Rethinking biotin therapy for hair, nail, and skin disorders

Biotin (vitamin B7 or H) is an essential cofactor for mammalian carboxylase enzymes that are involved in important metabolic pathways in humans. 1 Zempleni J. Kuroishi T. Biotin. Adv Nutr. 2012; 3: 213-214 Crossref PubMed Scopus (28) Google Scholar , 2 Said H.M. Biotin: biochemical, physiological and clinical aspects. Subcell Biochem. 2012; 56: 1-19 Crossref PubMed Scopus (69) Google Scholar , 3 Mock D.M. Biotin: from nutrition to therapeutics. J Nutr. 2017; 147: 1487-1492 Crossref PubMed Scopus (48) Google Scholar 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. 4 Daft F.S. Ashburn L.L. Sebrell W.H. Biotin deficiency and other changes in rats given sulfanilylguanidine or succinyl sulfathiazole in purified diets. Science. 1942; 96: 321-322 Crossref PubMed Scopus (3) Google Scholar Biotin deficiency is quite uncommon in humans, and results in similar findings to that seen in rats. 5 Bonjour J.P. Biotin in man's nutrition and therapy–a review. Int J Vitam Nutr Res. 1977; 47: 107-118 PubMed Google Scholar , 6 Swick H.M. Kien C.L. Biotin deficiency with neurologic and cutaneous manifestations but without organic aciduria. J Pediatr. 1983; 103: 265-267 Abstract Full Text PDF PubMed Scopus (20) Google Scholar For the inherited holocarboxylase synthetase and biotinidase deficiencies, biotin supplementation can be life saving. 7 Nyhan W.L. Inborn errors of biotin metabolism. Arch Dermatol. 1987; 123: 1696-1698a Crossref PubMed Google Scholar Biotin supplementation at high doses (300 mg/day) resulted in sustained reversal of multiple sclerosis–related disabilities. 8 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. Mult Scler. 2016; 22: 1719-1731 Crossref PubMed Scopus (210) Google Scholar While there are no established daily allowances for biotin, 9 Higdon J. Drake V.J. An Evidence-Based Approach to Vitamins and Minerals. Health Benefits and Intake Recommendations. 2nd ed. Linus Pauling Institute, editor. Thieme Publishing Group, Stuttgart, Germany2012 Google Scholar the Food and Nutrition Board of the Institute of Medicine recommends 30 mg/day for adults. 10 Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and Its Panel on Folate OBV, and Choline. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. National Academies Press (US), Washington1998 Google Scholar Biotin supplementation is likely unnecessary for most individuals, since estimated biotin intake is 35-70 μg/day with a Western diet. 11 Zempleni J. Mock D.M. Biotin biochemistry and human requirements. J Nutr Biochem. 1999; 10: 128-138 Crossref PubMed Scopus (114) Google Scholar Response to: “Rethinking biotin therapy for hair, nail, and skin disorders”Journal of the American Academy of DermatologyVol. 79Issue 6PreviewTo 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. Full-Text PDF