Rethinking biotin therapy for hair, nail, and skin disorders

Published:February 10, 2018DOI:https://doi.org/10.1016/j.jaad.2018.02.018
      Biotin (vitamin B7 or H) is an essential cofactor for mammalian carboxylase enzymes that are involved in important metabolic pathways in humans.
      • Zempleni J.
      • Kuroishi T.
      Biotin.
      • Said H.M.
      Biotin: biochemical, physiological and clinical aspects.
      • Mock D.M.
      Biotin: from nutrition to therapeutics.
      It is acquired from food sources, including egg yolks, milk, nuts, grains, supplementation, and synthesis by intestinal bacteria. The importance of biotin was first observed when rats without biotin in their diets developed neuromuscular dysfunction, alopecia, and dermatitis.
      • Daft F.S.
      • Ashburn L.L.
      • Sebrell W.H.
      Biotin deficiency and other changes in rats given sulfanilylguanidine or succinyl sulfathiazole in purified diets.
      Biotin deficiency is quite uncommon in humans, and results in similar findings to that seen in rats.
      • Bonjour J.P.
      Biotin in man's nutrition and therapy–a review.
      • Swick H.M.
      • Kien C.L.
      Biotin deficiency with neurologic and cutaneous manifestations but without organic aciduria.
      For the inherited holocarboxylase synthetase and biotinidase deficiencies, biotin supplementation can be life saving.
      • Nyhan W.L.
      Inborn errors of biotin metabolism.
      Biotin supplementation at high doses (300 mg/day) resulted in sustained reversal of multiple sclerosis–related disabilities.
      • Tourbah A.
      • Lebrun-Frenay C.
      • Edan G.
      • et al.
      MD1003 (high-dose biotin) for the treatment of progressive multiple sclerosis: a randomised, double-blind, placebo-controlled study.
      While there are no established daily allowances for biotin,
      • Higdon J.
      • Drake V.J.
      An Evidence-Based Approach to Vitamins and Minerals. Health Benefits and Intake Recommendations. 2nd ed. Linus Pauling Institute, editor.
      the Food and Nutrition Board of the Institute of Medicine recommends 30 mg/day for adults.
      Biotin supplementation is likely unnecessary for most individuals, since estimated biotin intake is 35-70 μg/day with a Western diet.
      • Zempleni J.
      • Mock D.M.
      Biotin biochemistry and human requirements.

      Key words

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      Linked Article

      • Response to: “Rethinking biotin therapy for hair, nail, and skin disorders”
        Journal of the American Academy of DermatologyVol. 79Issue 6
        • In Brief
          To the Editor: We applaud Dr Lipner for her relevant critique and commentary in her recent article, “Rethinking biotin therapy for hair, nail, and skin disorders,” regarding the popularized use and promotion of biotin for improvement in hair and nails by media and physicians alike despite a lack of evidence to support routine use.1 We also recognize the trends of increasing consumer purchasing of biotin and physician recommendation of its use as alarming considering the warnings from the US Food and Drug Administration, as up to 20% of Americans consume some form of biotin, which may not be disclosed to physicians.
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