Treatment of Glossitis

Diagnostic Evaluation and Treatment

• The American College of Physicians recommends serum iron, vitamin B12, and folic acid levels to guide therapy in patients with glossitis 1

Treatment Based on Etiology

• The Infectious Diseases Society of America recommends nystatin oral suspension (100,000 units/mL, 4-6 mL four times daily for 7-14 days) as first-line topical therapy for infectious glossitis (candidiasis) 2
• The Infectious Diseases Society of America recommends oral fluconazole (100 mg/day for 7-14 days) as systemic therapy for resistant cases of candidal glossitis, which is superior to topical therapy and more effective than ketoconazole 2

Supportive Care Measures

• The American Academy of Oral Medicine recommends applying white soft paraffin ointment to the tongue every 2-4 hours for protection and moisturization, and using benzydamine hydrochloride rinse or spray every 2-4 hours for pain relief 1

Special Populations

• The Infectious Diseases Society of America recommends more aggressive and prolonged antimicrobial therapy for immunocompromised patients with glossitis, and considers suppressive antifungal therapy only if recurrences are frequent or disabling to reduce development of antifungal resistance 2

Treatment Monitoring

• The American College of Physicians recommends reassessing patients with glossitis within 2 weeks to evaluate response to therapy, and reevaluating the diagnosis if no improvement is seen 4