Treatment of Riboflavin-Deficiency Glossitis
For riboflavin-deficiency glossitis, oral riboflavin supplementation at 5-10 mg/day should be administered until clinical recovery is achieved. 1
Oral Riboflavin Supplementation Protocol
The primary treatment involves oral riboflavin replacement therapy:
- Standard dosing: Administer riboflavin 5-10 mg/day orally until complete resolution of glossitis and other oral-buccal lesions 1
- Severe deficiency: In cases of severe clinical riboflavin deficiency with extensive oral manifestations, IV administration of 160 mg riboflavin for 4 days may be necessary, which has demonstrated clinical cure within 10 days 1
- Route selection: Oral administration is generally well-absorbed and effective for most cases, though IV route should be considered when oral absorption is compromised or symptoms are severe 1
Clinical Response and Monitoring
Expected treatment outcomes:
- Prompt resolution: Mucocutaneous lesions, including glossitis, resolve quickly after therapeutic doses of riboflavin are administered, which confirms the diagnosis 2
- Treatment duration: Continue supplementation until complete clinical recovery of the glossitis is achieved 1
- Characteristic glossitis pattern: Chronic riboflavin deficiency produces a characteristic glossitis pattern that responds specifically to riboflavin replacement 2
Critical Management Considerations
Important clinical pitfalls to avoid:
- Multiple deficiencies: Riboflavin deficiency is frequently associated with pyridoxine, folate, and niacin deficiencies with their associated symptoms 1
- Comprehensive evaluation: While glossitis is a relatively early manifestation of riboflavin or pyridoxine deficiency (or both), consider screening for multiple B-vitamin deficiencies before initiating treatment 3
- Concomitant supplementation: In patients with confirmed multiple deficiencies, provide B-complex vitamins containing adequate riboflavin (at least 4 mg) along with other deficient vitamins 3
Adjunctive Considerations
Additional management strategies:
- Dietary counseling: Educate patients on riboflavin-rich food sources including enriched grains, cereals, meats, dairy products, fatty fish, eggs, and dark-green vegetables 1
- Address underlying causes: Identify and manage conditions predisposing to riboflavin deficiency, including malabsorption syndromes, alcoholism, thyroid dysfunction, diabetes, and renal disease 1
- Maintenance therapy: After acute treatment, ensure adequate daily riboflavin intake (RDA: 1.3 mg for males, 1.1 mg for females) to prevent recurrence 1