By Gary M. White, MD
Biotin, a water-soluble vitamin, is also called vitamin H. Biotin deficiency may cause skin changes identical to zinc deficiency/acrodermatitis enterohepathica. An acquired form of biotin deficiency is seen in infants from Japan as their baby formula historically has been biotin deficient [PD 2016;33;457]. Biotin responsive multiple carboxylase deficiency (BRMCD) an AD inherited deficiency of biotinidase that causes biotin deficiency.
A periorificial dermatitis along with seizures, recurrent infections and acidosis occurs in the infantile form of biotin responsive multiple carboxylase deficiency (BRMCD). Cutaneous manifestations of acquired biotin deficiency are similar to those of zinc deficiency and characterized by marginated periorifacial dermatitis, acrodermatitis and hair loss.
Measuring the serum biotin level may not be helpful. Usually, finding low biotin-containing carboxylase activities is diagnostic of biotin deficiency. Oral biotin (e.g., 2.0 mg/day) can clear the rash in days [PD 2016;33;457].
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Cutaneous manifestations of biotin deficiency are similar to those of zinc deficiency and characterized by marginated periorifacial dermatitis, acrodermatitis and hair loss. Seventeen Japanese infantile cases with acquired biotin deficiency caused by biotin-free formulas, including our case, have been documented between 1996 and 2015 (3–11 years old; eight boys, eight girls; some references are not shown) [4, 5]. Periorificial dermatitis was demonstrated in all cases, as well as a psoriasiform rash (31%), alopecia (23%), an atopic dermatitis-like rash (12%), and acrodermatitis (6%). It is still difficult to distinguish skin manifestations of acquired biotin deficiency from those of zinc deficiency.