“The four Hs” are the classical manifestations
of scurvy: hemorrhagic signs, hyperkeratosis of hair follicles,
hypochondriasis, and hematologic abnormalities. The earliest sign is usually
petechial hemorrhages, usually in hyperketotic areas such as the anterior
forearms. Next to occur are ecchymoses and purpura, usually at sites of
pressures, trauma, or irritation. Further depletion brings coiled
(corkscrew) and fragmented hair with hyperkeratosis and hemorrhagic
gingivitis. In severe cases, other symptoms include lower extremity edema,
muscle tenderness, conjunctival and ocular hemorrhages, arthralgias,
hemarthroses, gastrointestinal hemorrhage, sicca (dry eye) syndrome, poor wound healing, and
peripheral neuropathy. Generalized symptoms are weakness, fatigue, and
weight loss. Psychological symptoms include hypochondriasis, emotional
lability, depression, and hysteria. Sudden death for unknown reasons has
been reported. Treatment is simple, by replacing body stores of vitamin C by
oral or intravenous route in severe case.