Treatment of Atrophic Glossitis with Combined Vitamin B12 Deficiency and Iron Deficiency

This protocol covers atrophic glossitis (AG) in patients presenting with concurrent vitamin B12 deficiency and iron deficiency — a dual hematinic deficiency pattern that calls for a specific combined treatment approach distinct from single-deficiency cases.

Clinical Scenario

The patient has serum vitamin B12 ≤ 450 pg/mL (vitamin B12 deficiency) together with serum iron ≤ 70 mg/dL in men or ≤ 65 mg/dL in women (iron deficiency). This combined picture — described as group IV among AG patients in the underlying study — is a well-defined subgroup with its own supplementation strategy.

Treatment Approach (partial overview)

Management for this combined deficiency group involves an oral B-vitamin complex as the foundation, supplemented by additional intramuscular vitamin B12 injections and concurrent oral iron supplementation — addressing both deficiencies simultaneously. The specific agents, doses, and schedule are defined in the full protocol.

Full regimen — dosing, duration, and sequencing — is available via the link below.

Treatment Goals

Increase serum vitamin B12 to replete levels
Increase serum iron to normal range
Raise blood haemoglobin
Reduce elevated serum homocysteine
Resolve oral symptoms: burning sensation of oral mucosa, dry mouth, tongue numbness, and taste dysfunction

Endpoint: disappearance of all oral symptoms after a mean treatment period of 8.3–11.6 months.

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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 (one capsule, twice a day; each capsule contained 10 mg of vitamin B1, 5 mg of vitamin B2, 5 mg of vitamin B6, 5 mg of vitamin B12, 20 mg of calcium pantothenate, 50 mg of nicotinamide, 150 mg of vitamin C, and 60 mg of calcium).

Furthermore, group IV patients are treated with additional intramuscular injection of vitamin B12 and oral administration of iron tablet, and group V patients are treated with vitamin BC capsules only.

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