[Vitamin C deficiency and leg ulcers. A case control study].
Vitamin C is a necessary cofactor for collagen synthesis. A deficiency of vitamin C results in the breakdown of connective tissue in and around the walls of blood vessels. The disease is thus characterized by poor healing of wounds. Chronic leg ulcers are defined as wounds that do not heal.


OBJECTIVE
To investigate whether patients with chronic leg ulcers have vitamin C deficiency.


METHODS
Case control study; vitamin C was assayed in peripheral blood samples of 42 consecutive patients with chronic leg ulcers and in 37 consecutive patients without chronic leg ulcers. Patients without leg ulcers had peripheral vascular disease, or hypertension, or connective disorders. Patients with diabetes, immunodepression (cancer, HIV infection, corticosteroid therapy) and aged under 65 years were excluded. Reference range for plasma vitamin C was above 26 micromol/l (normal levels, group I), hypovitaminosis C as 6-26 micromol/l (group II) and concentrations<6 micromol/l as scurvy (group III).


RESULTS
Mean age was 77.2 years in the ulcers group and 73.8 in the control group (NS), mean weight 73.1 kg in the ulcers group and 67.5 kg in the control group (NS). Smoking was more frequent in the control group (P<0.001). Mean vitamin C levels were lower in the leg ulcers group: 23.9 vs 33.8 micromol/l (P<0.003). Normal levels of vitamin C (group I) were more frequent in the control group: 78.4 vs 50% (P<0.01). Hypovitaminosis C (group II) was more frequent in the leg ulcers group: 23.8 vs 16.2% (P<0.01). Scurvy was more frequent in the leg ulcers group: 26.2 vs 5.4% (P<0.01). C reactive protein levels were higher in the leg ulcers group: 31.8 vs 9.3 mg (P=0.002) and albumin levels were lower in the leg ulcers group: 25 vs 38 g/l (P=0.01) [retrospective data].


CONCLUSIONS
Patients with chronic leg ulcers have lower levels of vitamin C than patients without leg ulcers, although smoking was more frequent in patients without leg ulcers. The question is whether vitamin C deficiency is a cofactor of impaired healing or is a simple marker of poor healing? It would be interesting to conduct a randomized controlled study about treatment of chronic leg ulcers with vitamin C.
Lazareth
I
I
Service de médecine vasculaire, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, Paris 75675 cedex 14, France. ic.lazareth@wanadoo.fr
Hubert
S
S
Michon-Pasturel
U
U
Priollet
P
P
D000368:Aged; D001205:Ascorbic Acid / Q000097:blood*; D001206:Ascorbic Acid Deficiency / Q000097:blood*; D001835:Body Weight; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000453:epidemiology*; D008297:Male; D018579:Patient Selection; D012016:Reference Values
D001205:Ascorbic Acid