Treatment of Atrophic Glossitis with Isolated Folic Acid Deficiency (Serum Folic Acid ≤ 6 ng/mL)

Clinical Scenario

This protocol is for patients presenting with atrophic glossitis (AG) in the setting of a confirmed low serum folic acid level — at or below 6 ng/mL — without concurrent vitamin B12 or iron deficiency. Identifying this isolated deficiency pattern is the basis for selecting the appropriate supplementation strategy.

Folic Acid Deficiency in Atrophic Glossitis

Among AG patients, a serum folic acid level ≤ 6 ng/mL defines isolated folic acid deficiency. This sub-group is distinct from those with vitamin B12 or iron deficiency, or from patients without any hematinic deficiency. Correct classification of the deficiency type determines which targeted supplementation is needed.

Serum folic acid ≤ 6 ng/mL — no vitamin B12 deficiency, no iron deficiency

Treatment Approach (Partial Overview)

The regimen for this group involves oral vitamin B complex supplementation together with additional targeted oral folic acid supplementation. The complete formulation, schedule, and duration are specified in the full structured protocol.

Specific dosing, duration, and sequencing are available in the protocol below.

Treatment Goals

Successful management targets an increase in serum folic acid level and blood hemoglobin, a reduction of elevated serum homocysteine, and full resolution of all oral symptoms — including burning sensation of oral mucosa, dry mouth, numbness of the tongue, and dysfunction of taste — over a mean treatment course of 8.3–11.6 months.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jfma.2019.04.015

AG patients with the serum level of vitamin B12 ≤ 450 pg/mL, folic acid ≤6 ng/mL, or iron ≤70 mg/dL for men and ≤ 65 mg/dL for women are defined as having vitamin B12, folic acid or iron deficiency, respectively.

Moreover, our 91 AG patients can be divided into five groups: group I, patients with vitamin B12 deficiency only (n = 39); group II, patients with folic acid deficiency only (n = 10); group III patients with iron deficiency only (n = 9), group IV, patients with both vitamin B12 and iron deficiencies (n = 19); and group V, patients without definite hematinic deficiencies (n = 14).

In brief, all 91 AG patients are treated with oral administration of vitamin BC capsule. Moreover, groups I, II, and III patients are treated with additional oral folic acid tablet (group II), intramuscular vitamin B12 injection (group I), and oral iron tablet (group III), respectively.

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