Are there any indications of a biotin deficiency?

There are certain population groups that have an increased risk of developing a vitamin B7 (biotin) deficiency. These include, for example, people with high alcohol consumption or chronic recurrent gastrointestinal disorders. If hair loss is associated with such risk factors, it may make sense to measure the biotin level.

In the guidelines published in 2022 by the European Society for Clinical Nutrition and Metabolism (ESPEN), it is mentioned that hair loss is one of the clinical symptoms indicating a possible biotin deficiency [1]. Since a trichogram alone does not reveal the cause of telogen effluvium, determining the biotin status is a potentially useful measure in patients with hair loss, according to a statement published in the International Journal of Trichology. Supplementation with this water-soluble vitamin, which belongs to the group of B vitamins, is very easy to carry out: regardless of the cause, a deficiency can be remedied with oral biotin at a dosage of 5 mg daily [2]. However, the author points out that other possible causes of hair loss should be investigated in parallel, such as the presence of other nutrient deficiencies or endocrine disorders.

Risk factors and symptoms of biotin deficiency at a glance

Alcoholics are more likely to suffer from low biotin levels compared to the general population [3]. In addition, smoking can accelerate biotin depletion in women [4]. Another risk group for low biotin levels are patients who receive parenteral nutrition or who have had a partial gastrectomy or other causes of achlorhydria [5,6]. People who take anti-epileptic drugs or isotretinoin, athletes and older people are also more likely to have a biotin deficiency [7–9]. There may also be an increased need for biotin during pregnancy and breastfeeding, which may be due to an acceleration of biotin degradation [10].

Symptoms of biotin deficiency include hair loss, conjunctivitis and a scaly skin rash around the eyes, nose and mouth. However, neurological symptoms such as depressive disorders, lethargy, hallucinations as well as numbness and tingling of the extremities can also indicate low biotin levels. Hair loss generally only occurs with a more severe deficiency. In addition to the risk factors mentioned above, there are also people with hereditary biotin deficiency who also have impaired immune system function, including an increased susceptibility to bacterial and mycotic infections [11].

Empirical study on biotin status in alopecia patients

In the study published under the title “Serum Biotin Levels in Women Complaining of Hair Loss”, serum biotin levels were determined in 541 women suffering from hair loss [2]. The age range of the participants ranged from 9 to 92 years (mean: 45.9 years). Of the study participants, 38% had values that indicated a biotin deficiency (<100 ng/L), während die Werte bei 13% im optimalen Bereich lagen (>400 ng/L). The cut-off of <100 ng/l was chosen because biotin values <200 ng/l eigentlich als Mangelzustand gelten, aber die Biotinwerte im Serum täglichen Schwankungen unterliegen. 200–400 ng/L wurde als suboptimaler und>400 ng/L are defined as optimal serum levels. Of the women with telogen effluvium and biotin levels <100 ng/L, 35% had associated seborrheic-like dermatitis, while none of the study participants with optimal biotin levels did. 11% of the patients in the biotin-deficient group had risk factors, including chronic inflammatory bowel disease, isotretinoin treatment, antiobiotic use or antiepileptic therapy. Among those with optimal biotin levels, a corresponding risk factor (antibiotic intake) was only identified in one person.

Literature:

Berger MM, et al: ESPEN micronutrient guideline. Clin Nutr 2022; 41(6): 1357-1424.
Trüeb RM: Serum Biotin Levels in Women Complaining of Hair Loss. Int J Trichology 2016; 8(2): 73-77.
Subramanya SB, et al: Inhibition of intestinal biotin absorption by chronic alcohol feeding: Cellular and molecular mechanisms. Am J Physiol Gastrointest Liver Physiol 2011; 300: G494-501.
Sealey WM, et al: Smoking accelerates biotin catabolism in women. Am J Clin Nutr 2004; 80: 932-935.
Mock DM, et al: Biotin deficiency complicating parenteral alimentation: Diagnosis, metabolic repercussions, and treatment. J Pediatr 1985; 106: 762-769.
Greenway FL, et al: Loss of taste responds to high-dose biotin treatment. J Am Coll Nutr 2011; 30: 178-181.
Mock DM, Dyken ME: Biotin catabolism is accelerated in adults receiving long-term therapy with anticonvulsants. Neurology 1997; 49: 1444-1447.
Schulpis KH, et al: Low serum biotinidase activity in children with valproic acid monotherapy. Epilepsia 2001; 42: 1359-1362.
Schulpis KH, et al: The effect of isotretinoin on biotinidase activity. Skin Pharmacol Appl Skin Physiol 1999; 12: 28-33.
Mock DM, Quirk JG, Mock NI: Marginal biotin deficiency during normal pregnancy. Am J Clin Nutr 2002; 75: 295-299.
Seymons K, et al: Dermatologic signs of biotin deficiency leading to the diagnosis of multiple carboxylase deficiency. Pediatr Dermatol 2004; 21: 231-235.