ArticleLiterature Review

A Review of the Use of Biotin for Hair Loss

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Abstract

Background: Biotin has gained commercial popularity for its claimed benefits on healthy hair and nail growth. Despite its reputation, there is limited research to support the utility of biotin in healthy individuals. Objective: To systematically review the literature on biotin efficacy in hair and nail growth. Methods: We conducted a PubMed search of all case reports and randomized clinical trials (RCTs) using the following terms: (biotin and hair); (biotin and supplementation and hair); (biotin supplementation); (biotin and alopecia); (biotin and nails); (biotin and dermatology), and (biotin recommendations). Results: We found 18 reported cases of biotin use for hair and nail changes. In all cases, patients receiving biotin supplementation had an underlying pathology for poor hair or nail growth. All cases showed evidence of clinical improvement after receiving biotin. Conclusions: Though its use as a hair and nail growth supplement is prevalent, research demonstrating the efficacy of biotin is limited. In cases of acquired and inherited causes of biotin deficiency as well as pathologies, such as brittle nail syndrome or uncombable hair, biotin supplementation may be of benefit. However, we propose these cases are uncommon and that there is lack of sufficient evidence for supplementation in healthy individuals.

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... Biotin is involved in the production of keratin; therefore, it may contribute to the well-being of nails and hair. There are some case reports demonstrating that oral biotin may improve hair loss and nail growth in cases of acquired and inherited biotin deficiency which are uncommon but still few evidences on the benefit of oral biotin supplementation in healthy subjects [29]. Boccaletti et al. evaluated the efficacy of oral biotin 5 mg/ day on two young patients with uncombable hair syndrome, characterized by dry, frizzy, and light-colored hair, described as blond or silvery with a glistening sheen. ...
... Vitamin B3 Anti-inflammatory effect [20]; synthesis of proteins and ceramides important for the skin barrier and reduction in trans epidermal water loss [19]; contribution in DNA repair processes [22] Treatment of acne [21], atopic dermatitis [19], actinic keratosis [23], and prevention of skin cancers [22] and photoaging [24] Vitamin B8 Involved in the production of keratin [29] and in several metabolic pathways (gluconeogenesis, fatty acid synthesis, amino acid catabolism) [26] Treatment of seborrheic dermatitis [31] and several hair and nail disorders [29] Vitamin C Inhibition of reactive oxygen accumulation [32]; involved in collagen synthesis processes [34] Treatment and prevention of photoaging [36] and photocarcinogenesis [42] Vitamin D Immunomodulatory effect [45]; control of keratinocyte proliferation and calcium homeostasis [43]; reduction of UV-induced DNA damage [48] Treatment of psoriasis [45] and prevention of non-melanoma skin cancers [49] Vitamin E Antioxidant activity [54] and reduction in lipid peroxidation [53] Treatment of scleroderma [57], yellow nail syndrome [55], acne [56], and melasma [58]. Prevention of skin aging [33] Vitamin K Involved in the activation processes of some coagulation factors [59]; antioxidant activity [61••] Treatment of acute and chronic skin wounds [61••] and laser-induced purpura [62] Coenzyme Q10 Antioxidant activities against environmental aggressions; component of mitochondrial respiratory chain [64] Treatment of skin aging [65] subjected to stresses of different nature, and the resulting damage can be repaired through processes that require energy. ...
... Vitamin B3 Anti-inflammatory effect [20]; synthesis of proteins and ceramides important for the skin barrier and reduction in trans epidermal water loss [19]; contribution in DNA repair processes [22] Treatment of acne [21], atopic dermatitis [19], actinic keratosis [23], and prevention of skin cancers [22] and photoaging [24] Vitamin B8 Involved in the production of keratin [29] and in several metabolic pathways (gluconeogenesis, fatty acid synthesis, amino acid catabolism) [26] Treatment of seborrheic dermatitis [31] and several hair and nail disorders [29] Vitamin C Inhibition of reactive oxygen accumulation [32]; involved in collagen synthesis processes [34] Treatment and prevention of photoaging [36] and photocarcinogenesis [42] Vitamin D Immunomodulatory effect [45]; control of keratinocyte proliferation and calcium homeostasis [43]; reduction of UV-induced DNA damage [48] Treatment of psoriasis [45] and prevention of non-melanoma skin cancers [49] Vitamin E Antioxidant activity [54] and reduction in lipid peroxidation [53] Treatment of scleroderma [57], yellow nail syndrome [55], acne [56], and melasma [58]. Prevention of skin aging [33] Vitamin K Involved in the activation processes of some coagulation factors [59]; antioxidant activity [61••] Treatment of acute and chronic skin wounds [61••] and laser-induced purpura [62] Coenzyme Q10 Antioxidant activities against environmental aggressions; component of mitochondrial respiratory chain [64] Treatment of skin aging [65] subjected to stresses of different nature, and the resulting damage can be repaired through processes that require energy. ...
Article
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Purpose of review: Skin is the main defense organ of the human body against external insults (ultraviolet radiations, infections by pathogenic microorganisms, and mechanical and chemical stress). The integrity and functions of the skin barrier are supported by an adequate supply of micronutrients, such as several vitamins. The purpose of this review was to analyze all vitamin-related skin problems. Recent findings: The World Health Organization has estimated that more than 2 billion people worldwide experience deficiencies in the intake of essential vitamins and minerals; the percentage of adults all over the world using daily vitamin supplements, for treatment or prevention of chronic disease, has increased very rapidly in recent years. In this review, 65 studies have been selected in order to examine the role of the main vitamins and their derivatives involved in maintaining the well-being of the skin and their use as prophylactic and therapeutic agents in the management of skin disorders.
... Em relação a biotina, estudo de revisão retrospectivo sobre seus benefícios realizados por Deepa et al. [20] demonstrou que, apesar de sua popularidade nos meios de comunicação e entre os consumidores, a biotina não tem eficácia comprovada sobre o crescimento de cabelo e unha em indivíduos saudáveis. Dentro desta revisão apenas um estudo demostrou diminuição dos níveis de biotina em indivíduos saudáveis, embora esses dados foram confundidos por vários fatores, incluindo histórico do paciente. ...
... Dentro desta revisão apenas um estudo demostrou diminuição dos níveis de biotina em indivíduos saudáveis, embora esses dados foram confundidos por vários fatores, incluindo histórico do paciente. Portanto, na ausência de estudos adicionais não encontraram nenhuma evidência sobre os benefícios da suplementação de biotina exceto nas deficiências congênitas ou adquiridas [20]. ...
Article
A alopecia é um problema comum com importante impacto negativo na qualidade de vida de seus portadores. Devido à ausência de uma terapia totalmente eficaz para o tratamento de alopecia, o microagulhamento surge como uma promissora e efetiva alternativa para esta disfunção. O objetivo deste trabalho foi apresentar um protocolo de tratamento eficaz para tratar a alopecia androgenética a curto e médio prazo bem como expor a autopercepção do paciente através de análise subjetiva em relação ao tratamento realizado. Paciente do sexo masculino, com alopécia androgenética foi tratado com 6 sessões de microagulhamento associado à mescla manipulada estéril de ativo. Houve melhora de 75% em relação ao crescimento capilar e coloração dos fios e em relação a espessura dos fios observou-se melhora de 50%. O protocolo apresentado neste trabalho mostrou-se seguro, rápido e eficaz para a terapia de crescimento capilar a curto e médio prazo, pois os resultados se mantiveram por um período de 5 meses pós o termino do tratamento.Palavras-chave: alopecia androgenética, microagulhamento, crescimento capilar, fator de crescimento.
... In clinical practice, it may present as periorificial dermatitis, conjunctivitis, ataxia, hypotony, keto-lactic acidosis/organic aciduria, epilepsy, skin infection, growth restriction in children, psychosis, neuritis, hair loss, and fragile nail structure [13,14]. Biotin is used to stimulate hair and nail growth; however, there is only limited data on the benefit of biotin in people with a healthy diet [16]. ...
... Due to its stimulating effect on epidermal cell growth and differentiation, biotin has been used to treat several nail diseases, including nail fragility, trachyonychia, triangular worn down nails, and habit-tic deformity [42]. In a review study by Patel et al., different doses of biotin were used to treat hair loss and nail changes in individuals with biotin deficiency and without such a deficiency (healthy) [16]. It was determined that ASI did not affect nail growth, while MgB contributed to nail growth at high doses. ...
Article
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The purpose of this study was to examine the effects of a combination of inositol-stabilized arginine silicate complex (ASI) and magnesium biotinate (MgB) on hair and nail growth in an animal model. Twenty-eight female Sprague–Dawley rats (8 weeks old) were randomized into one of the following groups: (i) group (control), shaved; (ii) group (ASI), shaved + ASI (4.14 mg/rat/day); (iii) group (ASI + MgB I), shaved + ASI (4.14 mg/rat/day) + MgB (48.7 μg/rat/day); and (iv) group (ASI + MgB II), shaved + ASI (4.14 mg/rat/day) + MgB (325 μg/rat/day). On day 42, compared with the control group, while hair density (p < 0.05, p < 0.01, and p < 0.0001, respectively) and anagen ratio (p < 0.01, p < 0.01, and p < 0.001) increased in the ASI, ASI + MgB I, and ASI + MgB II groups, telogen ratio decreased (p < 0.01, p < 0.01, and p < 0.001, respectively). In the molecular analysis, VEGF, HGF, and KGF-2 increased in the ASI (p < 0.01, p < 0.01, and p < 0.05, respectively), ASI + MgB I (p < 0.0001 for all), and ASI + MgB II (p < 0.0001 for all) groups when compared to the control group. FGF-2 (p < 0.01) and IGF-1 (p < 0.001) were found to be increased in the ASI + MgB I and ASI + MgB II groups. SIRT-1 and β-catenin increased in the ASI (p < 0.05 and p < 0.01), ASI + MgB I (p < 0.001 for both), and ASI + MgB II (p < 0.0001 for both) groups. Wnt-1 increased in the ASI + MgB I (p < 0.001) and ASI + MgB II (p < 0.0001) groups. In conclusion, the combination of ASI and MgB could promote hair growth by regulating IGF-1, FGF, KGF, HGF, VEGF, SIRT-1, Wnt, and β-catenin signal pathways. It was also established that ASI did not affect nail growth, whereas the MgB combination was effective using a higher dose of biotin.
... 19 Gut bacteria also synthesize biotin as a by-product, an additional source of biotin to the host. 22 Biotin that is not absorbed in the gastrointestinal (GI) tract is excreted in the feces, whereas absorbed serum biotin is excreted through the kidney. 22 In addition to malabsorptive diseases and alcohol use disorder, deficiency can occur in patients with biotinidase deficiency, individuals consuming large amounts of raw egg whites, and pregnant and lactating women. ...
... 22 Biotin that is not absorbed in the gastrointestinal (GI) tract is excreted in the feces, whereas absorbed serum biotin is excreted through the kidney. 22 In addition to malabsorptive diseases and alcohol use disorder, deficiency can occur in patients with biotinidase deficiency, individuals consuming large amounts of raw egg whites, and pregnant and lactating women. 19 Deficiency of biotin can manifest as alopecia ( Figure 6), brittle nails (Figure 7), and dermatitis, particularly involving the face. ...
Article
Micronutrient deficiencies (MNDs) commonly lead to cutaneous abnormalities involving the skin, hair, and nails, and these cutaneous manifestations often provide clues to the existence of the underlying deficiency. MNDs may be present in at‐risk individuals who have impaired absorption or poor dietary intake. The micronutrients that most commonly present with cutaneous findings include the B vitamins riboflavin, niacin, pyridoxine, biotin, and vitamin B12; vitamin C; the fat‐soluble vitamins A, E, and K; the minerals zinc, iron, copper, and selenium; and essential fatty acids. This review will highlight the most common clinical hair, skin, and nail presentations associated with MNDs and an approach to their treatment.
... Badania Patel i wsp. (38) pokazały, że suplementacja biotyną ma wpływ na zmniejszenie wypadania włosów oraz łamliwość paznokci. ...
... Niedobory tej witaminy mogą prowadzić do łysienia, stanów zapalnych skóry oraz wtórnych zakażeń grzybiczych w organizmie wywołanych przez grzyby Candida albicans. Suplementacja biotyną jest korzystna dla polepszenia jakości skóry i włosów (38,39). ...
Article
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Beer is a popular low-alcohol liquor, consumed from antiquity. In addition to the taste values, it can also be considered a natural cosmetic and medicine. The purpose of the work was to describe the use and impact on the skin of beer and brewing raw materials. Beer baths as a therapeutic form were also characterized. Based on the analysis o scientific and industry literature, the types of beer baths and their procedure as well as the potential impact on the organism were described, the knowledge of hops and its antioxidant, bacteriostatic, sedative and estrogenig properties was deepened. The topic of yeast has also been developed as a source of ingredients useful in cosmetology. General information on malt and its potentially anaphylactic activity were presented. Brewery raw materials can be an interesting local specialty of Polish SPAs, but this requires conducting directional analyzes of their cosmetic properties.
... Vitamin, micro-and macroelement deficiencies lead to a number of changes in the skin, mucosa, hair and nails. Table 1 shows the symptoms of deficiency of selected nutrients [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. ...
... Niedobory witamin oraz mikro-i makroelementów prowadzą do wielu zmian w obrębie skóry, błony śluzowej, włosów i paznokci. W tabeli 1 przedstawiono objawy niedoborów wybranych składników odżywczych [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. ...
Article
Crohn’s disease and ulcerative colitis are the most common representatives of non-specific inflammatory bowel diseases. It is a group of chronic diseases of multifactorial and not fully understood aetiology. The characteristic gastro-intestinal symptoms may be accompanied by numerous extraintestinal manifestations. Skin lesions are observed in more than half of patients with inflammatory bowel diseases. Their appearance sometimes precedes development of typical abdominal symptoms. Therefore, the awareness of skin manifestations occurring in the course of inflammatory bowel diseases may contribute to early diagnosis and implementation of therapy.
... There are no known toxicity or adverse effects of receiving high doses of biotin. 5 While the response of splitting, brittle nails (i.e., onychoschizia, onychoschisis) to daily biotin supplementation, irrespective of serum biotin levels, has been demonstrated, 6 little data exists on the frequency of biotin deficiency in the general population and in patients reporting hair loss. 5 Currently, there is no available information on the relationship between hair loss and abnormal biotin levels. ...
... 5 While the response of splitting, brittle nails (i.e., onychoschizia, onychoschisis) to daily biotin supplementation, irrespective of serum biotin levels, has been demonstrated, 6 little data exists on the frequency of biotin deficiency in the general population and in patients reporting hair loss. 5 Currently, there is no available information on the relationship between hair loss and abnormal biotin levels. 7 Biotin deficiency can affect the skin, immune system, and nervous system. ...
Article
BACKGROUND: Biotin is popular in hair loss treatment supplements, although the frequency of its deficiency in patients with hair loss has not been established. OBJECTIVES: This work sought to assess the serum levels of biotin in patients with telogen effluvium. METHODS: This case-control study included 60 patients with telogen effluvium and 20 control subjects. Subjects who were on biotin therapy three months prior to the study and those reporting other causes of hair loss were excluded. The scalp of each patient was clinically and dermoscopically examined. Serum biotin levels were measured using enzyme-linked immunosorbent assay kits. RESULTS: Serum levels of biotin were optimal in patients and control groups with no significant difference between the groups. Insignificantly lower biotin levels in elderly patients, smokers, athletes, those with a history of recurrent infections, and women who were pregnant and/or lactating were observed. There was also an insignificant positive correlation between the serum level of biotin and patient age and an insignificant negative correlation between disease duration and patient body mass index. Serum biotin has a weak specificity and sensitivity in differentiating between cases and control subjects or between acute and chronic telogen effluvium. CONCLUSION: There was no significant difference in serum biotin levels between cases and controls or between those with acute or chronic telogen effluvium.
... Cutibacterium was the most abundant bacterial genus on hair, even though the physical condition of hair seems dry and different from other sebaceous human skin zones. Cutibacterium acnes carries the genes for biosynthesis of biotin, which is an essential nutrient for hair growth and scalp health [11,36,37]. On the other hand, Pseudomonas, the second major bacterial genus present on hair, was not identified in a key role. ...
Article
In this study, we investigated and compared characteristics of the bacterial community structures on hair (scalp hair) and scalp in 18 individuals. Significant differences were found between the sites, in terms of cell density, alpha and beta diversity, and relative abundance of the phyla, Firmicutes and Proteobacteria, whereas no difference was found in relative abundance of the phylum Actinobacteria. Bacteria of the genus Cutibacterium showed similar relative abundance at both sites, whereas those of genus Pseudomonas were highly abundant on hair, and those of genus Staphylococcus were significantly lesser in abundance on hair than on scalp. Statistical correlations between the sites were high for the individual relative abundance of five major operational taxonomic units (OTUs). This suggests that the bacterial community structure on hair is composed of hair-specific genus, Pseudomonas, and skin-derived genera, Cutibacterium and Staphylococcus, and is distinguishable from other human skin microbiomes.
... Patel et al. [26] dissected 18 case-reports of biotin connection with hair and nail development and discovered clinical improvement in the wake of accepting biotin in all cases, and three revealed instances of uncombable hair disorder demonstrated improvement in hair quality following a couple of long periods of biotin treatment. ...
... A ingestão insuficiente de vitaminas, minerais, proteínas e ácidos graxos essenciais causada por dietas restritivas, inadequadas, erros inatos do metabolismo ou modificações anatômicas dos sítios de absorção levam a anormalidades estruturais, de pigmentação ou até mesmo à perda do fio [2,5,6,8,9,10,11,12]. Como exemplo temos a desnutrição energético-proteico, pacientes submetidos a grandes cirurgias, como retiradas de tumores, cirurgia bariátrica e metabólica (CBM) [13,14,15]. ...
Article
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Introduction: Beauty is directly linked to the appearance of hair, always and in all cultures. Being nutrition an important tool for hair health, since the hair follicle cells present several cycles of continuous growth, constantly renewing themselves, and their active metabolism requires an adequate supply of nutrients and energy. Objective: The objective of this study was to evaluate the impact of dietary supplements on hair health. Material and Method: A bibliographic review was carried out in the main health databases: SciElO, Medline, Lilacs with the descriptors: Nutrients, polyphenols, hair in Portuguese and English, considering the period from 2010 to 2020. Results: 209 studies were found, 11 were included and 195 were excluded because they did not meet the eligibility criteria. Conclusion: The analysis of the literature allowed us to conclude that nutrition is closely related to hair health, acting in the entire process of growth and maintenance of hair follicle cells. Nutritional prescription of nutrients is important for maintaining capillary health. However, more randomized clinical studies should be carried out to confirm its effects and establish the appropriate dose of dietary supplements to prevent alopecia.
... Supra-physiologic biotin supplementation is used in various conditions, such as hair and skin problems, inborn errors of metabolism, mitochondrial disorders, and multiple sclerosis (up to 300 mg per day for this indication) or in the aim to alleviate muscle cramps in hemodialysis patients [2,3,[25][26][27][28]. These patients are likely to undergo virological evaluations. ...
Article
Background: Biotin has been reported to be a leading cause of interference on several immunoassay platforms using the streptavidin-biotin immobilization system. While biotin interferences have now been well characterized for several assays, only few data are available on their impact on serological markers of infectious viral diseases. Methods: Overall, 10 healthy volunteers (HVs) received a single 100mg dose of biotin to evaluate its effect on hepatitis B serological markers. Blood samples were taken several times before and after biotin intake. In addition, spiking experiments were applied to investigate biotin's impact on anti-HIV/p24 Ag and anti-HCV antibody levels. Several procedures designed to overcome this interference were evaluated. Results: Biotin intake resulted in a false-negative anti-HBs immunological status (<10 mIU/mL) in 40.0% of cases. According to our anti-HBc and anti-HBe results, biotin intake was associated with 90.0% and 80.0% of false positive results, respectively. At the theoretical biotin peak concentration following a 100mg intake, 50.0% and 66.6% of anti-HIV and anti-HCV results were false negatives, respectively. All the procedures evaluated to overcome the interference were proven effective. Conclusion: HBV, HCV, and HIV serological markers are likely to be highly sensitive to biotin. Our data confirm that the scope of biotin interference is broader than commonly described.
... Clinical, Cosmetic and Investigational Dermatology 2022:15 biotin levels. In 2017 Patel el al conducted a systematic review of the use of biotin for hair loss conditions 30 and concluded that only patients suffering from biotin deficiency do achieve clinical improvement after daily biotin supplementation, whereas no benefit is seen in individuals with normal baseline biotin levels. ...
Article
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Post-COVID-19 telogen effluvium has been largely reported as a sequela in the post-acute phase of COVID-19, causing major emotional distress among the affected patients. The affected individuals are further exposed to a vast amount of misinformation from the internet and social media and it is important for physicians to be familiar with the phenomenon and provide appropriate counselling to their patients regarding this condition. This article aims to review the evidence-based complementary strategies that can help enhance hair regrowth after post-COVID-19 hair loss, from psychological support and patient education to the importance of optimal nutrition and potential indications and benefits of oral nutritional supplementation, as well as the role of both topical and injectable hair growth stimulators.
... There are also studies suggesting that empirical biotin replacement is not beneficial in diffuse hair loss (25). Biotin treatment can work if any enzyme deficiency is detected. ...
... non-effective [31]. A longer study is needed to confirm the efficacy on nail thickness as well. ...
... Patients with acquired or congenital biotin deficiency, for example, may experience hair loss and would benefit from supplementation. However, no benefit from supplementation has been seen in those with normal baseline biotin levels [11]. ...
Article
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Background and objective Dietary supplements advertised to "boost collagen" or for "skin, hair, and nail" health are becoming increasingly popular, despite a lack of evidence to support their use. These products are not regulated by the United States (U.S.) Food and Drug Administration (FDA), and hence there is no centralized database listing current products. The goal of this study was to document and examine the labeling and marketing methods of these products. Methods Supplements including the words "glow," "beauty," "skin," "hair," or "nails" on the label were included in the sample. Seven stores within a 3-mile radius were included. Results A total of 176 unique supplements were identified. It was found that most products lacked independent testing; many utilized outdated daily values (DVs) of nutrients. Some had confusing dosing instructions, and most products made health-related marketing claims. Conclusion Dermatologists and primary care providers should be aware of the marketing claims commonly made by these products. Patients should be educated that these claims are generally not verified by independent testing agencies, the U.S. FDA, or by high-quality randomized control trials.
... Biotin supplementation has long time being discussed as helpful in hair growth disorders. A recent meta-analysis conducted by Patel et al. [27] confirmed the positive influence biotin has on hair and nail growth disorders. ...
... Similarly, improving the intake of some micronutrients such as calcium, iron and folic acid could lead to an improvement of hair follicle healthiness. Most interestingly, all analyzed groups reported a lower intake of vitamin D and biotin, two micronutrients strongly involved in hair follicle development (Finner, 2013;Chiu et al., 2015;Patel et al., 2017). The benefits of dietary intervention would be not be limited to hair follicle development itself, but also extended to the modulation of the microbial ecosystem around the hair follicle. ...
Article
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Introduction: The impact of diet on hair growth disorder is well established as the influence of diet on the gut microbiome. Poor information is still available as regards the link between microbiome, especially scalp microbiome and hair diseases. Aim: In the present work, we reported data on patients affected by Alopecia areata with the aim to study the impact of the diet on microbiome changing related to scalp disease. Methodology: Data from the dietary survey, qRT-PCR on main bacterial strains inhabiting the scalp were matched and compared each other and with healthy population. Results: Beyond the diet’s well-known impact on general human health, our results highlighted the role of one’s diet in modifying scalp microbiome, which in turn seems to have an impact on AA evolution. Conclusions: Our results provide the first evidence of strict intercorrelation between microbial dysbiosis on the scalp of patients with AA and dietary habits.
... Indicative of Vitamin B7 (biotin) [6] and calcium deficiency. ...
Article
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Kashyapa Samhita is the only Ayurveda classical text, which deals exclusively with pediatric anatomy, physiology, pathology, and its management. Out of which, chapter number 28 - Lakshanadhyaya has a detailed description of anatomical and physiological features of the child and correlated it with clinical, professional, social, and spiritual fortunes. But, Lakshanadhyaya is incomplete at the end. Objective: To reveal the clinical importance of features mentioned in Lakshanadhyaya and to provide probable justification for particular future predictions given in Lakshanadhyaya. Data Source: Lakshanadhyaya of Kashyapa Samhita published by Chaukhambha Sanskrit Sansthan, Varanasi. Materials and Methods: Relevant materials were searched from sources such as published books, journals, and the Internet. A critical review was done over the same. Result: Acharya Kashyapa has predicted the quality and quantity of life by assessment of anatomical and physiological features of the child from birth till adolescence. All clinical points such as signs of gestational maturity (by examining the skin, hair, movement, and genitals), anthropometry (size of body parts), secondary sex characters (such as pubic hair, breast, and genitals), and systemic examinations (such as per vaginal, per rectal, musculoskeletal, and per abdomen examinations) are covered in Lakshanadhyaya. Conclusion: This article highlights that time to time examination of a child helps to predict their future life. The abdomen, vagina, nail, scrotum, penis, hair, joints, back, gait, etc., are important areas of examination for early detection of impending clinical manifestation.
... Although biotin may offer some clinical benefits to patients with hair or nail disorders (e.g., brittle nail syndrome), there is limited evidence to support the use of biotin supplementation in healthy individuals [34][35][36][37][38][39]. The US Food and Drug Administration (FDA) regulates vitamin products and other dietary supplements once they have entered the marketplace [40][41][42]. ...
Article
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Dietary biotin intake does not typically result in blood biotin concentrations that exceed interference thresholds for in vitro diagnostic tests. However, recent trends of high-dose biotin supplements and clinical trials of very high biotin doses for patients with multiple sclerosis have increased concerns about biotin interference with immunoassays. Estimates of the prevalence of high biotin intake vary, and patients may be unaware that they are taking biotin. Since 2016, 92 cases of suspected biotin interference have been reported to the US Food and Drug Administration. Immunoassays at greatest risk from biotin interference include thyroid and reproductive hormones, cardiac, and immunosuppressive drug tests. Several case studies have highlighted the challenge of biotin interference with thyroid hormone assays and the potential misdiagnosis of Graves' disease. Biotin interference should be suspected when immunoassay test results are inconsistent with clinical information; a clinically relevant biotin interference happens when the blood biotin concentration is high and the assay is sensitive to biotin. We propose a best practice workflow for laboratory scientists to evaluate discrepant immunoassay results, comprising: (1) serial dilution; (2) retesting after biotin clearance and/or repeat testing on an alternate platform; and (3) confirmation of the presence of biotin using depletion protocols or direct measurement of biotin concentrations. Efforts to increase awareness and avoid patient misdiagnosis should focus on improving guidance from manufacturers and educating patients, healthcare professionals, and laboratory staff. Best practice guidance for laboratory staff and healthcare professionals would also provide much-needed information on the prevention, detection, and management of biotin interference.
... We excluded biotin and zinc pyrithione from our in vitro cell culture experiments since biotin and zinc pyrithione are widely used in cosmetic products and show cytotoxicity at certain temperature ranges. Though the use of biotin or zinc pyrithione as a hair growth supplement is prevalent, research demonstrating the efficacy of biotin [27] or zinc pyrithione is limited [28]. ...
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Sulforaphane increases the expression of the dihydrotestosterone (DHT)-degrading enzyme, 3α-hydroxysteroid dehydrogenase (3α-HSD) in the liver, which accelerates DHT degradation, thereby inhibiting hair loss in the animal model. In this study, we elucidated its underlying mechanism and demonstrated that sulforaphane has hair loss inhibitory functions in RAW264.7 macrophage cells and Hepa1c1c7 cells at the cellular and gene levels. The gene expression level of an isoform of 3α-HSD, Akr1c2, increased in a dose-dependent manner when these cells were treated with sulforaphane, but there were no significant differences at the gene levels of Akr1c2 and Dhrs9 for the negative control mixture of biotin, dexpanthenol, and L-menthol. These studies indicated that sulforaphane is involved in regulating the gene expression of Akr1c2. To further determine whether this hair product has effects on alleviating hair loss symptoms, clinical trials were also conducted for 18 weeks. We performed a visual evaluation of the parietal and frontal lines of 23 patients before and after using the product, and then calculated the total number of hairs. This clinical study showed that the parietal lines and bangs visually improved and the number of hairs increased by 6.71% from before using the test product to 18 weeks after using the test product. Taken together, these cellular and clinical studies strongly suggest that sulforaphane may be an active ingredient that significantly alleviates hair loss symptoms.
... Biotin is a water-soluble vitamin that has been recently used in many over-the-counter supplements to improve hair and nail health [1]. The recommended daily dose of biotin is 30 μg/day [2]. ...
Article
Biotin is a component of the B-complex vitamins that has been widely used in over-the-counter supplements. The effects of biotin on thyroid function tests (TFTs) have been recently reported by multiple authors. We report here a case of a patient who presented with TFTs consistent with hyperthyroidism and a positive radioactive iodine uptake (RAIU) scan while taking biotin supplements. The TFTs normalized almost a month later and continued to be normal even after resumption of biotin supplements. Interpreting TFTs while patients are taking biotin could pose a diagnostic challenge, so we suggest more frequent monitoring for those patients before starting them on long-term anti-thyroid medications.
... 6 Biotin (vitamin B7 or H) acts as an essential cofactor for carboxylase enzymes in multiple metabolic pathways. 7 The role of biotin in protein synthesis, and in the production of keratin, explains its contribution to the healthy growth of hair. 8 During mesotherapy, the trauma of the injection has mild effects; however, the psychological impact of this therapy is significant and strongly influences patients' satisfaction. ...
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Androgenetic alopecia (AGA) is the most common type of alopecia. Currently, only topical minoxidil and oral finasteride, for men, are approved for its treatment. We report a case of a patient with male pattern AGA treated with topical minoxidil and oral finasteride for 2 years, with partial improvement. At this point, we added mesotherapy to the previous treatment. The patient had 20 sessions of sterile mesotherapy blend, containing minoxidil, finasteride, biotin, and D‐panthenol. We did the injections every two weeks and made the response assessment with global clinical photographs at the 10th and the 20th sessions when we noted a significant visible improvement in hair density and thickness. Mesotherapy or intradermotherapy is defined as a technique that involves the use of multiple intradermal injections of a mixture of compounds in low doses, at many points, near/over the affected sites. In our case, the patient had an excellent response to intradermotherapy as an adjunctive treatment, with no side effects. Although we still need additional clinical trials to standardize the therapy and treatment guidelines, mesotherapy seems to be a therapeutic option in the treatment of AGA, especially if the procedure happens in a medical facility, with correct indication and adequate execution of this promising technique.
... The three modules for biotin metabolism, M00123, M00573 (BioI), and M00577 (BioW), which are involved in the biosynthesis of biotin from Pimeloyl ACP/CoA were also enriched in the healthy scalp ( Figure S12). Biotin is a necessary cofactor for carboxylase enzymes that play a major role in metabolic processes including glycolysis, fatty acid synthesis, and amino acid metabolism, and is an essential scalp nutrient for hair growth and scalp health (Patel et al., 2017). It is also reported to play a vital role in protein synthesis and more precisely in keratin production, which is essential for healthy hair growth (Chiu et al., 2015). ...
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Several scalp microbiome studies from different populations have revealed the association of dandruff with bacterial and fungal dysbiosis. However, the functional role of scalp microbiota in scalp disorders and health remains scarcely explored. Here, we examined the bacterial and fungal diversity of the scalp microbiome and their potential functional role in the healthy and dandruff scalp of 140 Indian women. Propionibacterium acnes and Staphylococcus epidermidis emerged as the core bacterial species, where the former was associated with a healthy scalp and the latter with dandruff scalp. Along with the commonly occurring Malassezia species (M. restricta and M. globosa) on the scalp, a strikingly high association of dandruff with yet uncharacterized Malassezia species was observed in the core mycobiome. Functional analysis showed that the fungal microbiome was enriched in pathways majorly implicated in cell-host adhesion in the dandruff scalp, while the bacterial microbiome showed a conspicuous enrichment of pathways related to the synthesis and metabolism of amino acids, biotin, and other B-vitamins, which are reported as essential nutrients for hair growth. A systematic measurement of scalp clinical and physiological parameters was also carried out, which showed significant correlations with the microbiome and their associated functional pathways. The results point toward a new potential role of bacterial commensals in maintaining the scalp nutrient homoeostasis and highlights an important and yet unknown role of the scalp microbiome, similar to the gut microbiome. This study, therefore, provides new perspectives on the better understanding of the pathophysiology of dandruff.
... As one example, biotin deficiency leading to hair loss may be improved with supplementation, but has not shown efficacy in hair loss overall. 78,79 In the case of AOs, supplements have not shown benefit and in some cases have shown harm. AO supplements were the subject of much research, given promising observational human studies of dietary intake as well as laboratory and animal studies. ...
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There is growing awareness of the complex link between nutrition and skin. In the last few decades, our understanding of this link has grown significantly with research findings from multiple laboratory, animal, and human studies. From the impact of diet on clinical features of aging skin, to documentation of the biochemical and histologic changes that occur, our understanding of this link continues to expand and evolve. In this paper, we review the research on the impact of diet on skin aging. A number of long-term observational population studies have documented that healthier diets are linked to fewer signs of skin aging. Animal and laboratory studies have elucidated the biochemical processes that play a large role in the development of these clinical findings. A number of studies have also reported on the role of specific dietary compounds in impacting these processes, whether by combating or potentiating these forces. This body of research serves as guidance in recommending nutritional strategies that can combat the skin aging forces of oxidation, inflammation, and glycation.
Article
One of the most common micronutrient deficiencies with cutaneous findings is the vitamin B, also known as biotin, deficiency. Biotin deficiency may be due to congenital lack of biotinidase, or acquired following some conditions that interfere with its absorption, such as inflammatory bowel disorders, a diet too rich in avidin, magnesium deficiency, smoking habit and treatment with broad-spectrum antibiotics, anticonvulsants and sulfonamides. This review highlights the role of biotin in the most common skin disorders such associated with biotin deficiency and an approach to their treatment. Biotin administration may improve the treatment of hair loss when deficiency is detected on the basis of a careful patient history, clinical examination and the determination of serum biotin levels. The use of biotin is rationale in seborrheic dermatitis as the vitamin intercepts the main metabolic pathways underlying the pathogenesis of the disease. Treatment with biotin could also be useful in comedonal acne characterized by a high rate of seborrhea, and may be helpful for acne treated with topical retinoids, contributing to the control of flaking and irritation. The tolerability of biotin is excellent and there is no risk of hypervitaminosis even in the case of high doses. It is important that administration is controlled by physicians and follows a medical diagnosis and prescription. Correct doses used in dermatological conditions are safe and are not at risk of interference with laboratory tests.
Article
Background Biotin is an essential cofactor for metabolic pathways in humans. It is frequently self-prescribed by consumers and often recommended by dermatologists and primary care physicians, despite limited evidence of its effect on skin, hair, and nail disorders. A recent Food and Drug Administration (FDA) warning stated that biotin can interfere with laboratory tests. Objectives Our objectives were to determine the perception of biotin by Amazon consumers, including perception of improvement in hair, skin, or nails with biotin supplementation and consumers’ awareness of the FDA warning on biotin. Methods The keyword biotin was searched on Amazon.com, and the top 1 percentile of biotin products according to average consumer review were analyzed for dosage, indications, price, quantity, warnings, number, and average score of reviews. Results From 16 biotin products analyzed, the mean review score was 4.38. The mean percentage of reviews stating that biotin helped hair, nails, and skin was 27.2%, 15.03%, and 2.8%, respectively. No biotin products mentioned the FDA warning, and only 1 reviewer referenced the warning. Conclusions These findings suggest that biotin supplementation is prevalent and perceived as helpful despite limited evidence of improvement. The majority of biotin users were unaware that biotin interacted with laboratory testing demonstrating the need for biotin manufacturers to include a warning label about the FDA warning and for physicians to warn their patients on the risks and benefits of biotin supplementation.
Article
Background Biotinidase deficiency is a treatable metabolic disease that can be seen with various neurological and dermatological complications. Biomarkers such as alanine, propionylcarnitine (C3) and 3-hydroxyisovalerylcarnitine (C5-OH), which are used to diagnose biotinidase deficiency, are also present. Materials and methods In cases with partial biotinidase deficiency and normal biotinidase activity, alanine, C3 and C5-OH levels were compared in the field by liquid chromatography-tandem mass spectrometry. Results There was no significant difference between subjects with partial biotinidase deficiency and those with normal biotinidase activity between C3 and C5-OH levels. The mean alanine levels in heel blood and plasma were significantly higher than those with normal biotinidase activity in patients with partial biotinidase deficiency. Conclusion In cases with partial biotinidase deficiency, the heel blood alanine level that can be detected in the neonatal screening program may be a leading marker in diagnosis.
Article
Background Male androgenetic alopecia (MAGA) is caused by the conversion of the terminal to vellus hair. Zinc is one of the most studied trace elements in hair disorders and biotin is one of the most prescribed supplement for its treatment. Objectives The study aimed to evaluate serum zinc and biotin levels in MAGA patients to answer the question if there is a value to add zinc or biotin as a supplements in the MAGA treatment. Patients and Methods Sixty MAGA patients and 60 age, sex, and body mass index‐matched healthy volunteers were included. We measured serum biotin and zinc in all participants. Results Zinc (µg/dL) was lower significantly in patients compared to controls (P = 0.01), suboptimal biotin (ng/L) levels were in patients, and within normal values in controls (P = 0.01). A positive significant correlation was found between serum zinc and serum biotin (r = 0.489, P = 0.001). Serum zinc and biotin showed a nonsignificant correlation with age and disease duration. A non‐significant relation was obtained between the MAGA grades, and zinc (P = 0.485) and biotin levels (P = 0.367). Conclusions Serum zinc showed subnormal value and adding zinc supplement in MAGA treatment is recommended. Serum biotin showed a suboptimal level in MAGA patients that is not correlated with patients’ age or disease severity. Biotin supplement in MAGA treatment may add value to hair quality and texture. We recommend future biotin evaluation in serum combined with its metabolites in MAGA patients’ urine.
Chapter
Biotin (vitamin B7 or vitamin H), a member of vitamin B complex, acts as a cofactor for five biotin-dependent carboxylases, thus playing critical roles in gluconeogenesis, fatty acid synthesis and amino acid catabolism. Although rare inborn errors of metabolism may cause biotin deficiency, these can be successfully treated with biotin supplementation. In general, normal individuals do not get any benefit from taking biotin supplement. Nevertheless, biotin use remains widespread for growing healthy hair and nail. Unfortunately, the use/overuse of supplemental biotin may interfere with immunoassays that incorporate biotinylated antibody in assay design. Biotin if present in elevated concentration in serum or plasma, may falsely increase analyte concentration using competitive immunoassay (positive interference). In contrast, biotin shows negative interference if sandwich immunoassay format is used. Such interferences may cause diagnostic error, most commonly in cases of hyperthyroidism due to (1) positive interference of biotin in free triiodothyronine (FT3) and free thyroxine (FT4) assays (competitive format) and (2) negative interference in thyroid stimulating hormone (TSH) assay (sandwich format). In this review, I explore the biochemistry of biotin and discuss its role as a potential interferent in immunoassay formats that are biotin based.
Article
Introduction Biotin supplementation (mainly OTC preparations) has gained popularity. There are concerns about biotin interference in immunoassays and potential misdiagnosis, especially since the discovery of high dose therapy in MS. This review summarizes the dangers of biotin usage and possible countermeasures. Methods Immunoassays design determines whether positive or negative analytical errors may occur. Techniques using biotinylated reagent and biotin binding proteins may generate errors. In sandwich immunoassays, biotin causes lowered results. Competitive immunoassays are more vulnerable: biotin usage causes false increased results. The interference is platform dependent. Parameters vary in their susceptibility: a combination of false positives and negatives mimicking a coherent profile is dangerous, e.g. combining falsely lowered TSH with falsely elevated FT4/FT3 mimicking hyperthyreosis. Other susceptible parameters are thyroglobulin, DHEA-S, estradiol, testosterone, ferritin, progesterone, Vitamin D, Vitamin B12, PSA, PTH, LH, FSH, Troponins I and T, Pro-BNP. Digoxin and PSA may also be affected. Tumor markers and ß-hCG are robust. Inserts of serological markers of HIV, hepatitis B and C warn for biotin interference. Results Manufacturers have made assays less vulnerable for biotin interference. In doubtful cases, it is helpful to determine testosterone in females and estrogen in males. Both are elevated if biotin interference is present. Biotin supplementation should be discontinued. However, this is impossible in MS patients needing biotin, as interrupting this medication is discouraged. Conclusions Solutions to overcome this interference are: informing patients prior to analysis (avoiding peak biotin values when sampling), choice of appropriate immunoassays, and use of biotin removing steps prior to analysis.
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Given the rise in worldwide chronic diseases, supplemented by an aging population, the volume of global major surgeries, encompassing cardiac and orthopedic procedures is anticipated to surge significantly. Surgical trauma can be accompanied by numerous postoperative complications and metabolic changes. The present review summarized the results from studies assessing the effects of orthopedic and cardiovascular surgery on vitamin concentrations, in addition to exploring the possible mechanisms associated with changes in concentrations. Studies have revealed a potentially severe depletion in plasma/serum concentrations of numerous vitamins following these surgeries acutely. Vitamins C, D and B1 appear particularly vulnerable to significant depletions, with vitamin C and D depletions consistently transpiring into inadequate and deficient concentrations, respectively. The possible multifactorial mechanisms impacting postoperative vitamin concentrations include changes in hemodilution and vitamin utilization, redistribution, circulatory transport and absorption. For a majority of vitamins, there has been a lack of investigation into the effects of both, cardiac and orthopedic surgery. Additionally, studies were predominantly restricted to short-term postoperative investigations, primarily performed within the first postoperative week of surgery. Overall, results indicated that further examination is necessary to determine the severity and clinical significance of the possible depletions in vitamin concentrations that ensue cardiovascular and orthopedic surgery.
Article
Biotin film was prepared by low-energy electron beam deposition (LEBD). The molecular structure, chemical composition and micromorphology of the biotin film were investigated by ¹HNMR, FTIR, XPS, AFM and SEM. The results showed the molecular structure of a monolayer of biotin film is fully consistent with the molecular structure of the initial biotin powders. The contact angle test showed that the biotin film exhibit good hydrophilicity. The release kinetics of biotin film was tested by UV–Vis method. It was found that the film was almost completely released in about two weeks. The cell viability of MC3T3-E1 cells on the surface of the biotin film was attaining 100.54 ± 1.7% (P < 0.05), showing excellent biocompatibility and biosafety. Titanium implant with surface of biotin film was implanted into the femoral head of rabbits as experimental group. The animals were euthanized after four weeks. Compared with the control group, mature lamellar bone formation was observed with dense trabecular bone, and the expression of Coll-I, Runx2 and BMP-2 was better. The results showed that the repair effect of bone defect in the experimental group was excellent.
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In recent years and over the previous few decades, the evolution of bioactive molecules embedded with the heterocyclic scaffolds has attracted considerable awareness in drug-discovery research and medicinal chemistry. Analysis of the U.S. FDA-approved drugs database acknowledges that 59% of particular drugs are related to small molecules embedded with a heterocycle containing nitrogen atom. Among these, azole-based compounds are particularly interesting because of their broad range of pharmacological activities. The solitary constitutional ingredient of azole moiety with reasonable electron-abundant aspect is advantageous for azole compounds to easily bind with various receptors and enzymes in the biological environment through unique specific interactions, which contributes to innumerous valuable biological properties. The related development and research findings of azole derivatives on pharmaceutical chemistry have arisen as a swiftly developing and progressively active topic. This activity consistently delivers a comprehensive overview on current improvements in biological action and pharmacological activity of azole derivatives in the wide spectrum of pharmaceutical chemistry as anti-inflammatory, anticancer, antihypertensive, antibacterial, antiparasitic, anti-neuropathic, antiviral, anti-obesity, antihistaminic, antitubercular, anti-HIV, antifungal and other medicinal agents. This is the first comprehensive overview of biological and pharmacological activity of azole family, which will assist the readers in understanding the SAR on azole-containing drugs and other medicinally active azole molecules. The basis of substitution pattern on thiazole ring will lead the medicinal chemist towards further developments.
Article
Background and objective: As a minimally invasive procedure, mesotherapy has been used in the cosmetic field for half a century and gets favorable results in fat reduction, facial rejuvenation, and hair regrowth. So far, it has achieved some exciting progression in pattern hair loss (PHL), which bothers plenty of people and has cost billion dollars searching for more effective treatment. The aim of this study is to summarize the efficacy of mesotherapy treating PHL. Methods: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science were searched until January 2021. All literature was evaluated according to established criteria. Results: We got 336 studies from searched databases, and 12 studies were included after selection process. A total of 253 males and 274 females participated in 6 randomized control trials, 2 non-randomized controlled trials and 3 observational studies. Mesotherapy showed positive efficacy in all studies to a certain extent and no significant side effect occurred. Conclusion: Mesotherapy demonstrated as an effective treatment for PHL. However, the sample size is not big enough and studies about mesotherapy compared to other treatments are insufficient. Future research is required to claim more evidence.
Chapter
The quantity and quality of hair are closely related to the nutritional state of an individual. In instances of protein and calorie malnutrition, deficiency of essential amino acids, of trace elements, and of vitamins, hair growth and pigmentation may be perturbed. The effects of nutrition on hair growth and pigmentation have been recognized from observations in rare inborn errors of metabolism of copper (Menkes kinky hair syndrome), zinc (acrodermatitis enteropathica), biotin (biotinidase and holocarboxylase synthetase deficiency), and amino acids (homocystinuria, Hartnup disease, phenylketonuria, and methionine malabsorption syndrome), in specific acquired deficiency disorders, and from the respective supplementation studies. All vitamins were identified by 1948, ushering in a half century of discovery focused on single-nutrient-deficiency diseases. The first half of the twentieth century witnessed the identification and synthesis of many of the known essential vitamins and minerals and their use to prevent and treat nutritional deficiency-related diseases, specifically protein-calorie malnutrition, deficiencies of biotin, vitamin C, vitamin B12, niacin, essential fatty acids, iron, zinc, copper, selenium, and vitamin D. Accelerating economic development and modernization of agricultural, food processing, and food formulation techniques continued to reduce single-nutrient-deficiency diseases globally. In response, nutrition science shifted to the research on the role of nutrition in more complex conditions, such as gluten sensitivity, obesity, bariatric surgery, anorexia and bulimia, alcoholism, aging, and the oncologic patient. Additional complexity may arise in nutritional recommendations for general well-being versus treatment of specific conditions. Recognition of complexity is a key lesson of the past. Initial observations lead to reasonable, simplified theories that achieve certain practical benefits, which are then inevitably advanced by new knowledge and recognition of ever-increasing complexity.
Article
Background The short anagen syndrome (SAS) is a rare idiopathic pediatric disorder characterized by the short duration of the anagen phase. SAS mainly affects Caucasian children. Parents complain of their child's inability to grow long hair. Topical minoxidil may be an effective treatment for SAS; however, a slow spontaneous improvement is typical. Objective Our aim was to collect data on out cases of SAS and create an algorithm to facilitate diagnosis of SAS. Methods A retrospective review of 25 patients with SAS was performed within the Dermatology Department of the University of Bologna. We collected data regarding symptoms, pull test, hair card test, trichoscopy, trichogram, treatments, including biotin and minoxidil, and clinical outcome. Results Characteristic findings included parental reporting that the hair had not required a haircut, hair card test showing hairs with conical-shaped tips, and hair shafts of different diameters, with more 10%-20% of hair shafts less than 60 μm thick on trichoscopy. Trichogram revealed an increased percentage of telogen hair with normal hair shafts and tapering ends. The mean anagen-to-telogen ratio was 66:34 (normal ratio 90:10). Conclusion We developed an algorithm to facilitate the diagnosis of this rare hair disease using clinical examination and invasive and non-invasive testing to differentiate SAS from other forms of pediatric alopecia. In conclusion, the collected data of the therapy showed that biotin alone or in combination with topical minoxidil is an effective treatment for SAS.
Article
delete Edited by K O'Connor, L J Golderg Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.
Article
The nail is a specialized keratinous skin appendage that is often overlooked, even though nail disorders comprise approximately 10% of all dermatologic conditions. We provide an overview on the basic anatomy of the nail and function of each structure. We examine the chemical profile, including the keratin and mineral composition, of the nail plate. Subsequently, nail manifestations are reviewed, as virtually every nutritional deficiency can affect nail growth in some manner. We focus on how each nutritional deficiency can affect the different anatomic structures of the nail unit. The terminology and the differential diagnoses of the many different nail plate and nail bed abnormalities are reviewed. Finally, we focus on the evidence behind nutrition-based treatments in the setting of several nail disorders
Article
Side effects of nutritional supplements, Edited by F. Anselmo, M.S. Driscoll Where on earth did the copy editor decide to do this?Abstract Vitamin and mineral supplement consumption is widespread. They are taken for a variety of conditions, including dermatologic disorders. Although consumers often assume these supplements are safe, excessive consumption of supplements may have deleterious effects. Such vitamin supplements include vitamin A, niacin, biotin, vitamin D, and vitamin E, and specific mineral supplements include zinc, copper, and iron. These supplements may have a number of potential adverse effects.
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Brittle nails are a polymorphic disorder characterized by increased fragility or loss of flexibility of the nail plate. The prevalence is approximately 20%, with women being nearly twice as likely to be affected than men. Patients may complain of both aesthetic and functional problems. The cardinal clinical features are onychoschizia, or lamellar splitting and peeling of the nail plate’s free edge, and onychorrhexis, or longitudinal ridging of the nail plate. The pathophysiology is not fully understood, and there are few evidence-based treatments. In this chapter, we review the etiology, history, physical findings, and treatment options for brittle nails.
Article
Background Over the past decade, use of high-dose biotin has increased significantly and can lead to erroneous results on some clinical immunoassays. In collaboration with pharmacists at our institution, we discovered that high biotin doses were being administered to inpatients as a continuation of patient-reported home biotin use. Methods This retrospective study evaluated high-dose biotin administration in 226 inpatient encounters from 2009 to 2019 and its potential impact on concurrent immunoassay testing. Results In 96% of cases, biotin was administered in the inpatient setting as a continuation of patient-reported home use. In total, 322 immunoassays capable of biotin interference were performed across 100 inpatient encounters with high-dose biotin administration. Troponin T and TSH were the most commonly performed immunoassays in this cohort. Discussion Even though less than 5% of all high-dose biotin orders at our institution are placed for inpatients, hospitalized patients are still at risk for mismanagement due to erroneous immunoassay results. Immunoassay testing susceptible to biotin interference was performed in approximately 45% of inpatient encounters with biotin administration. Laboratories utilizing biotin-susceptible, sensitive cardiac troponin assays should be particularly cautious. Pharmacokinetic data for biotin clearance is especially lacking for certain populations likely to be hospitalized, such as those with renal failure. Given that medical conditions requiring high-dose biotin therapy are extremely rare, we recommend restricting biotin dosing during inpatient encounters for all other patients.
Article
Hair supplements are a vast and growing industry. Patients often turn to oral supplements to address hair concerns as they are easily accessible. There are numerous products on the market, many with thousands of reviews (both positive and negative). Nutritional supplements are regulated by the FDA as foods instead of drugs, meaning they do not have to prove their efficacy and safety before becoming available to consumers. While some oral supplements have strong evidence supporting their use for hair growth, many ingredients have not been tested in clinical trials, have only in vitro evidence for hair growth, or have only been tested in animals. Given these industry characteristics, it is important for dermatologists to be aware of the safety and utility of these ingredients to provide appropriate counseling to their patients. The goal of this review is to evaluate the efficacy of popular hair growth oral supplement ingredients and formulations. This review does not address the topical formulations of these ingredients and their effects on hair growth.
Article
Over‐nutrition and its late consequences are a dominant theme in medicine today. In addition to the health hazards brought on by over‐nutrition, the medical community has recently accumulated a roster of health benefits with obesity, grouped under “obesity paradox”. Throughout the world and throughout history until the 20th century, under‐nutrition was a dominant evolutionary force. Under‐nutrition brings with it a mix of benefits and detriments that are opposite to and continuous with those of over‐nutrition. This continuum yields J‐shaped or U‐shaped curves relating body mass index to mortality. The overweight have an elevated risk of dying in middle age of degenerative diseases while the underweight are at increased risk of premature death from infectious conditions. Micronutrient deficiencies, major concerns of nutritional science in the 20th century, are being neglected. This “hidden hunger” is now surprisingly prevalent in all weight groups, even among the overweight. Because micronutrient replacement is safe, inexpensive, and predictably effective, it is now an exceptionally attractive target for therapy across the spectrum of weight and age. Nutrition‐related conditions worthy of special attention from caregivers include excess vitamin A, excess vitamin D and deficiency of magnesium.
Article
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Human biotin turnover and requirements can be estimated on the basis of (1) concentrations of biotin and metabolites in body fluids, (2) activities of biotin-dependent carboxylases, and (3) the urinary excretion of organic acids that are formed at increased rates if carboxylase activities are reduced. Recent studies suggest that the urinary excretions of biotin and its metabolite bisnorbiotin, activities of propionyl-CoA carboxylase and beta-methylcrotonyl-CoA carboxylase in lymphocytes, and urinary excretion of 3-hydroxyisovaleric acid are good indicators of marginal biotin deficiency. On the basis of studies using these indicators of biotin deficiency, an adequate intake of 30 microg (123 nmoles) of biotin per day is currently recommended for adults. The dietary biotin intake in Western populations has been estimated to be 35 to 70 microg/d (143-287 nmol/d). Recent studies suggest that humans absorb biotin nearly completely. Conditions that may increase biotin requirements in humans include pregnancy, lactation, and therapy with anticonvulsants or lipoic acid.
Article
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Biotin is a water-soluble vitamin that serves as an essential coenzyme for five carboxylases in mammals. Biotin-dependent carboxylases catalyze the fixation of bicarbonate in organic acids and play crucial roles in the metabolism of fatty acids, amino acids and glucose. Carboxylase activities decrease substantially in response to biotin deficiency. Biotin is also covalently attached to histones; biotinylated histones are enriched in repeat regions in the human genome and appear to play a role in transcriptional repression of genes and genome stability. Biotin deficiency may be caused by insufficient dietary uptake of biotin, drug-vitamin interactions and, perhaps, by increased biotin catabolism during pregnancy and in smokers. Biotin deficiency can also be precipitated by decreased activities of the following proteins that play critical roles in biotin homeostasis: the vitamin transporters sodium-dependent multivitamin transporter and monocarboxylate transporter 1, which mediate biotin transport in the intestine, liver and peripheral tissues, and renal reabsorption; holocarboxylase synthetase, which mediates the binding of biotin to carboxylases and histones; and biotinidase, which plays a central role in the intestinal absorption of biotin, the transport of biotin in plasma and the regulation of histone biotinylation. Symptoms of biotin deficiency include seizures, hypotonia, ataxia, dermatitis, hair loss, mental retardation, ketolactic acidosis, organic aciduria and also fetal malformations. This review focuses on the deficiencies of both biotin and biotinidase, and the medical management of such cases.
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The literature reveals what little is known about nutritional factors and hair loss. What we do know emanates from studies in protein-energy malnutrition, starvation, and eating disorders. In otherwise healthy individuals, nutritional factors appear to play a role in subjects with persistent increased hair shedding. Hård, 40 years ago, demonstrated the importance of iron supplements in nonanaemic, iron-deficient women with hair loss. Serum ferritin concentrations provide a good assessment of an individual's iron status. Rushton et al. first published data showing that serum ferritin concentrations were a factor in female hair loss and, 10 years later, Kantor et al. confirmed this association. What level of serum ferritin to employ in subjects with increased hair shedding is yet to be definitively established but 70 micro g/L, with a normal erythrocyte sedimentation rate (< 10 mm/h), is recommended. The role of the essential amino acid, l-lysine in hair loss also appears to be important. Double-blind data confirmed the findings of an open study in women with increased hair shedding, where a significant proportion responded to l-lysine and iron therapy. There is no evidence to support the popular view that low serum zinc concentrations cause hair loss. Excessive intakes of nutritional supplements may actually cause hair loss and are not recommended in the absence of a proven deficiency. While nutritional factors affect the hair directly, one should not forget that they also affect the skin. In the management of subjects with hair loss, eliminating scaling problems is important as is good hair care advice and the need to explain fully the hair cycle. Many individuals reduced their shampooing frequency due to fear of losing more hair but this increases the amount seen in subsequent shampoos fuelling their fear of going bald and adversely affecting their quality of life.
Article
Biotin is a coenzyme for carboxylase enzymes that assist various metabolic reactions involved in fatty acid synthesis, branched-chain amino acid catabolism, and gluconeogenesis important for maintenance of healthy skin and hair. Due to its availability, affordability, and effective marketing for this purpose, biotin is a popular nutritional supplement for treatment of hair loss. However, there are little data on the frequency of biotin deficiency in patients complaining of hair loss and on the value of oral biotin for treatment of hair loss that is not due to an inborn error of biotin metabolism or deficiency. The aim of this study was to determine the frequency and significance of biotin deficiency in women complaining of hair loss. Biotin deficiency was found in 38% of women complaining of hair loss. Of those showing diffuse telogen effluvium in trichograms (24%), 35% had evidence of associated seborrheic-like dermatitis. About 11% of patients with biotin deficiency had a positive personal history for risk factors for biotin deficiency. The custom of treating women complaining of hair loss in an indiscriminate manner with oral biotin supplementation is to be rejected, unless biotin deficiency and its significance for the complaint of hair loss in an individual has been demonstrated on the basis of a careful patient history, clinical examination, determination of serum biotin levels, and exclusion of alternative factors responsible for hair loss.
Article
An unusual presentation of biotinidase deficiency is described, The disorder classically presents in infancy or early childhood with intractable seizures, hypotonia, ataxia, hearing loss, dermatitis, and alopecia, A 5-year-old girl developed acute visual loss associated with optic atrophy, and disturbance of gait with predominantly lower-limb pyramidal signs. She had no seizures, and skin, hair, hearing; and intellect were normal. Biotinidase deficiency was confirmed biochemically and she responded well to biotin therapy, A diagnosis of biotinidase deficiency should be considered in children with unexplained bilateral optic neuropathy, particularly when there is accompanying gait disorder.
Article
Untreated profound biotinidase deficiency results in a wide range of clinical features, including optic atrophy, cutaneous abnormalities, hearing loss and developmental delay. Ontario, Canada incorporated this treatable deficiency in newborn screening over the past 8years. This study elucidates the molecular, biochemical, and clinical findings from the pilot project. Information from initial screens, serum biotinidase activity level assays, molecular testing, and family history for 246 positive newborns screens were analyzed. A mutation spectrum was created for the province of Ontario, including common mutations such as D444H, D444H/A171T, Q456H, C33fs, and R157H. Individuals with partial deficiency were separated into 3 groups: D444H homozygotes (Group 1); compound heterozygotes for D444H with another profound allele (Group 2); compound heterozygotes with two non-D444H alleles (Group 3). Biochemical phenotype-genotype associations in partial deficiency showed a significant difference in serum biotinidase activity in between any given two groups. Three children with partial deficiency discontinued biotin for varied lengths of time. Two of whom became symptomatic with abnormal gait, alopecia, skin rashes and developmental delay. A need for more congruency in diagnostic, treatment and educational practices was highlighted across the province. Heterogeneity and variation in clinical presentations and management was observed in patients with the partial deficiency.
Article
Biotinidase is a ubiquitous mammalian cell enzyme occurring in liver, serum and kidney. It cleaves biotin from biocytin, which is a cofactor for biotin dependent enzymes, namely the human carboxylases. Biotinidase deficiency is associated with a wide spectrum of neurological, dermatological, immunological and ophthalmological abnormalities. This is a case of a 3-year-old boy presenting with delayed developmental milestones, tachypnea, progressively increasing ataxia, alopecia and dermatitis, all which dramatically responded to high doses of biotin.
Article
This study reports the clinical, laboratory profile and outcome in seven patients with biotinidase deficiency. The serum biotinidase activity was assayed using spectrophotometric analysis. The age at presentation varied from day 1 of life to the 5 th month. Seizures were the presenting complaint in six patients and clonic seizures were the predominant seizure type. Sparse hair was seen in four patients, while three did not have any cutaneous manifestation. None of the patients had acidosis or hyperammonemia. The clinical response to biotin was dramatic with seizure control in all patients. One patient had neurological deficit at follow-up, while none had optic atrophy or sensorineural hearing loss. Biotinidase deficiency, a potentially treatable condition, should be thought of in any child presenting with neurological symptoms, especially seizures, even in the absence of cutaneous or laboratory manifestations.
Article
Hair follicle cells have a high turnover. A caloric deprivation or deficiency of several components, such as proteins, minerals, essential fatty acids, and vitamins, caused by inborn errors or reduced uptake, can lead to structural abnormalities, pigmentation changes, or hair loss, although exact data are often lacking. The diagnosis is established through a careful history, clinical examination of hair loss activity, and hair quality and confirmed through targeted laboratory tests. Examples of genetic hair disorders caused by reduced nutritional components are zinc deficiency in acrodermatitis enteropathica and copper deficiency in Menkes kinky hair syndrome.
Article
An unusual presentation of biotinidase deficiency is described. The disorder classically presents in infancy or early childhood with intractable seizures, hypotonia, ataxia, hearing loss, dermatitis, and alopecia. A 5-year-old girl developed acute visual loss associated with optic atrophy, and disturbance of gait with predominantly lower-limb pyramidal signs. She had no seizures, and skin, hair, hearing, and intellect were normal. Biotinidase deficiency was confirmed biochemically and she responded well to biotin therapy. A diagnosis of biotinidase deficiency should be considered in children with unexplained bilateral optic neuropathy, particularly when there is accompanying gait disorder.
Article
Six children with morphological hair-shaft abnormalities and neurological disease are presented, including two with Pollitt syndrome, one with biotin deficiency, two with Menkes diseases and one with argininosuccinic aciduria. The child with biotin deficiency grew normal hair following oral biotin therapy. Although the hair-shaft abnormalities may be seen with light microscopy (LM), they are best visualised with scanning electron-microscopy (SEM). Pili torti may be mistaken for monilethrix by LM, but SEM shows the true defect. A review of the literature shows that these hair-shaft abnormalities (trichorrhexis nodosa, monilethrix and pili torti) are not specific or pathognomonic, but do indicate a group of neurological disorders, including potentially treatable inborn errors of metabolism. The term 'neurotrichosis' is suggested to classify this group of disorders.
Article
A 2-month-old male infant, born of second degree consanguineous parentage, presented with seizures not responding to phenytoin and phenobarbitone. His perinatal period had been uneventful and there was no family history of seizures. On examination, he had failure to thrive, perioral and perianal rash, alopecia with hypopigmented hair, seborrhoeic dermatitis, bilateral blepharitis, respiratory distress and stridor. Neurological examination revealed hypertonia of all the four limbs, exaggerated deep tendon reflexes and papilloedema. Biotinidase deficiency was suspected within 24 h of admission and empiric oral biotin 10 mg twice daily was started. The symptoms, especially seizures, dramatically improved within 48 h. Serum biotinidase levels revealed a profound deficiency (0.10 nmol/min/ml serum) and the parents were advised regarding the need for regular biotin supplementation. The child is presently 10 months old, thriving well, developmentally normal and is seizure free with total resolution of skin and hair lesions.
Article
We determined the serum concentration of biotin, zinc, antiepileptic drugs, and biotinidase enzyme activity in 20 children treated with valproic acid, in 10 children treated with carbamazepine, and in 75 age- and sex-matched healthy controls. There were no significant differences in the serum levels of biotin, and biotinidase enzyme activity between the patients treated with valproic acid, the patients treated with carbamazepine, and the control group. Zinc serum levels were lower in the patients treated with valproic acid and with carbamazepine than in the control group, but within the normal range. Hair loss was observed in 3 patients treated with valproic acid, with normal serum levels of biotin, zinc, and biotinidase activity, and the alopecia disappeared with the oral administration of biotin (10 mg/d) in 3 months. These results suggest that the treatment with valproic acid does not alter the serum levels of biotin, zinc, and biotinidase enzyme activity.
Article
Biotinidase deficiency is a disorder of biotin metabolism that manifests with cutaneous, ophthalmological and neurologyical symptoms in childhood. Spinal cord involvement has rarely been reported and all of the reported cases are spastic paraparesis. A 3 year-old girl with biotinidase deficiency was admitted to our clinic with hyperventilation, hair loss and spastic tetraparesis. To our knowledge, our case is the first reported tetraparesis associated with biotinidase deficiency. She was treated with oral biotin and benefited significantly from this therapy.
Article
Healthy-appearing hair is a sign of excellent general health, as well as good hair care practices. Most healthy individuals have adequate nutrients in their diet; however, many people do not have access to good nutrition, and others have medical illnesses that predispose them to nutritional deficiency. This is often reflected in changes of scalp and, at times, body hair. Malnutrition, congenital heart disease, neuromuscular disease, chronic illnesses, malignancy, alcoholism, and advanced age can cause hair to change color, be weakened, or lost. Recognition of the populations at risk for vitamin deficiency is the first step to their detection. Changes in skin and hair can provide clues to the presence of an underlying vitamin deficiency.
Article
This article reviews current knowledge concerning the dermatologic manifestations of biotin deficiency. Biotin is a water-soluble vitamin that acts as an essential cofactor for four carboxylases, each of which catalyzes an essential step in intermediary metabolism. For example, acetyl-CoA carboxylase catalyzes the rate-limiting step in fatty acid elongation. In infants, children, and adults, deficiency of biotin causes alopecia and a characteristic scaly, erythematous dermatitis distributed around body orifices. The rash closely resembles that of zinc deficiency. Candida albicans often can be cultured from the skin lesions. Biotinidase deficiency, an inborn error, causes biotin deficiency, probably as a consequence of unpaired intestinal absorption, cellular salvage, and renal reclamation of biotin; biotinidase deficiency causes dermatologic manifestations similar to biotin deficiency. There is evidence that impaired fatty acid metabolism secondary to reduced activities of the biotin-dependent carboxylases (especially acetyl-CoA carboxylase) plays an etiologic role in the dermatologic manifestations of biotin deficiency. Candida infections secondary to impaired immune function might also contribute to the dermatitis of biotin deficiency.
Article
Pathologic hoof changes in horses and swine can be normalized by administration of biotin. This vitamin has been given orally to women with brittle fingernails or onychoschizia. The aim of the study was to test whether the favorable clinical results could be corroborated by scanning electron microscopy. We investigated the distal ends of the fingernails from 32 persons. They were placed into three groups: group A consisted of 10 control subjects with normal nails, group B comprised eight patients with brittle nails studied before and after biotin treatment, and group C was 14 patients with brittle nails in whom the administration of biotin did not coincide exactly with the initial and terminal clipping of the nails. The thickness of the nails in group B increased significantly by 25%. In group C, the increase was 7%. Splitting of the nails were reduced in groups B and C and the irregular cellular arrangement of the dorsal surface of brittle nails became more regular in all nails of group B and in 8 of 11 nails of group C.
Article
Frailty and brittleness of the finger nails is frequently seen, particularly in women. In veterinary medicine, it has been documented that defect hooves of horses or claws of swines respond well to oral application of biotin. Accordingly, we studied the effect of biotin on human dystrophic finger nails, a keratin structure as well. 71 patients were treated with a daily oral dose of biotin of 2.5 mg. Out of the 45 cases which finally could be evaluated, 41 (91%) showed definite improvement with firmer and harder finger nails after an average treatment of 5.5 +/- 2.3 months. In 4 of the 45 patients (9%), the improvement was questionable. None of the patients considered the treatment altogether ineffective. We conclude that biotin in most of the cases provides an effective therapy also for human patients with brittle nails.
Article
Cutaneous changes occur in deficiency states of many nutritional elements: ascorbic acid, retinol, protein-energy, cyanocobalamin, phytonadione (vitamin K), biotin, ribroflavin, pyridoxine, niacin, essential fatty acids, and zinc. There are also inherited disorders of copper, biotin, zinc, and tryptophan metabolism. Cutaneous vitamin D synthesis is inhibited by sunscreen use. The striking skin changes of the glucagonoma syndrome may be related to nutritional pathways.
Article
A case of an infant suffering from progressive lethargy, sparse scalp hair, autistic-like behavior, myoclonias, and drug-resistant generalized seizures is reported. Laboratory investigations revealed, in the absence of metabolic acidosis, an increased urinary excretion of 2-ketoglutaric acid and a small peak of 3-hydroxyisovaleric acid. The serum biotinidase activity was 0.15 nmol min-1 ml-1 (normal range 5.2 +/- 0.9) in the propositus and 0.310 and 0.420 in her father and mother, respectively. The interictal EEG showed multifocal abnormalities; numerous seizures were recorded, with the pattern of true tonic-clonic fits, exceptional in infancy. Also myoclonias, auditory myoclonus, and repetitive startles were documented. Because of dramatic improvement of all symptoms and signs after starting biotin (5 mg twice daily), the authors suggest a therapeutical trial in all drug-resistant infantile seizures.
Article
• The important role of biotin in human physiology has been highlighted by the recognition of two newly discovered human inborn errors of the metabolism of biotin. The molecular defect in the neonatal-onset disease is in the enzyme holocarboxylase synthetase. The defect in the later infantile-onset disease is in the enzyme biotinidase. Both disorders present with impressive clinical manifestations involving the skin and hair. In the neonatal disease, alopecia totalis is associated with a bright red scaly total body eruption. In biotinidase deficiency, the alopecia is more patchy and the skin lesions resemble acrodermatitis enteropathica. Both disorders are complicated by recurrent episodes of life-threatening acidosis and massive ketosis. (Arch Dermatol 1987;123:1696-1698a)
Article
Three children are reported with uncombable hair syndrome, consisting of slow-growing, straw-colored scalp hair that could not be combed flat. The hairs appeared normal on light microscopy but on scanning electron microscopy were triangular in cross section, with canal-like longitudinal depressions. Oral biotin, 0.3 mg three times a day, produced significant improvement after 4 months in one patient, with increased growth rate and with strength and combability of the hair, although the triangular shape remained. The other two patients were unique in having associated ectodermal dysplasia. Their hair slowly improved in appearance and combability over 5 years without biotin therapy.
Article
The clinical and biochemical features of an infant affected by holocarboxylase synthetase deficiency are presented. The patient was the sibling of the deceased child in whose cultured skin fibroblasts the precise enzymatic disorder was first determined. This fact permitted administration of specific therapy in the form of oral biotin, resulting in immediate improvement from impending respiratory failure and shock. The clinical response to biotin was accompanied by recovery of the biochemical mechanisms known to be biotin-dependent, as manifested by disappearance of intermediates in urine and blood. The variability of biotin responsiveness and the diversity of clinical presentation in the patients originally thought to have a deficiency of beta methylcrotonylCoA carboxylase, a biotin-dependent enzyme, raises the question of a separate, specific apocarboxylase defect.
Article
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.
Article
In humans and in animals, biotin deficiency causes pathological changes in the skin and its appendages. High doses of biotin may also have beneficial effects on skin, hair and fingernails in humans and animals with normal biotin status. Therefore, we investigated the effects of low and high concentrations of biotin on proliferation and differentiation of cultured outer root sheath cells from human hair follicles as an in vitro model for skin. The activities of biotin-dependent carboxylases were measured to evaluate the biotin status of the cells. In monolayer cultures of outer root sheath cells, proliferation and expression of the differentiation-specific keratins K1 and K10 were not influenced by extremely low concentrations of biotin (<2 x 10(-10) mol/l) or by pharmacological doses of biotin (10(-5) mol/l). Biotin deficiency of the cells was confirmed under the former condition by demonstrating decreased activities of the mitochondrial carboxylases. In organotypic cocultures of outer root sheath cells and dermal fibroblasts, in which stratified epithelia resembling epidermis were developed, the biotin concentration had no effect on the expression of all tested epidermal differentiation markers, including the suprabasal keratins K1 and K10, the hyperproliferation-associated keratin K16, involucrin and filaggrin.
Article
Among the reaction and effects of isotretinoin, mucocutaneous reactions, xerosis and erythema of the skin as well as elevation of liver enzymes and lipids except high density lipoprotein have been reported. Since biotinidase is mainly produced in the liver and partial biotinidase deficiency causes dermatological manifestations, seborrheic dermatitis, alopecia etc., isotretinoin side effects in relation to biotinidase activity were studied. Forty-two (n = 42) patients with severe cystic acne had liver function tests, lipid estimations, serum biotin as well as biotinidase activity evaluations before (value 1) and on the 30th day (value 2) of treatment with isotretinoin monotherapy (Roaccutane 0.5 mg/kg/24 h). The same laboratory tests were evaluated in 50 controls only once. Moreover, the effect of isotretinoin on a known plasma biotinidase activity was evaluated after incubation in vitro with various concentrations of the drug. A statistically significant elevation of liver enzymes and lipids, except high density lipoprotein, was observed at the end of this study. On the contrary, biotinidase activity was found to be significantly decreased as compared to the initial values (value 1 = 4.70 +/- 0.89 nmol/min/l, value 2 = 2.50 +/- 0.8 nmol/min/l, p < 0.001) and to controls (5.2 +/- 0.9 nmol/min/l vs. value 2 = 2.50 +/- 0.8 nmol/min/l, p < 0.001). Additionally, biotin levels showed no significant alterations and the in vitro incubation of the enzyme with various concentrations of the drug exhibited no effect on its activity. It is suggested that isotretinoin isomers-metabolites act in the liver, resulting in low biotinidase activity.
Article
Biotin deficiency is rarely encountered in an infant on weaning from breast and formula feeding. It is characterized by alopecia and scaly, erythematous dermatitis distributed around the body orifices. We report a 5-month-old Japanese infant with typical skin lesions who had been diagnosed as a neonate with dyspepsia and fed only an amino acid formula. Serum and urine levels of biotin were below the normal range, but zinc and biotinidase were within normal range. Urinary excretion of 3-methylcrotonylglycine, 3-hydroxyisovaleric acid, and methylcitric acid was significantly elevated. Daily oral supplementation with 1 mg of biotin resulted in dramatic improvement of the periorificial dermatitis and hair growth together with a complete disappearance of the organic aciduria. Our case shows that the characteristic skin manifestations are the most important clue to the diagnosis of biotin deficiency and demonstrated that urinary excretion of biotin and organic aciduria, rather than the serum concentration of biotin, are the sensitive indicators for evaluating the patient's status of biotin deficiency.
Article
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.
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