For many patients with cancer, hair loss can be one of the most distressing side effects of their therapy. Increasingly, patients have been taking oral supplements of biotin, which are marketed to consumers for their potential to improve hair regrowth and brittle nails.
However, there is little scientific evidence that oral biotin supplements promote hair and nail growth for those living with or recovering from cancer, and they may actually interfere with lab results, said Brittany Dulmage, MD, an oncodermatologist at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
Biotin, or vitamin B7, is used by the body to build protein, including keratin, which is a key component of hair, skin, and nails. Biotin deficiency is rare because it is readily available in many foods such as fruits, vegetables, meats, eggs, and dairy products.
“People have the misconception that biotin supplements are harmless and there’s no reason not to take them. The reality is that the supplements may cause inaccurate lab results, resulting in a delay or change in patients’ treatment plans,” she explained.
Dr. Dulmage is the Associate Director of Dermatology at The Ohio State University College of Medicine and Director of the Oncodermatology Clinic, which addresses hair, skin, and/or nail side effects from patients’ cancer treatment such as chemotherapy, immunotherapy, or targeted therapy.
“More than half the patients who come to see me with a problem related to hair loss are on a supplement that they’ve started on their own after learning about it online, by word of mouth, and sometimes even at the advice of their doctor,” she said.
Determined to raise awareness about the unintended consequences of taking biotin, Dr. Dulmage is the senior author of an article published by Mager et al in JCO Oncology Practice. The authors of this report urge oncologists to talk with patients about their hair loss and educate them about how taking biotin could affect their test results.
The Potential Effects of Biotin on Bloodwork
Biotin in particular can mask changes in prostate, thyroid, ovarian, and breast cancers, Dr. Dumage noted. Some lab tests rely on a chemical reaction involving biotin, so when patients take biotin supplements, lab results may falsely be high or low.
“Biotin does not actually change the levels of hormones in the body, but it interferes with the way those levels could be checked when blood work is done,” she said. “For some of the hormones such as prostate-specific antigen or thyroid-stimulating hormone, it may falsely suppress or lower those levels, potentially masking cancer recurrence in cancer survivors. For reproductive hormones including estrogen and testosterone, it may falsely elevate levels, resulting in delayed therapy.”
For patients who want to continue to take biotin supplements, Dr. Dulmage recommends they stop taking them 72 hours before blood work.
“The challenge is that not all blood work is planned—so you may not be able to hold your biotin. Biotin can also impact the levels of troponin, which is a marker of whether or not someone is having a heart attack,” she said. “Obviously, you’re not planning to have a heart attack, so you can’t hold biotin before troponin levels are checked. This is why I recommend to patients—think about not taking it at all, especially since very few people are biotin-deficient.”
A Safe, FDA-Approved Alternative
For hair loss, Dr. Dulmage recommends patients take minoxidil instead of biotin supplements, pointing out that it is both effective and safe, except for those who are pregnant or breastfeeding. Over-the-counter minoxidil is approved by the U.S. Food and Drug Administration (FDA) for hair loss and available in topical forms such as lotions or foams.
“If you have been trying minoxidil for several months and not seeing any improvement or want to know about other options, see a dermatologist. There are many other types of treatments that may be an option,” she concluded.
DISCLOSURE: For full disclosures of the report authors, visit ascopubs.org.
