Oral Fixation: Dietary Supplements for Skin Support
From ingestible collagen to UV protection and hair growth pills, beauty-boosting supplements are all the rage—and patients can’t seem to get enough of them.
A simple search for the term “beauty supplement” on Amazon.com yields more than 70,000 results. Some oral supplements may work, and others either lack proof of efficacy or proof of lack of efficacy. It is our job as dermatologists to sort through the existing evidence and counsel our patients in non-judgmental ways.
Following are my thoughts on several popular supplement classes, after weighing the available data.
FDA Guidance on Biotin
FDA notes that many lab tests use biotin technology due to its ability to bond with specific proteins that can be measured to detect certain health conditions and makes the following recommendations for health care providers:
- Talk to your patients about any biotin supplements they may be taking, including supplements marketed for hair, skin, and nail growth.
- Be aware that many lab tests, including but not limited to cardiovascular diagnostic tests and hormone tests, that use biotin technology are potentially affected, and incorrect test results may be generated if there is biotin in the patient’s specimen.
- Communicate to the lab conducting the testing if your patient is taking biotin.
- If a lab test result doesn’t match the clinical presentation of your patient, consider biotin interference as a possible source of error.
- Know that biotin is found in multivitamins, including prenatal multivitamins, biotin supplements, and dietary supplements for hair, skin, and nail growth in levels that may interfere with lab tests.
- Report to the lab test manufacturer and the FDA if you become aware of a patient experiencing an adverse event following potentially incorrect laboratory test results due to biotin interference.
L-histidine
Recommended for AD. Supplements of L-histidine do have a role in preventing infection among patients with atopic dermatitis. Research tells us that L-histidine increases levels of natural moisturizing factor (NMF), which, in addition to increasing hydration of the stratum corneum, also helps prevent Staphylococcus bacteria from adhering to the skin. Supplements are widely available on Amazon. Dosing is much higher than for routine use as a bodybuilding supplement. Studies on skin have shown efficacy at 4gm/day.
Hair growth supplements
A role to play with other therapies. Two of the biggest sellers in this category are Viviscal and Nutrafol. Anecdotal evidence and some stellar before-and-after photos suggest these supplements are efficacious.
I recommend Viviscal in conjunction with oral minoxidil for patients concerned with hair loss. I prescribe a very low dose of 0.25mg minoxidil, which has been shown to be too low to affect blood pressure but still works to stimulate hair growth. Compounding can be cost prohibitive, so I instruct my patients to buy generic minoxidil 2% solution. They should put 1 teaspoon into two measuring cups of water (approx. 500L) and drink 1.25 teaspoons every morning. This is the dose shown to be effective for hair loss, and the inactive ingredients are totally safe to drink. I’ve had really spectacular results for female pattern alopecia and telogen effluvium.
Note: These supplements contain biotin, and in late November 2017, the FDA published a safety alert stating that biotin can “significantly interfere with certain lab tests and cause incorrect test results…” One death occurred when a patient taking high doses of biotin had falsely low results from a troponin test known to have interference from biotin. (See Sidebar for more details.)
Polypodium Leucotomos Extract
Part of a sun protection regimen. Heliocare is the brand version of this extract, and I suggest only buying the brand. I purchased the generic version and got burned literally and physically. Heliocare is not a panacea, and it does not take the place of sunscreen and sun avoidance behaviors. It can protect against polymorphous light eruption. I recommend about one pill per 25lbs taken 30 minutes before sun exposure in order to get an SPF of 10-15 for about eight hours. If a patient is in a rush, they can spill capsules in water and drink the mixture. This is not an appropriate remedy for melasma.
Get more on oral supplements from Dr. Zirwas.
NiacinAmide
The jury is still out. At this time, there is not enough evidence to recommend niacinamide for skin health and non-melanoma skin cancer (NMSC) prevention. It does appear to inhibit development of squamous cell carcinoma (SCC), but if or when the patient stops taking it, there is likely to be accelerated development of the SCCs that were inhibited while the supplement was being taken.
Take Time to Educate
When asked about any supplement by a patient, don’t immediately shut them down. It may feel natural to say something like, “Supplements aren’t medicine and haven’t been proven to do anything.” But the patient will likely feel that you aren’t listening to them. Instead, point out that there are supplements with good science behind them that may be worth consuming as part of an overall skin health regimen. Then discuss some of the above. Tell patients that for most other supplements, we just don’t know yet if they really work or not.
Don’t miss Dr. Zirwas’ presentation at the Cosmetic Surgery Forum 2018 where he will weigh the available evidence on supplements promising longevity. CSF 2018 will be held November 28 to December 1 at Cosmopolitan, Las Vegas. For information, visit cosmeticsurgeryforum.com.
This article is based on a presentation given at Cosmetic Surgery Forum 2017.
Dr. Zirwas practices at Bexley Dermatology in Bexley, OH
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