What vitamin deficiencies are associated with lip lesions and swelling?

Vitamin Deficiencies Associated with Lip Lesions and Swelling

Riboflavin (vitamin B2) deficiency is the primary vitamin deficiency to check when patients present with lip lesions and swelling, as it commonly manifests with cheilosis (cracking at the corners of the mouth), angular stomatitis, and lip inflammation. 1

Key Vitamin Deficiencies to Evaluate

Riboflavin (Vitamin B2)

• Deficiency manifests with oral-buccal lesions including cheilosis (cracking at corners of the mouth), angular stomatitis, and lip inflammation 1
• Additional signs include glossitis (inflammation of the tongue) and seborrheic dermatitis of the face 1
• Riboflavin deficiency often coexists with deficiencies of other B vitamins, including pyridoxine (B6), folate, and niacin, which can compound oral symptoms 1

Vitamin B12

• Deficiency can cause painful erythema of oral mucosa, glossitis, papillary atrophy, burning sensation, and paresthesia 2
• Oral manifestations may occur even in the absence of anemia or macrocytosis 3
• Patients with vitamin B12 deficiency may present with recurrent oral ulcerations and inflammation 3

B-Complex Vitamins (B1, B2, B6)

• Deficiencies in thiamine (B1), riboflavin (B2), and pyridoxine (B6) have been associated with recurrent aphthous ulceration 4
• Approximately 28% of patients with recurrent mouth ulcers show deficiencies in one or more of these vitamins 4
• Replacement therapy in deficient patients has shown significant sustained clinical improvement in mouth ulcers 4

Vitamin C

• Deficiency (scurvy) can present with gingival swelling, bleeding, and mucosal changes 1
• Clinical suspicion of scurvy warrants plasma vitamin C measurement 1
• A trial of vitamin C supplementation (about 1g/day for at least one week) should not be delayed when clinical symptoms are present 1

Risk Factors for Vitamin Deficiencies

• Malabsorption conditions (short bowel syndrome, celiac disease) 1
• Alcoholism 1
• Chronic diseases: thyroid dysfunction, diabetes, renal disease 1
• Medications: psychotropic drugs, tricyclic antidepressants, barbiturates 1
• Pregnancy and lactation 1
• Elderly patients (decreased intake of dairy products and altered absorption) 1
• Patients with anorexia nervosa who avoid dairy products 1
• Inflammatory bowel disease, particularly Crohn's disease with small bowel involvement 1

Diagnostic Approach

• Measure plasma riboflavin levels - erythrocyte glutathione reductase activity test is preferred as it better indicates tissue saturation and long-term status 1
• Check vitamin B12 and folate levels, particularly in patients with glossitis or oral mucosal changes 2, 3
• Consider vitamin C levels in patients with gingival involvement or petechial hemorrhages 1
• Note that inflammation can decrease plasma riboflavin levels by 30-40%, so erythrocyte concentration assays are more reliable in inflammatory conditions 1
• In patients with inflammatory bowel disease, measure vitamin B12 and folate every 3-6 months, especially with small bowel involvement or previous resection 1

Treatment Considerations

• Daily recommended dose of riboflavin: 1.3 mg for males, 1.1 mg for females, and 1.4-1.6 mg during pregnancy and lactation 1
• For patients with chronic malabsorption, higher supplementation doses may be required 1
• In vitamin C deficiency with chronic oxidative stress or malabsorption, a dose of 200-500 mg/day may be provided 1
• For B12 deficiency, oral supplementation is effective in most cases, though parenteral administration may be needed in severe cases or malabsorption 2

Clinical Pearls and Pitfalls

• Riboflavin deficiency is frequently associated with deficiencies of other B vitamins, so comprehensive B vitamin testing is recommended 1
• Oral manifestations of vitamin deficiencies may precede systemic symptoms or hematologic abnormalities 3
• Inflammation can affect plasma vitamin levels, potentially leading to false interpretations 1
• Response to vitamin replacement therapy can be diagnostic - prompt resolution of lesions after therapeutic doses confirms the diagnosis 5
• Vitamin deficiencies should be considered in recurrent aphthous ulceration that is resistant to conventional treatments 4