## Vitamin C Deficiency (Scurvy) in Children **Key Point:** Vitamin C (ascorbic acid) is essential for collagen synthesis and cross-linking. Its deficiency leads to defective collagen formation, resulting in characteristic clinical features. ### Clinical Features of Vitamin C Deficiency | Feature | Mechanism | |---------|----------| | Bleeding gums, loose teeth | Defective gingival collagen | | Perifollicular hemorrhages | Fragile blood vessels around hair follicles | | Poor wound healing | Impaired collagen deposition | | Anemia | Iron malabsorption + chronic bleeding | | Bone pain, swelling | Subperiosteal hemorrhages | | Follicular hyperkeratosis | Abnormal keratin formation | **High-Yield:** The pathognomonic sign is **perifollicular hemorrhages with a "corkscrew" appearance of hair** — this is virtually diagnostic of scurvy. **Clinical Pearl:** Vitamin C deficiency is rare in developed countries but still seen in malnourished children, those on exclusive boiled milk diets, or with severe malabsorption. In India, it may occur in children with very restricted diets lacking fresh fruits and vegetables. ### Why Vitamin C? Vitamin C is a cofactor for prolyl and lysyl hydroxylase enzymes, which stabilize and cross-link collagen triple helices. Without adequate vitamin C, collagen is synthesized but remains unstable and non-functional.
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