An elderly man presents with large spots of bleeding on the skin, perifollicular hemorrhages, and receding gums. Which oral supplement is most appropriate?

An elderly man presents with large spots of bleeding on the skin, perifollicular hemorrhages, and receding gums. Which oral supplement is most appropriate?

• A. Ascorbic acid
• B. Vitamin D
• C. Vitamin A
• D. Niacin

Answer: (A)

This presentation is classic for scurvy due to vitamin C deficiency, which disrupts collagen synthesis and weakens connective tissues. Vitamin C acts as a cofactor for the enzymes that hydroxylate proline and lysine in collagen, a step essential for stable, cross-linked collagen. When this process is impaired, blood vessels become fragile, leading to bleeding in the skin (including perifollicular hemorrhages) and gum recession. Replenishing vitamin C with an oral ascorbic acid supplement directly corrects the underlying deficiency, restores collagen formation, and improves vascular and gum integrity as stores are rebuilt. The other vitamins don’t address this collagen-related defect: vitamin D supports bones, vitamin A deficiency causes skin and ocular issues but not perifollicular bleeding, and niacin deficiency causes pellagra with dermatitis, diarrhea, and dementia.

This presentation is classic for scurvy due to vitamin C deficiency, which disrupts collagen synthesis and weakens connective tissues. Vitamin C acts as a cofactor for the enzymes that hydroxylate proline and lysine in collagen, a step essential for stable, cross-linked collagen. When this process is impaired, blood vessels become fragile, leading to bleeding in the skin (including perifollicular hemorrhages) and gum recession. Replenishing vitamin C with an oral ascorbic acid supplement directly corrects the underlying deficiency, restores collagen formation, and improves vascular and gum integrity as stores are rebuilt. The other vitamins don’t address this collagen-related defect: vitamin D supports bones, vitamin A deficiency causes skin and ocular issues but not perifollicular bleeding, and niacin deficiency causes pellagra with dermatitis, diarrhea, and dementia.