Biotin Deficiency Treatment & Management

Updated: Oct 22, 2018
  • Author: Gratias Tom Mundakel, MBBS, DCH; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
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Treatment

Approach Considerations

Lifelong treatment with biotin is required in individuals diagnosed with genetic disorders affecting biotin metabolism (biotinidase deficiency and holocarboxylase synthetase deficiency). 

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Medical Care

The management of a patient with biotin deficiency must take the etiology into account.

If the deficiency is from excess consumption of raw eggs, the patient must stop consuming raw eggs and should be started on oral biotin therapy.

Ensure biotin containing vitamins are included in total parental nutrition (TPN) solutions if therapy is expected to last more than one week.

If the cause of biotin deficiency is anticonvulsant therapy, the anticonvulsant may be changed to another drug that does not interfere with biotin absorption. Alternatively, the patient may be started on supplemental biotin.

Similarly, those on prolonged oral antibiotic therapy may benefit from biotin supplementation.

Biotinidase deficiency can be detected with newborn screening. The most important aspects of the medical care in patients with biotin deficiency include the early recognition of the condition and the prompt institution of therapy with 5-10 mg per day of oral biotin. Some experts suggest increasing the dose to 15-20 mg per day at onset of puberty. [37]  Children with partial deficiency are usually treated with 1-5 mg per day. [23, 24]

Those with biotin deficiency secondary to genetic disorders of biotin metabolism (biotinidase deficiency, holocarboxylase synthetase deficiency) will need to be on lifelong biotin therapy. Non-compliance with treatment may be a significant problem and should be thought of especially when symptoms of biotin deficiency recur or the patient fails to show adequate improvement.  

Fungal skin infections should be treated with the appropriate antifungal agents; however, controlling such skin infections may be difficult until the biotin deficiency is corrected.

Antenatal treatment with biotin has been found to be useful when holocarboxylase synthetase deficiency has been detected antenatally. [38]

 

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Consultations

The services of experienced dermatologists, neurologists, and biochemical geneticists may be helpful in the evaluation and management of patients with biotin deficiency.  

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Diet

The patient should eat a regular, well-balanced diet that contains adequate amounts of biotin. Fortunately, almost all foodstuffs contain significant quantities of biotin, and many widely consumed foods are relatively rich in biotin. No dietary restriction is needed. 

Sources of Biotin

Foods that are rich in biotin, include meats, especially liver, eggs, brewers yeast,  fish, many cereals, especially oats, nuts, such as peanuts and walnuts, many vegetables such as cauliflower and peas, lentils and soybeans. 

Recommended Intakes

Recommendations for adequate intakes (AIs) for biotin have been developed by the Food and Nutrition Board of the National Academy of Sciences, Engineering and Medicine and are as follows: Birth to 6 months, 5 μg/day; 7-12 months, 6 μg/day; 1-3 yrs, 8 μg/day; 4-8 yrs, 12 μg/day; 9-13 yrs, 20 μg/day; 14-18 yrs, 25 μg/day and 30 μg/day in those 19 yrs or older. The AIs during pregnancy and lactation are 30 μg/day and 35 μg/day, respectively. [12]  It has been reported that the diet in developed countries contains 35- 70 μg/day of biotin. [10]  

Biotin supplements

Biotin supplements are popular among those seeking healthy skin, nails and hair. However, they contain up to 10000 mcg per pill which is more than 300 times the AI for biotin. It has been reported that up to 20% of individuals in the US consume biotin containing supplements. Although biotin toxicity with these doses have not been reported, biotin supplements may cause clinically significant interference with laboratory test results in those taking them. Therefore, doctors have been advised to include intake of biotin supplements as part of patient history. [1, 12]

 

 

 

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Activity

Activity restrictions are not necessary except in patients with neurologic symptoms (eg, myalgias, hyperesthesias, paresthesias).

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Long-Term Monitoring

Surveillance of patients with biotin deficiency, especially those with inborn errors of biotin metabolism may include:

  • periodic visual and auditory testing 
  • evaluation by clinical geneticist or metabolic specialist as needed

 

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