The Infatuation With Biotin Supplementation: Is There Truth Behind Its Rising Popularity? A Comparative Analysis of Clinical Efficacy versus Social Popularity

May 2017 | Volume 16 | Issue 5 | Original Article | 496 | Copyright © 2017

Teo Soleymani MD, Kristen Lo Sicco MD, and Jerry Shapiro MD FAAD FRCPC

aThe Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY

Abstract

Biotin, also known as Vitamin B7 or vitamin H, is a water-soluble B vitamin that acts as an essential cofactor for several carboxylases involved in the cellular metabolism of fatty acids, amino acids, and gluconeogenesis. Although there exists an incredible amount of social media hype and market advertising touting its efficacy for the improvement of hair quantity and quality, biotin’s efficacy for hair remains largely unsubstantiated in scientific literature. We reviewed all pertinent scientific literature regarding the efficacy of biotin supplementation for hair growth and quality improvement, and we also investigated its popularity in society defined as a function of market analytics. To date, there have been no clinical trials conducted to investigate the efficacy of biotin supplementation for the treatment of alopecia of any kind, nor has there been any randomized controlled trial to study its effect on hair quality and quantity in human subjects. Because of the lack of clinical evidence, its use to improve hair quantity or quality is not routinely recommended. However, societal infatuation with biotin supplementation is not only propagated by its glamorization in popular media, its popularity is vastly disproportionate to the insufficient clinical evidence supporting it’s efficacy in hair improvement. In other words, biotin supplements are quite “in vogue”, without there being any real reason to be so.

J Drugs Dermatol. 2017;16(5):496-500.

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INTRODUCTION

Biotin, also known as Vitamin B7 or vitamin H (the H comes from Haar und Haut, German for “hair and skin”), is a water-soluble B vitamin that acts as an essential cofactor for several carboxylases involved in the cellular metabolism of fatty acids, amino acids, and gluconeogenesis.1,2,3 Biotin is also an essential cofactor for mitochondrial carboxylases in hair roots.4,5 Although there exists a substantial amount of market advertising and social media publicity regarding the efficacy of biotin therapy for the improvement of hair quality, in reality the only human health condition for which there is strong evidence of biotin’s therapeutic utility is for the treatment of biotin deficiency.1-6 Biotin deficiency may be acquired, in which case the most common causes are: 1) a lack of sufficient biotin in parenteral nutrition, 2) gastrointestinal abnormalities including malabsorptive disorders, 3) excessive intake of raw egg whites (raw egg whites contain avidin, a protein that binds biotin and renders it useless; cooking egg whites denatures avidin while biotin remains functional) and 4) chronic anticonvulsant therapy.1,3,4 Biotin deficiency may also be inherited, in which case the most common causes are: 1) an inherited deficiency in holocarboxylase synthetase (an enzyme required to attach biotin onto biotin-dependent carboxylases; neonatal-onset of symptoms) and 2) an inherited deficiency in biotinidase (an enzyme required in releasing biotin from foods and biotin-related peptides; juvenile onset of symptoms).1,4,5 In industrialized countries such as the United States, true biotin deficiencies remain rare because the production of biotin from intestinal bacteria remain sufficient to meet the body’s daily requirements.2,3 For that reason, statutory agencies such as those in the United States do not prescribe a recommended daily intake of biotin.2.2

A Review of the Scientific Literature

In the mid-1980s, routine biotin supplementation for hair improvement was supported by both the pediatric and dermatologic communities. In fact, an article published in The Journal of the American Academy of Dermatology stated “It is a general recommendation that any child with unexplained hair loss, rash or candidiasis receive a trial of biotin therapy”.18However, to date, there have been no clinical trials conducted to evaluate the efficacy of biotin supplementation for any type of alopecia, and currently, its use to improve hair quantity or quality is not routinely recommended. 7 The initial literature investigating the efficacy of biotin for hair dates back to a study in 1965 in which 46 women were treated with an unknown dose of biotin and observed for “effects on hair roots”. The authors concluded that biotin supplementation produced no change in the “state of the hair roots” in any of the 46 women. 8 In the 1980s,

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