patients treated with valproic acid, biotinidase activity was found to be significantly reduced as compared with controls (P less than 0.001). 17 A strong inverse correlation was observed between biotinidase enzyme activity and serum valproic acid levels with the activity of the enzyme.17 In subjects treated with valproic acid, 18% demonstrated alopecia, which was once again improved with biotin supplementation at a dose of 10 mg/day.17 The findings above suggest that valproic acid may cause alopecia through an acquired deficiency in biotin secondary to a reduction in biotinidase activity, which may account for the utility of biotin therapy in reversing this type of medication-induced alopecia.Biotin supplementation has also been shown to improve hair quality in patients with uncombable hair syndrome.6,18-21 Uncombable hair syndrome, a rare autosomal dominant condition with incomplete penetrance, is characterized by dry, frizzy, unruly straw-colored or silvery blond hair that is extremely difficult to manage. 6,18 Although difficult to quantify, there have been several reports demonstrating the efficacy of biotin supplementation on improving hair quality and growth rate in these subset of patients.18-21 In one notable study, oral biotin supplementation at 0.9mg/day (given as 0.3 mg three times a day), produced significant improvement in hair strength, combability and growth rate after 4 months.18Apart from the aforementioned conditions including: 1) medication-induced alopecia (namely valproic acid) and 2) uncombable hair syndrome, there is no scientific evidence validating biotin’s clinical efficacy in the improvement of hair quality or quantity. Given the above, its use is not routinely recommended.7
The Infatuation With Biotin
The U.S. nutritional supplement industry is estimated to be worth a staggering $35 billion in 2016, and the global nutritional supplement industry is estimated to be worth an astronomical $104 billion dollars.22-24 Loosely defined as “Vitamins, Minerals and Supplements”, this broad category, in which biotin supplements are included, is a leading global economic consumer market retail industry. Despite the clear lack of scientific evidence supporting biotin’s use for hair growth or improvement in hair quality, its growing popularity in society is remarkable. From articles such as The Vitamin My Hairdresser Suggested I Try. And, Wow, He Was Totally Right 25 and Two Easy Ways to Get Longer, Stronger, Shinier Hair in Time for Your Wedding 26 to so-called “expert advice” touting its use based on popularity by current-day supermodels,27 biotin’s glamorization in popular media, particularly within high-end fashion and beauty magazines, has garnered the attention of many, despite it’s questionable track-record of efficacy.Utilizing search engine optimization analytics, we investigated biotin’s popularity based on keyword volumes searched on the popular search engine Google. (Figures 1-2). We investigated both the relative interest over time and the global geographic
