glossitis

Glossitis results from loss of the filiform papillae on the dorsal tongue surface, leading to a smooth, beefy-red, and often painful tongue. Causes include: Vitamin B12 deficiency (associated with megaloblastic anemia, subacute combined degeneration), folate deficiency, iron deficiency anemia (Plummer-Vinson syndrome: glossitis, esophageal webs, iron deficiency anemia), niacin deficiency (pellagra: dermatitis, diarrhea, dementia, glossitis), riboflavin (B2) deficiency, and pyridoxine (B6) deficiency. It can also occur in Sjögren syndrome, geographic tongue (benign migratory glossitis), infections (e.g., syphilis, candidiasis), and as a side effect of certain medications. Clinically, patients may present with a painful, smooth, red tongue with associated symptoms depending on underlying etiology—such as fatigue and pallor in anemia, or neurological symptoms in B12 deficiency. Diagnosis involves identifying the underlying cause through CBC, vitamin levels, and clinical correlation. Treatment focuses on correcting the underlying deficiency or disease process. High-yield associations for boards: glossitis + megaloblastic anemia = B12/folate deficiency; glossitis + esophageal web + iron deficiency anemia = Plummer-Vinson syndrome; glossitis + dermatitis + diarrhea = pellagra (niacin deficiency, B3).