Hunter glossitis is characterized by a change in the tongue caused by a deficiency of vitamin B12. In most cases, it is merely a symptom of an underlying disease. Its treatment is carried out as part of the therapy of the underlying disease.
What is hunter’s glossitis?
Hunter’s glossitis belongs to the large field of diseases of the tongue body, which is covered by the collective term glossitis. It is characterized by a burning, slippery, and lacquer-red tongue. It is merely a symptom of another underlying disease. This symptom is also known as Möller-Hunter glossitis or Möller glossitis. Originally, Hunter’s glossitis was mentioned only in connection with the so-called pernicious anemia. Here, it represents only an accompanying symptom. Today, however, this term is used more generally to describe various diseases such as iron deficiency anemia, avitaminoses, folic acid deficiency, beriberi, or other systemic diseases. In all of these diseases, a deficiency of vitamin B12 leads to the typical features of Hunter’s glossitis. The disease was first described in 1851 by Julius Otto Ludwig Möller, a German surgeon. Independently, there is a description by the Scottish physician William Hunter in 1900.
Causes
The actual cause of Hunter’s glossitis is vitamin B12 deficiency. Vitamin B12 performs important functions in the body. For example, it plays a prominent role in cell growth, blood formation, cell maturation, and the overall metabolism of amino acids, fats, and carbohydrates. However, a vitamin B12 deficiency can in turn have several causes. It should be noted that this vitamin is stored in the liver, with a direct deficiency becoming noticeable after about two years at the earliest. Vitamin B12 is found particularly in animal products and there mainly in the liver. Vegans or vegetarians can therefore develop a vitamin B12 deficiency over time. However, there are also diseases that prevent the absorption of vitamin B12 in the intestine. The best-known example is pernicious anemia. Thus, the so-called intrinsic factor ensures the absorption of this vitamin in the intestinal mucosa. In the absence of this factor, the body can no longer absorb vitamin B12. Blood formation and cell division processes are disturbed. Severe anemia occurs, which is also associated with other symptoms such as, among others, a change in the body of the tongue. Intrinsic factor is produced in the duodenum (small intestine) and can fail in gastric and small intestinal diseases. Its destruction is also possible due to autoimmune reactions against intrinsic factor. Other causes of vitamin B12 absorption disorders are malabsorption in celiac disease, alcoholism, bacterial colonization of the colon, fish tapeworm. Also an increased need for vitamin B12, genetic preconditions, increased formation of nitric oxide or displacement by chemically analogous drugs are possible triggers. Latent vitamin B12 deficiency can also occur during pregnancy. In all of these conditions, the development of Hunter glossitis, among others, is possible in this process.
Symptoms, complaints, and signs
Hunter glossitis is characterized by a severe burning sensation in the mouth and especially on the tongue. The tongue appears red, slippery, and varnish-like, especially at the tip or back of the tongue. Speaking and chewing are very difficult. The tongue mucosa contracts due to delayed cell division processes. This feature is also called atrophy of the tongue mucosa. Glossitis does not occur in isolation, however, but is an accompanying symptom of an underlying disease. However, it is also possible that this symptom dominates over all other disease symptoms and is therefore perceived as a single symptom. Compared to other forms of glossitis, Hunter glossitis can be well demarcated. There is an absence of blisters, aphthae, or whitish tongue coatings, among others.
Diagnosis and course of the disease
Diagnosis is always based on the typical features and in the context of the possible underlying diseases.Differentially, Hunter’s glossitis must be distinguished from bacterial and viral infections, mechanical interference by teeth or dentures, toxic influences by alcohol or nicotine, the so-called raspberry tongue in scarlet fever, or other diseases.
When should you see a doctor?
When the characteristic burning sensation in the mouth develops, a doctor should be consulted. Other signs of Hunter’s glossitis that require evaluation include speech problems and a red, varnish-like tip of the tongue. In addition, there is atrophy of the tongue mucosa, sometimes associated with a rash in the mouth. Accompanying this, the causative vitamin B12 deficiency can cause further symptoms. Typical symptoms are fatigue and exhaustion, dizziness and a general decrease in mental and physical performance. If these signs occur, the family doctor must be consulted immediately. People suffering from a vitamin B12 deficiency due to malnutrition are particularly susceptible to Hunter’s glossitis. Vegetarians and vegans should pay particularly close attention to any symptoms and complaints and, if in doubt, speak to a specialist. The same is true for people who suffer from chronic diarrhea or another chronic condition that may cause a vitamin B12 deficiency. If symptoms are severe, a hospital visit is indicated. Sufferers should also talk to their family doctor and a specialist in internal medicine and have the cause of Hunter’s glossitis clarified beyond doubt.
Treatment and therapy
Treatment of Hunter’s glossitis depends on the underlying cause. First, the cause of the vitamin B12 deficiency must be found. If this is nutritional, vitamin B12 can be easily supplied via dietary supplementation. Intramuscular injection several times a year is also possible. The symptoms of Hunter’s glossitis disappear quickly in these cases. However, it becomes more difficult if the vitamin B12 deficiency is due to resorption. This can be tested by the so-called shilling test, in which radioactively labeled vitamin B12 is administered and its excretion amount is examined via the urine. Since absorption disorders are caused by a variety of factors, the underlying disease must be identified and treated. Increasing the oral dose to 1000 times the normal intake has also proven effective. Thus, instead of microgram quantities, milligram quantities, among others, can be administered to avoid permanent injection. However, it is always important to administer vitamin B12 together with folic acid.
Outlook and prognosis
Hunter glossitis represents a sequela of an existing health impairment and is not a disease in its own right. Therefore, the prognosis is dependent on the curability of the causative disease. The trigger of the change in the tongue is a deficiency of B12. If this is caused by an alcohol disorder, the severity of the addiction and the patient’s willingness to cooperate must be considered for a prognosis. If the individual manages to beat the alcohol addiction, there is a good chance for relief of Hunter glossitis. In case of relapse to alcohol consumption, the change of the tongue body occurs again. In addition, the risk of premature death increases because the organism is weakened as a whole and organ damage occurs. If the vitamin deficiency is caused by another liver disease, the curability of the organ damage is also decisive for an improvement of health. In some cases, only a liver transplant can lead to a change. The surgical procedure is risky. In addition, the donor organ must be accepted by the organism. If the treatment is successful, there is a good chance of relief from Hunter glossitis. Lifelong health monitoring is necessary, so that by monitoring physical functions and blood values, it is possible to react as quickly as possible in case of abnormalities. A change in previous lifestyle must also be expected.
Prevention
Because Hunter glossitis is due to a deficiency of vitamin B12, prevention concerns all measures that prevent this vitamin B12 deficiency. Adequate vitamin B12 should be provided through a balanced diet. Also, to prevent the diseases that can cause Hunter glossitis, it is important to maintain a healthy lifestyle and avoid alcohol and smoking.Genetically determined absorption disorders can be compensated for by dietary adaptation. Thus, in the case of celiac disease, only gluten-free foods may be consumed.
Follow-up
After Hunter’s glositis has been treated causally and symptomatically, there are usually no further complaints. Typical symptoms such as burning and stinging in the area of the tongue and the characteristic itching on the tip of the tongue subside within a few days. Follow-up care includes a final progress check by the responsible physician. The physician will perform a physical examination. As part of a medical history, he will ask the patient about any complications and the general course of the disease. Finally, a mild painkiller such as aspirin may be prescribed if there is still a slight burning or pulling sensation. If the course is positive, there is no need for further visits to the doctor. However, the patient should be alert to any warning signs from the body and inform the doctor. Further follow-up measures focus on cooling the tongue for a few more days and maintaining dietary changes. Spicy or other, especially irritating foods, should be avoided initially after Hunter’s glossitis. Gentle foods and chamomile or lemon balm tea are better. Homeopathic remedies such as sage extracts or aloe vera can be used to eliminate itching. If the atrophy is based on a serious disease, the necessary aftercare measures must be discussed with the specialist after recovery.
What you can do yourself
The measures Hunter glossitis patients can take themselves depend on the cause of the symptoms. If there is an underlying nutritional deficiency of vitamin B12, the B vitamin can usually be supplied by changing the diet. In severe cases, dietary measures must be supported by dietary supplements or intramuscular injection. If the vitamin B12 deficiency is due to a serious illness, this must first be determined. The affected person can support the medical diagnosis by keeping a complaints diary and recording any symptoms and abnormalities in it. For most causes, medical treatment is indicated, which can be supported by the affected person through rest and bed rest. After the underlying condition has been treated, Hunter glossitis usually recedes. A prerequisite for a longer-lasting healing success is a change in the lifestyle habits that triggered the underlying disease. In general, a healthy lifestyle is recommended. Hunter glossitis patients should exercise regularly, avoid stress and, if possible, abstain from stimulants such as alcohol and cigarettes. Regular check-ups are also recommended. In this way, a recurrence of the disease can be detected early and treated in a targeted manner.