociedade brasileira de medicina tropical 44(1): 122-123. 2011.

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[[Category:Dermatology]]
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