Biotin Deficiency

Overview

Biotin is a vitamin, often called vitamin B7 or vitamin H. It is one of the B vitamins your body needs to turn food into energy and to keep your skin, hair, nerves and blood sugar steady. A biotin deficiency means your body does not have enough of it. This is a rare problem. Most people get all the biotin they need from a normal mixed diet, and the bacteria in your gut also make a little. When biotin does run low, it is usually because of another health problem, a very restricted diet, or a rare inherited condition rather than simply not eating enough of it.

No. Biotin deficiency is rare, especially in people who eat a normal, varied diet. It is seen more often in people with long-term health conditions that affect how the gut absorbs nutrients.

It mainly affects people with conditions that stop the gut absorbing food properly, people fed only through a drip or feeding tube for a long time without added biotin, people taking certain medicines for epilepsy for many years, people with heavy alcohol use, and occasionally pregnant women. It also affects babies born with a rare inherited condition called biotinidase deficiency. Healthy adults and children eating a normal diet are very unlikely to become deficient.

Symptoms

Common symptoms

• Hair thinning or unusual hair loss
• Brittle, dry or splitting nails
• A red, scaly or flaky rash, often around the eyes, nose and mouth, or in the creases of skin
• Feeling tired, weak or low on energy
• Muscle aches
• Loss of appetite or feeling sick
• Tingling, numbness or a pins-and-needles feeling in the hands and feet
• Low mood or feeling unusually flat
• Dry eyes or sore mouth in some people

Symptoms in children

• Floppiness or weak muscle tone
• Being slower than expected to reach milestones such as sitting, crawling or talking
• Seizures (fits)
• Skin rashes and hair loss
• Breathing problems, especially in babies
• Feeding difficulties or poor weight gain
• Vision or hearing problems, particularly with the inherited form

Symptoms in older adults

• Unsteadiness or difficulty with walking
• Numbness or tingling in the feet or hands
• Confusion or slowed thinking
• Low mood or loss of interest in things
• Tiredness that does not improve with rest
• Poor appetite and weight loss

Causes

Main causes

• Eating a lot of raw egg white over a long period: raw egg white contains a protein that stops the body using biotin, but cooking the egg switches that protein off.
• Problems with absorbing nutrients from the gut, such as long-term bowel conditions or after certain types of bowel surgery.
• Being fed only through a drip or feeding tube for months without extra biotin added.
• Long-term use of some epilepsy medicines, which can make the body break biotin down faster.
• Heavy alcohol use and severe malnutrition.
• A rare inherited condition called biotinidase deficiency, where the body cannot recycle biotin properly. This is often found by newborn screening in some countries.
• Very rare inherited problems affecting the enzymes that use biotin.
• Pregnancy, when the body may break biotin down faster. This is usually mild and not a concern for most women.

Risk factors

• A very limited diet, or eating lots of raw egg whites
• Long-term gut or liver disease
• Long-term feeding by tube or drip
• Long-term treatment with certain epilepsy medicines
• Heavy alcohol use
• Pregnancy
• A family history of the inherited form, especially in babies and young children
• Long-term use of high-dose biotin supplements, which can hide or distort test results

When to see a doctor

See a doctor urgently if:

• Numbness, tingling or weakness in the hands or feet that is new or getting worse
• A seizure
• Unsteadiness or a change in how you walk
• A baby or child who is floppy, very sleepy, not feeding, or having fits
• Vision or hearing changes

Book a routine appointment if:

• Hair thinning, hair loss or brittle nails that continue for weeks
• A red, scaly rash around the eyes, nose or mouth without an obvious cause
• Ongoing tiredness, muscle aches or low mood
• You have a long-term gut condition or take epilepsy medicines and you feel unwell
• You take a biotin supplement and have a blood test booked
• You eat a very restricted diet or a lot of raw egg white
• You are worried about your child's growth or development

Diagnosis

Your doctor will start by asking about your diet, your health history, any medicines you take and any supplements. They will look at your skin, hair and nails and may check how your nerves are working. Because biotin deficiency is rare and hard to test for, doctors often work it out from the whole picture. Sometimes a trial of extra biotin, with a check-up afterwards, is the simplest way to confirm it.

Tests that may be done

• A urine test to look at the level of biotin or related substances
• A blood test to measure biotin levels
• A blood test for the enzyme biotinidase, used when the inherited form is suspected, especially in babies and children
• Genetic testing in some cases, particularly when the inherited form runs in the family
• Newborn screening, which is offered in some countries and can pick up biotinidase deficiency before symptoms start
• General blood tests to check for other causes of your symptoms, such as thyroid, iron or vitamin levels

What to expect at your appointment

These are simple blood and urine tests, usually done in a clinic or your GP surgery. You may feel a small pinch when the needle goes in, and there may be a little bruising afterwards. Results often take a few days to a couple of weeks. If the inherited form is suspected in a child, you may be referred to a specialist children's team, and you may be offered genetic counselling to talk through what the results mean for your family.

Treatment

Treatment is usually straightforward once the cause is found. In most cases, it means topping up biotin, either through diet or with a supplement your doctor recommends, and treating any underlying condition. Because biotin is water-soluble, your body gets rid of what it does not need in your urine, which is one reason serious side effects from extra biotin are uncommon. In the inherited form, treatment is lifelong and usually needs specialist care.

Self-care at home

• Eat a varied diet with biotin-rich foods such as cooked eggs, nuts, seeds, whole grains, avocado, sweet potato, salmon, beans and lentils.
• Always cook eggs before eating them, and avoid long-term heavy use of raw egg white in drinks or shakes.
• Do not start high-dose biotin supplements on your own; ask your doctor or pharmacist first.
• If you take a biotin supplement, tell your doctor, nurse or lab before any blood test.
• Make a simple food diary for a week or two if you think your diet may be limited, and bring it to your appointment.
• Keep any follow-up appointments so your progress can be checked.

Medical treatments

Your doctor may recommend a nutritional supplement that contains biotin. How much and for how long depends on your age, your symptoms, the cause and whether you are pregnant or feeding a baby, so the plan is set by your healthcare team rather than by yourself. Any health condition behind the deficiency is treated too: for example, looking after a gut problem, reviewing epilepsy medicines with your specialist, or adding biotin to long-term tube or drip feeding. Babies and children with the inherited form need specialist care and, in most cases, lifelong treatment. If you have taken high-dose biotin supplements, your doctor may ask you to stop them for a few days before certain blood tests so the results are accurate.

When is surgery considered?

Surgery is not a treatment for biotin deficiency. It may sometimes be part of care for a separate gut condition that is causing poor absorption.

Living with this condition

For most people, biotin deficiency settles once it is treated and the cause is managed. You may not notice changes in your hair and nails for several weeks or even months, because hair and nails grow slowly. Try to be patient and keep to any follow-up plan. If you take a supplement, keep a note of what you take so you can tell your doctor or pharmacist, especially before blood tests.

Lifestyle tips

• Build meals around a mix of foods rather than relying on one or two items.
• If you drink alcohol, keep within your local guidelines.
• Mention all supplements, including hair, skin and nail products, to your doctor and pharmacist.
• Ask your pharmacist to check any new medicine for interactions with long-term epilepsy treatment.
• Keep a note of symptoms and dates so you can see slow improvements over time.
• If you follow a vegan or very limited diet, ask for advice about meeting your vitamin needs.

Diet and exercise

A balanced diet is the best source of biotin. Try to include cooked eggs, nuts, seeds, wholegrain cereals, oats, avocado, sweet potato, salmon and other oily fish, beans, lentils, cauliflower and mushrooms across the week. There is no special exercise plan for biotin deficiency, but staying active helps your general health, mood and appetite. Gentle walking, swimming or anything you enjoy is a good start, and you can build up gradually.

Mental health and emotional wellbeing

Changes to your hair, skin or nails can affect how you feel about yourself, and ongoing tiredness or numbness can be worrying. It is completely normal to feel anxious or low about it. If these feelings last more than a couple of weeks, or if they affect your sleep, appetite or daily life, please tell your doctor. Talking therapies and support are available, and reaching out is a sign of strength, not weakness. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away.

Prevention

In most people, yes. Eating a varied, balanced diet gives you enough biotin, and cooking eggs rather than eating them raw removes the main dietary cause. If you have a long-term gut condition, are fed by tube or drip, or take epilepsy medicines for many years, ask your healthcare team whether your biotin needs checking. The inherited form cannot be prevented, but it can be picked up early and treated.

Screening programmes

Some countries include a test for biotinidase deficiency in newborn screening, which can find the inherited form before symptoms appear. Ask your midwife, health visitor or doctor whether this is part of routine newborn screening where you live. There is no routine screening for biotin deficiency in adults.

Complications

If left untreated

• Ongoing hair loss and weak, splitting nails
• Persistent skin rashes
• Numbness, tingling or weakness in the hands and feet
• Difficulty walking or keeping your balance
• Low mood, confusion or, rarely, hallucinations
• Seizures
• In babies with the inherited form: delays in development, breathing problems, and problems with vision or hearing

Long-term outlook

The outlook is very good. When biotin deficiency is found and treated, most symptoms improve, and many people feel back to normal within weeks to a few months. Hair and nails take longer to recover simply because they grow slowly. The inherited form needs lifelong treatment, but children who are treated early usually grow and develop well. If you are worried at any point, your healthcare team is there to help.

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