2022 Top Story in Dermatology: Perils of Biotin Supplementation

If every publication had a simple, clinically relevant “take-home” message, the continuing education of dermatologists would be easy. A letter to the editor published in JAAD last February¹ impacted my practice! I had a history of prescribing biotin for almost every nail problem and for difficult hair conditions. Patients liked taking a vitamin, and I was convinced it was perfectly safe…like chicken soup. There was also a pseudo-scientific rationale for using it…if biotin deficiency caused hair and nail problems, might a little extra help such conditions? Of course, the latter is a fallacious argument. There is, in fact, no scientific evidence that biotin is useful outside conditions caused by its deficiency. In addition, as highlighted by recent FDA warnings, lab tests utilizing the biotin–streptavidin reaction as part of the testing procedure demonstrate significant interference in patients taking biotin supplementation. Both false-positive and false-negative findings can occur with thyroid tests, human chorionic gonadotropin, cancer biomarkers, and many other tests, perhaps most significantly, with troponin, which can lead to a false-negative test in patients with myocardial infarction. Let us use biotin when its truly indicated, probably 1% of times it is currently prescribed. In addition, when prescribed, warn patients to alert their physicians if lab tests are ordered. By the way, chicken soup contains a lot of sodium!