Which vitamin deficiency in children classically presents with bleeding gums, poor wound healing, and perifollicular hemorrhages?

Explanation

## Vitamin C Deficiency (Scurvy) in Children **Key Point:** Vitamin C (ascorbic acid) is essential for collagen synthesis and cross-linking. Its deficiency impairs connective tissue formation, leading to characteristic clinical manifestations. ### Clinical Features of Vitamin C Deficiency | Feature | Mechanism | | --- | --- | | Bleeding gums | Defective collagen in gingival tissue; poor wound healing | | Perifollicular hemorrhages | Fragile blood vessels around hair follicles | | Poor wound healing | Impaired collagen synthesis and cross-linking | | Anemia | Associated iron malabsorption; bleeding losses | | Bone pain | Subperiosteal hemorrhages; defective osteoid formation | | Follicular hyperkeratosis | Keratosis around hair follicles ("corkscrew" hairs) | **High-Yield:** Perifollicular hemorrhages with "corkscrew" hairs are **pathognomonic** for vitamin C deficiency in children. ### Biochemical Role Vitamin C acts as a cofactor for: 1. Prolyl and lysyl hydroxylase (collagen stabilization) 2. Tyrosine hydroxylase (catecholamine synthesis) 3. Carnitine synthesis **Clinical Pearl:** In Indian pediatric practice, vitamin C deficiency is most commonly seen in children with exclusive cow's milk feeding (unfortified) or severely restricted diets lacking fresh fruits and vegetables. **Mnemonic:** **SCURVY** = **S**ubperiosteal hemorrhages, **C**ollagen defect, **U**nhealed wounds, **R**ed/bleeding gums, **V**itamin C lack, **Y**ellow (anemia).