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Riboflavin Deficiency

(Vitamin B2 Deficiency)

By

Larry E. Johnson

, MD, PhD, University of Arkansas for Medical Sciences

Last full review/revision Nov 2020| Content last modified Nov 2020
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Riboflavin deficiency usually occurs with other B vitamin deficiencies. Symptoms and signs include sore throat, lesions of the lips and mucosa of the mouth, glossitis, conjunctivitis, seborrheic dermatitis, and normochromic-normocytic anemia. Diagnosis is usually clinical. Treatment consists of oral or, if needed, intramuscular riboflavin.

Riboflavin is involved in carbohydrate metabolism as an essential coenzyme in many oxidation-reduction reactions involved in carbohydrate and protein metabolism (see table Sources, Functions, and Effects of Vitamins). Riboflavin is essentially nontoxic.

Dietary sources include milk, cheese, liver, meat, eggs, and enriched cereal products. (See also Overview of Vitamins.)

Etiology

Primary riboflavin deficiency results from inadequate intake of the following:

  • Fortified cereals

  • Milk

  • Other animal products

Secondary riboflavin deficiency is most commonly caused by the following:

Symptoms and Signs

The most common signs of riboflavin deficiency are pallor and maceration of the mucosa at the angles of the mouth (angular stomatitis) and vermilion surfaces of the lips (cheilosis), eventually replaced by superficial linear fissures. The fissures can become infected with Candida albicans, causing grayish white lesions (perlèche). The tongue may appear magenta.

Seborrheic dermatitis develops, usually affecting the nasolabial folds, ears, eyelids, and scrotum or labia majora. These areas become red, scaly, and greasy.

Rarely, neovascularization and keratitis of the cornea occur, causing lacrimation and photophobia.

Diagnosis

  • Therapeutic trial

  • Urinary excretion of riboflavin

The lesions characteristic of riboflavin deficiency are nonspecific. Riboflavin deficiency should be suspected if characteristic signs develop in a patient with other B vitamin deficiencies.

Diagnosis of riboflavin deficiency can be confirmed by a therapeutic trial or laboratory testing, usually by measuring urinary excretion of riboflavin.

Treatment

  • Oral riboflavin and other water-soluble vitamins

Riboflavin 5 to 10 mg orally once a day is given until recovery. Other water-soluble vitamins should also be given.

Key Points

  • Riboflavin deficiency causes various nonspecific skin and mucosal lesions, including maceration of mucosa at the angles of the mouth (angular stomatitis) and surfaces of the lips (cheilosis).

  • Suspect riboflavin deficiency in patients with characteristic symptoms and other B vitamin deficiencies; confirm it with a therapeutic trial of riboflavin supplements or measurement of urinary excretion of riboflavin.

  • Treat with supplement of riboflavin and other water-soluble vitamins.

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