31 August 2026Chapter 3: Gastrointestinal disordersPDF page 129
Nutritional mouth lesions and scurvy stomatitis
Full paraphrased clinical guide to scurvy-related stomatitis, other vitamin-related mouth lesions, iron deficiency, and treatment principles.
This guide supports clinical education and care navigation. It does not replace bedside judgement, emergency care, specialist advice, or local treatment protocol.
Seek urgent care
- Bleeding gums with severe weakness, anaemia signs, poor feeding, dehydration, or extensive nutritional deficiency.
- Infant with gum bleeding and lower-limb pain or suspected subperiosteal haemorrhage.
- Mouth lesions with severe malnutrition, food insecurity, or dependence on food aid.
Scurvy stomatitis
Vitamin C deficiency can cause stomatitis with bleeding gums.
In infants, bleeding gums may be associated with lower-limb pain due to subperiosteal haemorrhage.
- Scurvy is more likely where food quality is poor or people depend completely on food aid.
- Assess for bruising, limb pain, anaemia, poor wound healing, food insecurity, severe malnutrition, and other micronutrient deficiencies.
| Patient | Dose direction |
|---|---|
| Children 1 month to 11 years, option 1 | Ascorbic acid 100 mg three times daily. |
| Children 12 years and over and adults, option 1 | Ascorbic acid 250 mg three times daily. |
| Children 1 month to 3 years, option 2 | Ascorbic acid 100 mg twice daily. |
| Children 4 to 11 years, option 2 | Ascorbic acid 250 mg twice daily. |
| Children 12 years and over and adults, option 2 | Ascorbic acid 500 mg twice daily. |
| Duration | Treat for at least 2 weeks or until symptoms resolve, then give preventive treatment 50 mg daily for children and adults while risk continues. |
Other nutritional mouth lesions
- Riboflavin deficiency can cause angular stomatitis.
- Niacin deficiency can cause mouth lesions and should prompt consideration of pellagra.
- Pyridoxine deficiency can cause glossitis or stomatitis.
- Iron deficiency can also cause angular stomatitis and should be assessed with anaemia risk.
Treatment principles
- Give the corresponding vitamin or nutrient at curative doses; multivitamins are not enough for true deficiency states.
- Assess nutrition, food access, anaemia, severe acute malnutrition, pregnancy, and other deficiency signs.
- Support hydration and feeding while mouth pain or bleeding is active.
- Correct the underlying food-access or dietary-quality problem where possible; otherwise recurrence is likely.
- Refer or manage urgently when severe malnutrition, severe anaemia, dehydration, inability to feed, or systemic illness is present.
- Handover should include dietary context, food-aid dependence, age, pregnancy status, lesion pattern, gum bleeding, limb pain, anaemia findings, hydration/feeding status, suspected deficiency, supplement dose, and prevention plan.
Medicines in this guide
Ascorbic acid = Vitamin C oralCurative and preventive treatment for scurvy.Nicotinamide = Vitamin PP = Vitamin B3 oralRelevant when niacin deficiency or pellagra is suspected.Pyridoxine = Vitamin B6 oralRelevant when pyridoxine deficiency contributes to glossitis or stomatitis.Ferrous salts oralTreatment pathway when iron deficiency contributes to angular stomatitis or anaemia.Ferrous salts/Folic acid oralAlternative iron/folate pathway in selected anaemia prevention or treatment contexts.Oral rehydration salts = ORSFluid support if mouth pain or systemic illness reduces intake.
Source
MSF Clinical guidelines - Diagnosis and treatment manual (December 2024)
This page is a paraphrased clinician-oriented guide derived from the source topic on PDF page 129. Medicine-specific details should be checked against local protocol and the linked drug-information pages.