Skin Diseases

Skin Diseases

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Scurvy is a condition characterized by general weakness, anaemia, gingivitis (gum disease), and skin haemorrhages caused by a prolonged deficiency of vitamin C (ascorbic acid) in the diet. Vitamin C plays a crucial role in the formation of collagen, a major component of connective tissue. Connective tissue has structural and supportive functions which are indispensable to blood vessels and all tissues within the body. Vitamin C is also important in the proper functioning of the immune system, iron absorption, cholesterol metabolism and other biological activities. Thus scurvy has widespread effects.

Scurvy was often seen in sailors on long ocean voyages described from the 15th century onwards. Many men died from the disease until it was discovered that scurvy could be effectively cured and prevented by consuming vitamin C through lemons, oranges and limes. The nickname for British sailors of ‘limey' derives from the practice of giving British sailors limes.

It is thought that scurvy occurs very rarely in modern societies of today as most people have access to year-round fresh fruits and vegetables which are rich sources of vitamin C. However, several groups of people are at risk. These include:

1. People with chronic malnutrition or those that eat less than 2 servings of fruits/vegetables per day

- Alcoholics
- Elderly
- Men who live alone (bachelor or widower scurvy)
- Children
- People on peculiar diets or food fads
- Psychiatric disease (delusions or fear of food, suicide attempt by self-starvation, eating disorders)

2. People with other medical conditions that may prevent the intake and/or absorption of vitamin C

- Dialysis patients
- Inflammatory bowel disease (Crohns Disease)
- Malabsorption disorders
- Severe dyspepsia

3. Under-developed third world countries where general malnutrition exists. Also, in populations that subsist mainly on cereal grains and without access to fresh fruit or vegetables.

The diagnosis of scurvy is primarily a clinical one, based on a dietary history of inadequate vitamin C intake and the signs and symptoms described below.

Symptoms of scurvy generally develop after at least 3 months of severe or total vitamin C deficiency. Patients initially complain of weakness, fatigue, listlessness and aching limbs, especially in the legs. If left untreated, scurvy can progress to the following more severe problems.

Skin problems - one of the first signs of scurvy is the development of perifollicular hyperkeratotic papules, often on the shins. These appear as reddish/bluish bruise-like spots surrounding hair follicles. The central hairs are twisted like corkscrews that may break easily. The papules may join together to form large areas of palpable purpura or ecchymoses (bruises).

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