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A Clinical Trial to Investigate the Effect of Cynatine HNS on Hair and Nail Parameters

  • University of British Columbia and Curtin University

Abstract and Figures

Objective. A new, novel product, Cynatine HNS, was evaluated for its effects as a supplement for improving various aspects of hair and nails in a randomized, double-blind, placebo-controlled clinical trial. Methods. A total of 50 females were included and randomized into two groups. The active group (n = 25) received 2 capsules containing Cynatine HNS, comprised of Cynatine brand keratin (500 mg) plus vitamins and minerals, per day, and the placebo group (n = 25) received 2 identical capsules of maltodextrin per day for 90 days. End points for hair loss, hair growth, hair strength, amino acid composition, and hair luster were measured. End points were also measured for nail strength and the appearance of nails. Results. The results show that subjects taking Cynatine HNS showed statistically significant improvements in their hair and nails when compared to placebo. Conclusion. Cynatine HNS is an effective supplement for improving hair and nails in 90 days or less. EudraCT number is 2014-002645-22.
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Clinical Study
A Clinical Trial to Investigate the Effect of Cynatine HNS on
Hair and Nail Parameters
Christina Beer,1Simon Wood,2,3 and Robert H. Veghte4
1CB Food Consulting LLC, 320 Sherman Avenue, Salt Lake City, UT 84115, USA
2Food, Nutrition and Health Program, Faculty of Land and Food Systems, University of British Columbia, 2357 Main Mall,
3School of Public Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
4Roxlor Global LLC, 1013 Centre Road, Suite 106, Wilmington, DE 19805, USA
Correspondence should be addressed to Robert H. Veghte;
Received  May ; Accepted  September ; Published  October 
Academic Editor: Dagrun Engeset
Copyright ©  Christina Beer et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective. A new, novel product, Cynatine HNS, was evaluated for its eects as a supplement for improving various aspects of
hair and nails in a randomized, double-blind, placebo-controlled clinical trial. Methods. A total of  females were included and
randomized into two groups. e active group (𝑛=25) received  capsules containing Cynatine HNS, comprised of Cynatine brand
keratin ( mg) plus vitamins and minerals, per day, and the placebo group (𝑛=25) received  identical capsules of maltodextrin
per day for  days. End points for hair loss, hair growth, hair strength, amino acid composition, and hair luster were measured.
Endpointswerealsomeasuredfornailstrengthandtheappearanceofnails.Results. e results show that subjects taking Cynatine
HNS showed statistically signicant improvements in their hair and nails when compared to placebo. Conclusion. Cynatine HNS
is an eective supplement for improving hair and nails in  days or less. EudraCT number is --.
1. Introduction
In recent years, the dietary supplement use has increased both
in Europe and in the USA with manyphysicians recommend-
ing their use [,].Asurveyofhealthprofessionalsconducted
in  found that % of dermatologists (𝑛 = 300)recom-
mended dietary supplements to patients in relation to skin,
hair, and nail health and % of them personally used sup-
plements []. e use of bioactive ingredients at concentrated
doses found in dietary supplements can eciently modulate
the physiological processes better than the single ingredients
in foods since heat or mechanical treatment of food before
eating can enhance or reduce its bioavailability or activity
[,]. e benets of food constituents may therefore dier
formulations. In the case of nails and hairs the classical
route of treatment is the use of topical application as well
as shampoos. Nowadays, another means to improve nails
and hairs is through oral administration (food and dietary
supplements). e advantage of the oral administration route
is that blood delivers nutraceutical bioactive compounds
continuously to all compartments of hairs and nails.
Dierent studies on dietary supplements are arising in
the scientic literature conrming the ecacy of dietary
supplementation on maintaining and improving skin, hairs,
and nails conditions. In , Jacquet et al. []reportedthe
ecacy of a dietary supplement containing  mg Shark
Cartilage, . mg vitamin B2,mgvitaminB
8, and  mg sh oil (omega  PUFA)
on skin, hairs, and nails in two open clinical trials (total
of  women). During  days of this trial the product
caused improvement in skin hydration, decrease of wrinkle
depth/volume, a signicant decrease of hair loss, and an
improvement of nail conditions. Authors concluded that the
product was eective in improving many signs of aging, such
as skin appearance, nails, and hair. Other studies demonstrate
the ecacy of oral minerals (i.e., zinc and iron) [], B-
vitamins [,,], and L-cystine [,] on hairs and nails.
Some of these studies demonstrate that oral supplementation
can have a positive eect on hairs or nails while some others
Hindawi Publishing Corporation
e Scientific World Journal
Volume 2014, Article ID 641723, 6 pages
e Scientic World Journal
demonstrate that the lack of nutrient intakes with the diet
has a detrimental role on hairs and nail conditions. However,
some studies lack the dose-relationship eect, employed
methods are not reliable or standardized, and the study design
sometimes does not take the placebo group into account.
Cynatine HNS contains a protein called keratin, in a
peptide form obtained by proprietary processing of New
Zealand sheep wool. is novel ingredient is stable over a
wide range of pH and under conditions of elevated tem-
perature. Keratin protein is one of nature’s richest sources
of cysteine. Based on this, we hypothesized that Cynatine
defense, boosting glutathione and other sulfur rich proteins
and peptides. Keratin is the protein from which the majority
of hair and nails are made. In vitro studies have shown
that Cynatine HNS is highly bioavailable making it capable
of delivering keratin peptides to the body, particularly to
blind, placebo-controlled study was conducted to examine
the ability of Cynatine HNS to improve end points for hair
loss, hair growth, hair strength, amino acid composition, and
appearance of nails.
2. Material and Methods
is study was a single-center, randomized, parallel group,
double-blind, placebo-controlled -day intervention study
in  subjects with signs of damaged hair and nails conducted
at a single site in Italy (Farcoderm, University of Pavia).
is clinical research study was done in accordance with
the ethical principles for medical research involving human
subjects (Helsinki Declaration, revised in ) and was
approved by the internal ethical committee (Rif. --SB).
Informed consent documents were signed by all participants
aer study details were explained and each participant was
evaluated for inclusion and exclusion criteria evaluated by
dermatologists in the screening phase. Inclusion criteria for
the study included being female and being between  and
 years old, Caucasian, clinical signs of stressed or damaged
hair, and an agreement not to use other possible cosmetic
treatments which could interfere with the study. Exclusion
criteria included subjects who did not t the inclusion
criteria, pregnant or breastfeeding women, use of a similar
product to the active, and metabolism disorders. Once the
inclusion criteria were met and consent forms were received,
a screening number was assigned and entered into a screening
and enrollment log. A randomization number was then given
to each subject and a nonblinded employee provided the
blinded examiner with the correct product at the beginning
of each treatment period.
Once subjects were enrolled in the study they were
the cosmetic habits for evaluation of product eects on hair
as well as instructions. ey were asked to use the base
shampoo for ve days and to return for their baseline visit
(Day ). At baseline, the dermatologist rechecked compliance
of subjects to the protocol, evaluated baseline value for
endpoints to be measured, hair (pull test, anagen/telogen
evaluation, amino acid composition, mechanical properties,
and appearance) and nails (clinical evaluation for nail status
and breakage tendency), and supplied subjects with either
active or placebo capsules and other information needed.
A daily diary was also maintained in order to evaluate the
At the end of the study period a questionnaire was lled
out regarding the participants’ personal opinion about the
treatment (tolerability, acceptability, and ecacy). Subjects
nails measured at , , and  days.
e investigational product Cynatine HNS and placebo,
provided by Roxlor Global, LLC, were given to the subjects
as capsules packaged in blister packages. All Cynatine HNS
capsules contained  mg Cynatine (keratin), . mg zinc,
. mg vit amin B3, . mg copper, . mg vitamin B5,
. mg vitamin B6,and.mgvitaminB
8(Biotin) on
an active dose basis. Each placebo capsule, identical in
size, shape, and color, contained the inactive ingredients
maltodextrin  mg and magnesium stearate . mg. On
the morning aer breakfast.
All subjects known to have started treatment and who
returned to the clinic for at least one follow-up visit were
included in the analyses. e Cynatine HNS group had one
withdrawal aer Day  giving an 𝑁value of  for Day
 and  for Days  and . e placebo group had one
withdrawal aer Day  giving an 𝑁value of  for Days 
using Student’s 𝑡-test and intergroup values were determined
using Mann Whitney 𝑈Tes t .
e eects of both the active and placebo groups were
measured on hair using ve separate tests. ese tests were a
pull test, an anagen/telogen evaluation of the hair, the amino
acid composition of the hair, the tensile strength of the hair,
and the clinically evaluated appearance of the hair.
e pull test helps evaluate diuse scalp hair loss. Gentle
traction was exerted on a bunch of hairs (about ) in three
areas of the scalp (frontal, temporal, and occipital) and the
number of extracted hairs was counted. e dermatologist
and pulls them gently. In anagen phase, growing hair should
remain rooted in place while hair in the telogen phase should
pull test is positive and suggestive of telogen euvium. e
subjects were asked to refrain from washing their hair -
days before the pull test.
Anagen/telogen testing is performed by choosing a tar-
geted area (mid-vertex) of approximately . cm2for clipping
hair, which was dyed for gray and fair colored hair. Close-up
digital photographs were immediately taken aer shaving and
 days later. e two photographs were compared by soware
composition of the hair, hair samples were hydrolyzed in  M
HCl aqueous solution. Amino acids were then separated by
reverse-phase liquid chromatography and identied in an X-
LC uorimeter (model FP). e amino acids measured
e Scientic World Journal
for this test are serine, glutamic acid, cystine, and methionine.
e breakage force of a single hair ber was evaluated by a
dynamometer (Tensolab A, Mesdan Lab). An average of
 readings is reported.
e hair appearance is evaluated by a licensed derma-
tologist who assigns a value of one to three based upon the
subject’s hair brightness and luster. A score of  is dull and
devoid of brightness, a score of  is basically dull and not so
bright, and a score of  is shiny and bright.
e nail appearance and tendency to break were eval-
uated by a licensed dermatologist. e appearance of the
nails is recorded in  either/or categories. ese cate-
gories are Hard/So, Resistant/Fragile, Broken/Not Broken,
Rough/Smooth, and Yellowish/White. e nails tendency to
break is evaluated on Day  with a score of one to three. A
a tendency to break, a score of  means nails are moderately
aked, broken, and a score of  indicates that neither nails
are aked, broken nor do they have a tendency to break. At
Days , , and , the nails tendency to break is measured
via a four-point scale. A score of  is no improvement, 
is slight improvement,  is moderate improvement, and 
is remarkable improvement. For the nail tendency to break
measures, a subject with a score of  initially is not included
in the analysis as there is no room for improvement. Eight
subjects on Cynatine HNS had scores of , which lowers the
respective 𝑁values by eight for each measure. Placebo had
 subjects with initial scores of , lowering the respective 𝑁
values by  for this calculation.
enough to detect variation of the measured parameter a post
hoc power analysis was performed. e output of the power
analysis clearly indicated that the sample sizes were large
enough (power of at least %) to detect the dierences
obtained before and aer treatment.
3. Results
3.1. Hair Measurement Results
Hair Pull Test.esubjectsintheplacebogroupshowedno
change in number of hairs lost during the study time points
 and  days. However, at the end of the study period
there was a signicant improvement compared to baseline
(𝑃 < 0.01). Subjects on Cynatine HNS showed a statistically
signicant improvement in reducing hair loss throughout
the test period. A statistically signicant improvement was
already seen within the Cynatine HNS group at Day  (𝑃<
0.001) with a .% improvement. is further improved
within the Cynatine HNS group at Day  (.%, 𝑃 < 0.001)
and Day  (.%, 𝑃 < 0.001). e Cynatine HNS group was
trending towards signicance at Day  (𝑃 = 0.07)andwas
statisticallysignicantatDaysand(𝑃 < 0.001 for both)
when compared to placebo. Overall, Cynatine HNS showed
a .% reduction in hair loss over placebo at Day  and a
.% and .% reduction at Days  and , respectively.
Figure  showstheresultsforbothgroupsoverthe-day
time period.
Mean reduction in hair pull test (%)
Day 30 Day 60 Day 90
F : Mean percent reduction in hair pull test from baseline for
placebo and Cynatine HNS. ∗∗𝑃 < 0.01 and ∗∗∗𝑃 < 0.001 within
group to baseline; 𝑃 < 0.001 between groups to baseline.
Anagen/Telogen Test.esubjectsintheplacebogroup
showed no change in either anagen (growth phase) or telogen
(nongrowth phase) phase of the hair cycle aer  days.
Subjects on Cynatine HNS showed statistically signicant
improvement in their anagen/telogen ratio. Both the telogen
and anagen phases improved at Day  by .% (𝑃 < 0.001)
compared to baseline. is was also a statistically signicant
period (𝑃 < 0.001).
Amino Acid Prole.Subjectstakingplaceboshowedno
improvement in the amino acid ratio of serine, glutamic acid,
cystine, and methionine. At the end of the test period at
 days the subjects on the active Cynatine HNS treatment
showed a statistically signicant increase in all  amino acids
based on their ratio to total protein content. At Day ,
the mean percent increase of serine was .% (𝑃 < 0.001),
glutamic acid .% (𝑃 < 0.001), cystine .% (𝑃 < 0.001),
and methionine .% (𝑃 < 0.001)comparedtobaseline.At
Day  these concentrations were all signicantly dierent to
placebo (𝑃 < 0.001). e increase of the amino acid ratio,
especially of cystine which is a main component of Cynatine,
also shows the bioavailability of Cynatine in the body. Figure
shows the results for both groups at baseline and Day .
Hair Tensile Strength.Subjectsonplaceboshowednostatisti-
cal improvement in their hair strength at the end of the test
a .% improvement in hair strength at Day  (𝑃 < 0.001)
compared to baseline as well as a statistically signicant
percent change to placebo at the end of the test period (𝑃<
Hair Appearance. Both groups in this test started with a
mean score of 1.70 ± 0.5.Subjectsonplaceboshowedno
of . (𝑃 < 0.01) at Day  and no further improvement
showed a statistically signicant improvement at all times
measured compared to both baseline and placebo. At Day 
themeanincreaseinappearancescoreswas.(𝑃 < 0.01),
e Scientic World Journal
Day 90 Day 90 Day 90 Day 90
Mean change in amino acid prole (%)
Serine Glutamic acid Cystine
∗∗∗‡ ∗∗∗‡
F : Mean percent change in amino acid prole from baseline
for placebo and Cynatine HNS. ∗∗𝑃 < 0.01 and ∗∗∗𝑃 < 0.001 within
group to baseline; 𝑃 < 0.001 between groups to baseline.
Mean change in hair brightness
Baseline Day 30 Day 60 Day 90
Numerical value
∗∗∗‡ ∗∗∗‡
F : Mean change in hair brightness from baseline for placebo
and Cynatine HNS. ∗∗𝑃 < 0.01 and ∗∗∗𝑃 < 0.001 within group to
baseline; 𝑃 < 0.05,𝑃 < 0.001 between groups to baseline.
at Day  it was . (𝑃 < 0.001), and at Day  it was .
(𝑃 < 0.001) when compared to baseline. e results at all
time points are also statistically signicant to placebo (Day
 𝑃 < 0.05,Day𝑃 < 0.001,andDay𝑃 < 0.001). e
percent improvement compared to placebo was .% at Day
, .% at Day , and .% at Day . It also should be
noted that  out of  subjects showed an improvement with
on placebo. e results at all times points for both groups are
shown in Figure .
3.2. Nail Measurement Results
Nails Tendency to Break.Subjectsonplaceboshowedno
statistical improvement over the -day time frame. On the
improvement scale used in this test placebo had a score
of . at Day , showing no improvement, and a mean
score of . at Day , showing very limited improvement.
at Day , and . at Day , showing slight to moderate
improvement in nails according to the grading scale used
in this test. At all three time points the results compared to
placebo were statistically signicant (𝑃 < 0.001). .% of
subjects taking Cynatine HNS showed an improvement in
their nails tendency to break, whereas only .% of subjects
on placebo showed any improvement.
Appearance of Nails. In the Hard/So quality of nails, hard
is the desirable trait. In the placebo group, at baseline .%
of the subjects had hard nails and at Day  .% had hard
nails. In the Cynatine HNS group, at baseline .% had hard
nails and at Day  .% had hard nails. A resistant nail
is the benecial quality in the Resistant/Fragile measure. At
baseline, the placebo group had .% of its subjects with
resistant nails and at Day  .% had resistant nails. In the
Cynatine HNS group, .% had resistant nails at baseline
is the desired result in the Broken/Not Broken measure. At
baseline, % of the placebo group had no broken nails and
.% had no broken nails at Day . At baseline, .% of
the Cynatine HNS group had no broken nails and .% had
no broken nails at Day . In the Rough/Smooth measure,
smooth is the desired trait. At baseline, .% of the placebo
group had smooth nails and at Day  .% had smooth
nails. At baseline, .% of the Cynatine HNS group had
smooth nails and by Day  % of the subjects had smooth
nails. A white or natural color is desired for the nail and at
baseline .% had this trait in the placebo group compared
to .% at Day . .% of the Cynatine HNS group had
white nails at baseline and by Day  % of the subjects
had white nails.
All ve measures of the nails appearance in the Cynatine
HNS group are statistically signicant to both baseline and
placebo by Day  and all have a value of 𝑃 < 0.02 or less at
Day . While being still statistically signicant, the 𝑃values
in the appearance measures are larger than other measures
many of the measures especially when compared to placebo.
However, when analyzing the number of people showing
improvement where possible, the largest percentage increase
for placebo in any measure is .%. is equates to four
total people showing improvement at most in any measure
on placebo. e lowest nal score in the Cynatine HNS group
the desired result and in the other two measures % of the
subjects achieved the desired result.
3.3. Adverse Events/Withdrawals. ere were no adverse
events reported during the study, with  withdrawals. Both
withdrawals were deemed by the principle examiner not to
be related to either the active or the placebo group. Both
withdrawals were because the subject claimed intolerance to
determined that it was individual susceptibility that was the
cause of the intolerance. Both the active and the placebo
groups were well tolerated in study with % of the subjects
nishing the study saying they were well tolerated. Subjects
in the active group also gave the product either an excellent
or a good score in the products acceptability. Based on this,
e Scientic World Journal
4. Discussion and Conclusion
A eutrophic eect for hair on the head was seen aer 
months of treatment. is was demonstrated by the decrease
of hair shedding in the pull test. e Cynatine HNS group
showed signicantly less hair loss aer , , and  days
which were signicantly dierent to the placebo group. is
could be explained by the improvement of the anagen and
telogen phases of the hair. In the Cynatine HNS group
both growth phase (anagen) and stationary phase (telogen)
improved resulting in less hair being pulled out. is was
not seen in the placebo group. Amino acid composition of
serine, glutamic acid, cystine, and methionine improved in
the Cynatine HNS group signicantly to give the hair a better
quality. is can be explained by the addition of the various
bioavailable amino acids from keratin, which is part of the
Cynatine HNS formula. With an improvement in the hair
quality its mechanical properties also improved signicantly
by the physician concluded that hair shininess and brightness
subjects compared to only .% in the placebo group. An
overall assessment of hair brightness showed a .% change
compared to only .% in placebo. is is more than a x
improvement in hair brightness at the end of the test period.
Nails also improved their condition aer , , and 
months of treatment as demonstrated by the increase of the
the subjects having broken and roughened nails. Hardness
of nails improved from .% of subjects reporting hard nails
the improvement in resistance and none broken nails. e
placebo group scored in all categories below %. As the
nails improved in hardness and resistance they also improved
signicantly in smoothness at Day  compared to placebo.
ey also changed to a more normal color than the yellow
discoloration seen. e clinical evaluation by a physician also
went along the same lines and an improvement in tendency
to break was seen in .% of subjects as compared to only
.% in the placebo group.
In a questionnaire administered aer completion of the
study, participants were asked to rate how eective they
felt the products were. Not surprisingly, the placebo scored
poorly in the questionnaire as .% of the participants felt
that it was ineective for hair and .% felt that it was poor
for nails. In the Cynatine HNS group, .% of the partici-
feeling that the product was either very good or excellent. For
nails, .% of the Cynatine HNS group felt that the product
was sucient with .% nding it very good or excellent.
mended that further clinical analysis should be performed
on Cynatine HNS. In order to better analyze the eect of
Cynatine HNS on hair and nails a study which includes
men and women, a larger sample size, and a longer duration
should be performed. Additionally it would be benecial
to look at a comparison of Cynatine with and without the
additional vitamins and minerals.
In conclusion, the results obtained for the Cynatine
HNS group were statistically dierent from that obtained
for the placebo group, demonstrating that Cynatine HNS
had a signicant inuence on the quality of skin, hair, and
nails. Cynatine HNS contains ingredients that are all seen as
nutrients for skin, hair, and nails. Keratin is a major structural
component of the hair and nails which can be seen by the
inuence Cynatine HNS has on the quality of hair and nails.
Conflict of Interests
Robert H. Veghte is the General Manager of Roxlor Global,
LLC. Neither Christina Beer nor Simon Wood is an employee
of Roxlor Global, LLC, nor do they receive any royalty or
payment based on performance of the product; they do
however receive consulting fees on a per job basis f rom Roxlor
Global, LLC.
e authors would like to thank Roxlor Global, LLC, for
providing all the raw materials in this study. Roxlor Global,
LLC, funded this study.
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... Cynatine HNS (Cynatine ® HNS) is a keratin-rich extract obtained from New Zealand sheep wool after a proprietary processing method. Cynatine is a highly stable preparation and the ingredients of this preparation are stable under harsh pH conditions and unfavorable temperature conditions [132]. Keratin is one of the main constituents of the hair cortex and thus essentially requires maintaining healthy hair [133]. ...
... Moreover, Cynatine is also a rich source of other important essential amino acids such as cysteine, serine, and methionine. Thus, Cynatine not only provides structural stability to hair but also increases the cell`s antioxidant capacity by promoting the synthesis of glutathione and other sulfur-rich proteins [132,134]. The higher bioavailability of Cynatine is another added advantage because it helps in the increased and swift delivery of keratin proteins to hair. ...
... The higher bioavailability of Cynatine is another added advantage because it helps in the increased and swift delivery of keratin proteins to hair. A recent randomized, double-blind, placebocontrolled study has demonstrated that treatment with 500 mg Cynatine for 30 days significantly improved hair health as evidenced by reduced hair fall in comparison with the placebo group [132]. Less hair fall was attributed to improved growth and stationary phases after Cynatine treatment. ...
Background: Hair loss or alopecia is a common dermatological problem that occurs in up to 2% of the human population. Often it is hereditary male- or female-pattern baldness. However, different environmental factors, unbalanced diet and chronic diseases result in hair loss. Hair loss is not a life-threatening sickness, but it may result in anxiety and depression, and other serious psychological problems affecting the individual`s quality of life. Objective: Different treatments for hair loss, including synthetic or/and natural drugs such as Minoxidil and Finasteride, approved by the Food and Drug Administration (FDA) for hair growth. These drugs are effective, but they have potential side effects. Natural remedies that are used for the treatment of various diseases have been proposed for hair loss healing because many chronic disorders cause alopecia. Therefore, the main focus of our study was search for alternative efficient treatment agents, particularly medicinal plants, with limited side effects. Methods: To find relevant information, different databases, including Scopus, PubMed and Google Scholar, were used, and various search terms such as “Hair loss”, “Alopecia”, “Hair loss AND Natural remedies”, “Alopecia AND natural remedies”, “Herbal treatment AND Hair loss” etc. were applied to extract related articles. Results: Different herbs and other natural compounds are believed to reduce hair loss due to their anti-inflammatory and antioxidant potential as well as due to the ability to improve local metabolism when applied externally. As per the literature, herbal extracts and formulations made from Urtica dioica, Humulus lupulus, Serenoa repens, Pygeum africanum, Vitis vinifera, Cucurbita pepo, Crocus sativus, Medicago sativa, Linum usitatissimum, Broccoli, etc., and some individual herbal compounds, micronutrients, bee products, and keratin have potential to reduce hair loss directly or indirectly. Conclusion: Medicinal plants and several promising natural molecules can promote hair growth and prevent alopecia by reducing the activity of the 5-α-reductase enzyme
... Pemberian peptida oral terutama yang mengandung keratin (cynatine) yang dikombinasi dengan zat-zat lain contohnya zink, biotin dan vitamin B meningkatkan efektivitas terapi minoksidil. Suplemen yang mengandung cynatine bermanfaat pada kesehatan kulit, kuku dan rambut sehingga dapat dipertimbangkan sebagai terapi tambahan pada kasus ET. 4 Tujuan penulisan laporan kasus ini adalah untuk melaporkan satu kasus ET kronis pada pasien SLE yang ditatalaksana dengan minoksidil topikal 2% dikombinasi dengan antioksidan oral. Diharapkan dengan laporan kasus ini dapat menambah informasi mengenai penegakan diagnosis ET dan pemberian tatalaksana yang tepat. ...
... Berbagai suplemen mineral dilaporkan bermanfaat memperbaiki kesehatan kulit, kuku dan rambut. 4 Konsumsi suplemen rambut secara oral direkomendasikan karena senyawa bioaktif nutraceutical yang di bawa oleh darah dapat dialirkan ke rambut secara terus menerus. Beer dkk (2014) melaporkan bahwa efek suplemen cynatine terlihat setelah 3 bulan terapi, yang ditandai dengan berkurangnya kerontokan rambut saat dilakukan HPT. ...
... Cynatine HNS menunjukkan perbaikan signifikan mengurangi kerontokan rambut pada evaluasi setelah 30 hari, 60 hari dan 90 hari karena terjadi perbaikan pada fase anagen dan fase telogen. 4 Jacquet dkk (2007) melaporkan bahwa pemberian suplemen yang mengandung kartilago hiu 100 mg, vitamin B2 1,6 mg, vitamin B5 6 mg, vitamin B6 2 mg, vitamin B8 0,150 mg dan minyak ikan (omega 3) memperbaiki kelembaban kulit, mengurangi kerutan dan kerontokan rambut serta memperbaiki kondisi kulit selama evaluasi 58 hari. 17 Pada kasus ini diberikan antioksidan yang mengandung keratin (cynatine HNS) 250 mg, biotin 0,150 mg, zink glukonat 7,5 mg, copper gluconate 0,825 mg, vitamin B3 (niacinamide) 9 mg, vitamin B5 (d-calcium pantothenate) 13,68 mg dan vitamin B6 (piridoksin HCl) 1 mg. ...
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Latar belakang: Efluvium telogen (ET) adalah kelainan pada rambut, ditandai dengan pelepasan rambut telogen berlebihan tanpa adanya inflamasi. Salah satu faktor pencetusnya adalah systemic lupus erythematosus (SLE). Minoksidil topikal 2% adalah terapi pilihan yang bekerja dengan meningkatkan aliran darah dan oksigen ke folikel rambut. Antioksidan oral yang mengandung keratin (cynatine HNS) juga memperbaiki kesehatan rambut sehingga dapat diberikan sebagai terapi tambahan pada kasus ET. Kasus: Perempuan berusia 19 tahun dengan keluhan rambut rontok sejak 1 tahun yang lalu. Pasien mengeluhkan demam, ruam merah di wajah dan nyeri sendi 5 bulan lalu dengan hasil tes ANA >1/80, dsDNA positif lemah, Scl-70 positif lemah dan Ro-60 positif lemah. Pasien didiagnosis dengan SLE, diberikan terapi metilprednisolon tablet 48 mg/hari dan siklosporin tablet 100 mg/hari. Status dermatologis pada regio scalp tampak kerontokan rambut difus, pemeriksaan hair pull test positif dan pada pemeriksaan dermoskopi tampak penurunan densitas rambut dengan beberapa folikel rambut kosong. Terapi dengan minoksidil topikal 2% dua kali sehari dan antioksidan oral prosentials® mengandung keratin 250 mg dua kali sehari. Kesimpulan: Diagnosis ET ditegakkan berdasarkan anamnesis, pemeriksaan fisik, hair pull test dan pemeriksaan dermoskopi. Minoksidil adalah vasodilator yang meningkatkan aliran darah dan oksigen ke folikel rambut. Antioksidan oral yang mengandung keratin (cynatine HNS) adalah protein yang bagus untuk kesehatan rambut, kulit dan kuku sehingga dapat dipertimbangkan sebagai terapi tambahan. Pertumbuhan rambut baru dengan peningkatan densitas rambut terlihat pada hari ke-90 (Gambar 3 dan Gambar 4) setelah terapi minoksidil topikal 2% dan antioksidan oral.
... KeraGEN-IV Nutraceutical R , DFK-FLEX R , GLOW R and Kerapro R tablets or beverages (Keraplast Technologies LLC, Lincoln, New Zealand) can boost the production of collagen, hair follicle and nail strength improvement and increase skin compactness (Houltham et al., 2014). Clinical trials also demonstrated that Cynatine R FLX1 (Beer et al., 2013b) and Cynatine R HNS (500 mg/day; Roxlor LLC, Delaware, USA; Beer et al., 2014) could supplement bioactive peptides and amino acids responsible for protecting and rebuilding damaged joints and improving the growth and strength of hair and nails. Other product claims include boosting body protein supply and promoting healing on injury or vigorous activity (Beer et al., 2013a(Beer et al., , 2014Kelly et al., 2007; regeneration (i.e., new capillaries and collagen synthesis) and hair follicle development (Moore et al., 2016). ...
... Clinical trials also demonstrated that Cynatine R FLX1 (Beer et al., 2013b) and Cynatine R HNS (500 mg/day; Roxlor LLC, Delaware, USA; Beer et al., 2014) could supplement bioactive peptides and amino acids responsible for protecting and rebuilding damaged joints and improving the growth and strength of hair and nails. Other product claims include boosting body protein supply and promoting healing on injury or vigorous activity (Beer et al., 2013a(Beer et al., , 2014Kelly et al., 2007; regeneration (i.e., new capillaries and collagen synthesis) and hair follicle development (Moore et al., 2016). ...
... Naturally, keratin is produced by the body to maintain tissue integrity, including skin and hair, but the body's ability to produce keratin decreases with age. Therefore, keratin supplements can be beneficial in replenishing keratin balance and supporting hair growth (Beer et al., 2013b(Beer et al., , 2014. Beer et al. (2013b) investigated the ability of Cynatine R (Roxlor, La Ciotat, France), a commercial keratin-based supplement, to relieve symptoms associated with knee osteoarthritis. ...
The growing global population and lifestyle changes have increased the demand for specialized diets that require protein and other essential nutrients for humans. Recent technological advances have enabled the use of food bioresources treated as waste as additional sources of alternative proteins. Sheep wool is an inexpensive and readily available bioresource containing 95%–98% protein, making it an outstanding potential source of protein for food and biotechnological applications. The strong structure of wool and its indigestibility are the main hurdles to achieving its potential as an edible protein. Although various methods have been investigated for the hydrolysis of wool into keratin, only a few of these, such as sulfitolysis, oxidation, and enzymatic processes, have the potential to generate edible keratin. In vitro and in vivo cytotoxicity studies reported no cytotoxicity effects of extracted keratin, suggesting its potential for use as a high‐value protein ingredient that supports normal body functions. Keratin has a high cysteine content that can support healthy epithelia, glutathione synthesis, antioxidant functions, and skeletal muscle functions. With the recent spike in new keratin extraction methods, extensive long‐term investigations that examine prolonged exposure of keratin generated from these techniques in animal and human subjects are required to ascertain its safety. Food applications of wool could improve the ecological footprint of sheep farming and unlock the potential of a sustainable protein source that meets demands for ethical production of animal protein.
... In the cosmetics, biomedical and health industries, countless products such as anti-aging creams, shampoos and hair treatment oils along with various types of creams have been developed for the local and international markets. Additionally, bioactive keratin, which is essentially a form of solubilized keratin have been found to offer vast benefits in the health, pharmaceutical and beauty industries when ingested orally regardless of the source it originated from [5]. ...
... In 2014, a double-blind, randomized, placebo-controlled study established that solubilized keratin as a supplement showed positive effects in improving various aspects on hair and nails compared to a placebo among the participants of the study. The effects on hair were measured in terms of hair growth, hair loss, amino acid composition, hair luster and hair strength, while the effect on nails were measured and determined in terms of nail strength and physical appearance of nails [5]. ...
... The crosslinked network found in the structure of keratin can be a contributor to this condition as it is packed with many disulphide and hydrogen bonds [4]. The importance of keratin lies in its solubility and bioactivity are essential in the process of keratin being an active ingredient in pharmaceutical and beauty products which generally involves the keratin protein playing a necessary role as a nutrient in improving and replenishing various aspects of the body [5]. ...
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Keratin powder is produced from the drying of keratin solution extracted from chicken feathers. Powdered form of keratin protein eases the storage and transport of keratin and can be further developed into nutrient supplements. The objective of this research is to convert liquid keratin obtained from chicken feathers into powder through different methods and also to identify the effects of various drying methods on the keratin sample. Liquid keratin was converted into solid particles through spray drying, freeze drying and vacuum-oven drying where the products were visually observed and analysed using FTIR and SEM to determine the effects of the drying methods on the keratin sample. The SEM results show that the product of spray drying produced smaller spherical particles with diameter ~3µm-17µm while freeze drying and vacuum-oven drying produced coarse, flaky irregular-shaped particles with diameter ~70µm-470µm and ~100µm-530µm respectively. FTIR spectroscopy shows that the keratin samples remained their characteristics as a true protein including spray drying when encapsulated with Arabic gum even at high temperatures up to 110°C. Conclusively, spray drying should be considered for future development of keratin as a nutrient supplement while freeze drying and vacuum-oven drying for storage and transport of keratin.
... The drug delivery system helps protect and stabilise the incorporated drug and maintain a significant level for a sustained therapeutic response even at a low frequency of administration (Vasconcelos and Cavaco-Paulo, 2013). Solubilised keratin protein in the form of cynatine NHS is clinically proven to supplement the body with bioactive peptides and amino acids, which aid in protecting and repairing damage to the skin, nails, and hair (Beer et al., 2014). The solubilised keratin proteins are also incorporated in joint care products (Kelly et al., 2005). ...
... Bioactive keratins proteins of low molecular weights have a scavenging capacity and inhibit collagenases, protecting against skin ageing and wrinkling caused by ultraviolet radiation (UV-B) (Michalak et al., 2021). Solubilised keratin proteins formed as cynatine HNS are used in beauty formulas for hair and nail treatment (Beer et al., 2014;Dell, 2018). ...
The valorisation of keratinous wastes involves biorefining and recovering the bioresource materials from the keratinous wastes to produce value-added keratin-based bioproducts with a broad application, distribution, and marketability potential. Valorisation of keratinous wastes increases the value of the wastes and enables more sustainable waste management towards a circular bioeconomy. The abundance of keratinous wastes as feedstock from agro-industrial processing, wool processing, and grooming industry benefits biorefinery and extraction of keratins, which could be the optimal solution for developing an ecologically and economically sustainable keratin-based economy. The transition from the current traditional linear models that are deleterious to the environment, which end energy and resources recovery through disposal by incineration and landfilling, to a more sustainable and closed-loop recycling and recovery approach that minimises pollution, disposal challenges, loss of valuable bioresources and potential revenues are required. The paper provides an overview of keratinous wastes and the compositional keratin proteins with the descriptions of the various keratin extraction methods in biorefinery and functional material synthesis, including enzymatic and microbial hydrolysis, chemical hydrolysis (acid/alkaline hydrolysis, dissolution in ionic liquids, oxidative and sulphitolysis) and chemical-free hydrolysis (steam explosion and ultrasonic). The study describes various uses and applications of keratinases and keratin-based composites fabricated through various manufacturing processes such as lyophilisation, compression moulding, solvent casting, hydrogel fabrication, sponge formation, electrospinning, and 3D printing for value-added applications.
... The composition of this supplement addresses two of the central pathogenic factors of hair disorders: nutritional deficiencies and inflammation. Indeed, beside the classic vitamin and minerals approach, there is increasing evidence of the role of keratin as an effective supplement for improving hair conditions [40]. The role of keratin (alone or in combination with vitamins) in improving hair conditions in subjects with acute telogen effluvium has also been investigated by our team (unpublished data). ...
Full-text available
Background: Hair loss is a not life-threatening dermatological condition with some physical effects but with more severe psychosocial consequences. Nutrition deficiencies have been associated to hair loss, opening the door for food supplement's use in decreasing hair loss.
... However, when it comes to the claims accompanying skin, hair, and nails food supplements, most of the time, they are not supported by evidence-based-science. 2,4 In a previous study, we demonstrated the effect of L-Cystine amino acid in improving hair and nail conditions. 5 Nowadays, due to the increasing evidence that protein-based dietary supplements can be effective in reducing hair loss 6 and improving nails conditions, 7 we extended our previous research to nutrients obtained from poultry feathers which composition is close to the human keratin and also highly bioavailable for the organism. As a matter of fact, the use of animal co-products in food supplementation represents an effective way to make them value-added products and to decrease their impact on the environmental pollution. ...
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Background Telogen effluvium (TE) and its acute form (aTE) are two of the commonest occurrences in a trichology clinic, with patients claiming excessive hair shedding. ATE can occur in people of any age and ethnicity and is considered to be a quite common condition in either sex even if women are more likely to have a lowered quality of life and restricted social contacts as compared to men as a result of hair loss. Brittle nail syndrome (BNS) is a common condition affecting up to 20% of the population, especially women over 50 years of age. Nails affected by BNS appear ragged, thin, and dull. The clinical features of BNS include horizontal splits within the nail plate (onychoschizia) and increased longitudinal ridging or splitting (onychorrhexis). In BNS oral supplementation, trace elements and amino acids (especially L-Cystine) have been reported to be useful to ameliorate the nail plate condition. Objective We hypothesized that a nutritional approach, with nutrients of which the composition is close to the human keratin, could be effective to decrease hair loss during telogen effluvium and to improve brittle nails condition. At this purpose, a clinical study was designed to investigate the efficacy of a natural keratin hydrolysate obtained from a non-human source (feathers) on both aTE and BNS. Methods The in vivo effects of a natural keratin hydrolysate, Kera-Diet® (KD) upon human hair and nails condition was tested in a randomized, double-blind, parallel-group, benchmark (BE) and placebo (PL) controlled study involving 60 women during 90 days. In all subjects, Anagen/Telogen hair, hair volume and density, pull test, global photography, hair and nails brightness, and nail plate growth were measured at baseline and after 45 and 90 days of products use. A self-assessment test was carried out at the end of the study. Results With the KD treatment group, hair density, percentage of hair in anagen phase, hair and nails brightness, and nails growth were significantly increased compared to PL treatment group. Interestingly, with this same group, the diagnosis of aTE by pull testing was negative from 45 days. The efficacy of KD was equal to or greater than PL treatment group. Conclusion In this study, we demonstrated that daily oral administration of 1000 mg during 3 months of a natural extensively keratin hydrolysate, Kera-Diet®, associated to trace elements and specific vitamins was effective to improve both hair and nails condition. Furthermore, it demonstrates the role of nutrients in both aTE and BNS.
Cysteine is a sulfur-containing, α-amino acid with the chemical formula O2CCH(NH2)CH2SH. Cysteine is unique amongst the 20 natural amino acids as it contains a thiol group. It is classified as a conditionally non-essential amino acid since the human body can naturally synthesize it [1, 2]. Like other amino acids, cysteine has an amphoteric character and is extensively used as an additive in the food industry, mainly in bakery, in the production of flavors, and as a processing aid [3]. When used as a food additive, it is labeled as E920 [4].
Pantothenic acid or Vit B5 is a water-soluble vitamin and an essential nutrient. Vit B5 was discovered in 1933 by Williams et al. during their studies on microbial growth factors [1]. Pantothenic acid is the amide between pantoic acid and β-alanine, with the latter playing a vital role in the crystallization and subsequent artificial production of Vit B5, first achieved in 1940. The name of pantothenic acid derives from the Ancient Greek word “πάντοθεν = from everywhere”, indicating its widespread occurrence in nature since small quantities of Vit B5 are found in nearly every known food. Remarkably, only one of the popular foods lacks pantothenic acid, and that is olive oil.
Male and female pattern hair loss (PHL) is an innocuous condition, but it has a major psychological impact on the sufferer. This paper aims to provide a simple algorithmic approach toward diagnosis, staging, and treatment of PHL in males and females. It also aims at simplifying the decision-making process for the surgeon with regard to timing and extent of procedure for hair transplant surgeries. Various treatment options, their merits and demerits, along with scientific evidence supporting or not supporting the treatment options are discussed in detail.
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Bariatric surgery leads to a significant body weigh reduction although it is associated to a higher risk of presenting some nutritional deficiencies. A common complication, little studied and mainly related to zinc deficiency is alopecia. To compare the nutritional status of zinc, iron, copper, selenium and protein-visceral in women with different degrees of hair loss at 6 months after gastric bypass or tubular gastrectomy. The patients were categorized into two groups according to the degree of hair loss: group 1 or mild loss (n = 42) and group 2 or severe hair loss (n = 45). Zinc, iron, copper, and selenium, as well as the indicators of the nutritional status of zinc, iron, copper, and proteinvisceral were assessed before and after 6 months of the surgery. In both groups there was a significant body weight reduction at 6 months post-surgery (-38.9% ± 16.4%). Patients in group 1 presented a significantly higher intake of zinc (20.6 ± 8.1 vs. 17.1 ± 7.7 mg/d) and iron (39.7 ± 35.9 vs. 23.8 ± 21.3 mg/d.), and lower compromise in the nutritional status of zinc and iron than group 2. However, patients in group 2 had lower compromise in the nutritional status of copper. There were no differences regarding the plasma concentrations of albumin. The patients having lower hair loss at six months after surgery had higher zinc and iron intake and lower compromise of the nutritional status of both minerals.
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Dietary supplement use is increasing, but there are few comparable data on supplement intakes and how they affect the nutrition and health of European consumers. The aim of this study was to describe the use of dietary supplements in subsamples of the 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). Specific questions on dietary supplement use were asked as a part of single 24-h recalls performed on 36,034 men and women aged 35-74 years from 1995 to 2000. Between countries, the mean percentage of dietary supplement use varied almost 10-fold among women and even more among men. There was a clear north-south gradient in use, with a higher consumption in northern countries. The lowest crude mean percentage of use was found in Greece (2.0% among men, 6.7% among women), and the highest was in Denmark (51.0% among men, 65.8% among women). Use was higher in women than in men. Vitamins, minerals or combinations of them were the predominant types of supplements reported, but there were striking differences between countries. This study indicates that there are wide variations in supplement use in Europe, which may affect individual and population nutrient intakes. The results underline the need to monitor consumption of dietary supplements in Europe, as well as to evaluate the risks and benefits.
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Dietary supplements are regularly used by a majority of the American population, and usage by health professionals is also common. There is considerable interest in usage patterns within the population and in the reasons for using dietary supplements. The "Life...supplemented" Healthcare Professionals 2008 Impact Study (HCP Impact Study) surveyed usage of dietary supplements by physicians in three specialties: cardiology, dermatology, and orthopedics. The HCP Impact Study was conducted online by Ipsos Public Affairs for the Council for Responsible Nutrition (CRN), a trade association of the dietary supplement industry. Respondents were 900 physicians, including 300 each from three specialties--cardiology, dermatology, and orthopedics. Fifty-seven percent of cardiologists said they use dietary supplements at least occasionally, as did 75% of dermatologists and 73% of orthopedists. The product most commonly reported to be used was a multivitamin, but over 25% in each specialty said they used omega-3 fatty acids and over 20% said they used some botanical supplements. Regular dietary supplement use was reported by 37% of cardiologists, 59% of dermatologists, and 50% of orthopedists. Seventy-two percent of cardiologists, 66% of dermatologists, and 91% of orthopedists reported recommending dietary supplements to their patients. The primary reason given for recommending dietary supplements to patients was for heart health or lowering cholesterol for the cardiologists; benefits for skin, hair and nails for the dermatologists; and bone and joint health for the orthopedists. Reported dietary supplement use was relatively common in this sample of physicians, and when they recommended dietary supplements to patients, they tended to do so for reasons related to their specialty.
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It has been reported that some alopecia areata patients have zinc deficiency. There have also been several reports published concerning oral zinc sulfate therapy, with encouraging results, in some alopecia areata patients. The purpose of this study was to evaluate the therapeutic effects of oral zinc supplementation for twelve weeks in alopecia areata patients who had a low serum zinc level. Oral zinc gluconate (50 mg/T/day) supplementation was given to alopecia areata patients without any other treatment for twelve weeks. The serum zinc level was measured before and after zinc supplementation. A four-point scale of hair regrowth was used to evaluate the therapeutic effect of oral zinc supplementation in these patients. Fifteen alopecia areata patients were enrolled in this study. After the therapy, the serum zinc levels increased significantly from 56.9 microg/ to 84.5 microg/dl. Positive therapeutic effects were observed for 9 out of 15 patients (66.7%) although this was not statistically significant. The serum zinc levels of the positive response group increased more than those of the negative response group (p=0.003). Zinc supplementation needs to be given to the alopecia areata patients who have a low serum zinc level. We suggest that zinc supplementation could become an adjuvant therapy for the alopecia areata patients with a low serum zinc level and for whom the traditional therapeutic methods have been unsuccessful.
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Dietary bioactive compounds (vitamin E, carotenoids, polyphenols, vitamin C, Se and Zn) have beneficial effects on skin health. The classical route of administration of active compounds is by topical application direct to the skin, and manufacturers have substantial experience of formulating ingredients in this field. However, the use of functional foods and oral supplements for improving skin condition is increasing. For oral consumption, some dietary components could have an indirect effect on the skin via, for example, secondary messengers. However, in the case of the dietary bioactive compounds considered here, we assume that they must pass down the gastrointestinal tract, cross the intestinal barrier, reach the blood circulation, and then be distributed to the different tissues of the body including the skin. The advantages of this route of administration are that the dietary bioactive compounds are metabolized and then presented to the entire tissue, potentially in an active form. Also, the blood continuously replenishes the skin with these bioactive compounds, which can then be distributed to all skin compartments (i.e. epidermis, dermis, subcutaneous fat and also to sebum). Where known, the distribution and mechanisms of transport of dietary bioactive compounds in skin are presented. Even for compounds that have been studied well in other organs, information on skin is relatively sparse. Gaps in knowledge are identified and suggestions made for future research.
Growth and quality of hair was studied after treatment with Pantogar, another prescription (Verum-2) and placebo for four months in 60 patients with diffuse effluvium capillorum and agnogenic structural alternations of hair. Efficacy was assessed by measurements of swelling, dye-binding and thickness for hair-quality and evaluation of hair-density and trichograms for hair-growth. Statistical analysis of swelling properties and trichogram data indicated that Pantogar was effective, the second preparation improved quality of hair and retarded hair loss. Placebo was ineffective judged by the used parameters. Tolerance of the treatment was good and adverse effects could not be substantiated.
A controlled randomized double-blind study was carried out in 72 female patients to compare tolerance and efficacy of two therapeutic agents containing vitamins of the B-group and L-cystine in different compositions versus a placebo in diffuse effluvia and hair structure lesions. Hair swelling as a criterion of hair quality and frontal and parietal anagen rates in trichograms as criteria of hair growth were determined before and after 4 months of therapy. Treatment with active medication 1 was statistically significantly superior to treatment with the placebo according to these criteria. Treatment with active medication 2 was superior to treatment with the placebo but inferior to treatment with active medication 1. The overall evaluation of efficacy by investigator and patient was in good agreement with these results. The additional active ingredients contained in active medication 1 but not contained in active medication 2 contribute to the efficacy of the medication. They cannot be compensated by the higher amounts of L-cystine contained in active medication 2. Given their good tolerance, no adverse effects were observed with the two active medications.
An unusual case of yellow nail syndrome (YNS) is reported. Total resolution of yellow nails and lymphoedema was observed following oral zinc supplementation for 2 years. A few years later, the patient developed a classical seropositive rheumatoid arthritis (RA). YNS, alone or associated with RA remains a rare clinical condition. The reported beneficial effects of zinc supplementation in YNS, as well as in several other pathological conditions, raise interest about the role of this trace element and its potential therapeutic implications and suggest further investigations are necessary.
A recent study from Switzerland demonstrated a 25 percent increase in nail plate thickness in patients with brittle nails who received biotin supplementation. Analysis of all visits to a nail consultation practice over a six-month period revealed forty-four patients with this condition who had been prescribed the B-complex vitamin biotin. Of these, thirty-five who took daily supplementation were subjectively evaluated. Twenty-two of thirty-five (63 percent) showed clinical improvement and thirteen (37 percent) reported no change in their condition. The results of this small, retrospective study suggest a positive response to biotin in the treatment of brittle nails in some patients.
We report a family affected to the fourth generation by uncombable hair syndrome. This syndrome is characterized by unruly, dry, blond hair with a tangled appearance. The family pedigree strongly supports the hypothesis of autosomal dominant inheritance; some members of the family had, apart from uncombable hair, minor signs of atopy and ectodermal dysplasia, such as abnormalities of the nails. The diagnosis was confirmed by means of extensive scanning electron microscopy. A trial with oral biotin 5 mg/day was started on two young patients with excellent results as regards the hair appearance, although scanning electron microscopy did not show structural changes in the hair. After a 2-year-period of follow-up, hair normality was maintained without biotin, while nail fragility still required biotin supplementation for control.