peripheral neuropathy and other signs and symptoms. The glossitis in vitamin B2 deficiency is described as magenta. Vitamin B3 deficiency (pellagra) can cause glossitis. Vitamin B6 deficiency (pyridoxine deficiency) can cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy and seborrheic dermatitis. Folate deficiency (vitamin B9 deficiency) can cause glossitis, along with macrocytic anemia, thrombocytopenia, leukopenia, diarrhea, fatigue and possibly neurological signs. Apart from pernicious anemia discussed above, any other cause of vitamin B12 deficiency can cause glossitis, which tends to be painful, smooth and shiny. Infections Bacterial, viral or fungal infections can cause glossitis. Chronic Candida infections of the tongue can cause an atrophic glossitis known as median rhomboid glossitis. Syphilis is now relatively rare, but the tertiary stage can cause diffuse glossitis and atrophy of lingual papillae, termed "syphilitic glossitis", "luetic glossitis" or "atrophic glossitis of tertiary syphilis". It is caused by Treponema pallidum and is a sexually transmitted infection. Other causes Many conditions can cause glossitis via malnutrition or malabsorption, which creates the nutritional deficiencies described above, although other mechanisms may be involved in some of those conditions listed. Alcoholism Sprue (celiac disease, or tropical sprue), secondary to nutritional deficiencies Crohn’s disease Whipple disease Glucagonoma syndrome Cowden disease Acquired immunodeficiency syndrome (AIDS) Carcinoid syndrome Kwashiorkor amyloidosis Veganism and other specialized diets, without B12 supplementation. Poor hydration and low saliva in the mouth, which allows bacteria to grow more readily Mechanical irritation or injury from burns, rough edges of teeth or dental appliances, or other trauma Tongue piercing Glossitis can be caused by the constant irritation by the ornament and by colonization of Candida albicans in site and on the ornament Exposure to irritants such as tobacco, alcohol, hot foods, or spices Allergic reaction to toothpaste, mouthwash, breath fresheners, dyes in confectionery, plastic in dentures or retainers, or certain blood-pressure medications (ACE inhibitors) Administration of ganglion blockers (e.g., Tubocurarine, Mecamylamine). Oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris Heredity Albuterol (bronchodilator medicine) A painful tongue may be an indication of an underlying serious medical condition and nearly always merits assessment by a physician or dental surgeon. Diagnosis Classification Glossitis could be classified as a group of tongue diseases or gastrointestinal diseases. It may be primary, where there is no underlying cause, or secondary where it is a sign or symptom of another condition. It can be acute or chronic. Generally speaking, there are several clinical patterns of