A deficiency in biotin is rare and may be hereditary or acquired. The possibility of biotin deficiency should be considered if a patient at risk for biotin deficiency shows clinical findings compatible with the diagnosis.
Causes of acquired biotin deficiency:
(1) diet very high in raw egg whites or raw whole eggs (due to the presence of avidin which binds to the biotin)
(2) total parenteral nutrition (TPN) without added biotin
(3) chronic hemodialysis
(4) pregnancy
(5) severe protein-energy malnutrition
(6) therapy with anticonvulsant drugs (phenytoin, primidone, carbamazepine, phenobarbital)
A patient with an acquired deficiency should respond to administration of biotin.
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