Hair modifications associated to most cancers remedy can lead sufferers to discover dietary supplements that promise regrowth or strengthening, ceaselessly with out realizing these merchandise could carry unintended scientific penalties, in keeping with Dr. Brittany Dulmage, a doctor and affiliate professor of dermatology on the Ohio State College Wexner Medical Middle.
New analysis is drawing consideration to biotin, a extensively used vitamin discovered in lots of hair and nail dietary supplements, and its potential to disrupt laboratory testing that oncologists depend on to watch illness standing and information care. These findings, revealed in JCO Oncology Observe, underscore the necessity for larger consciousness of complement use throughout and after most cancers remedy, notably when lab outcomes play a central function in remedy selections.
Dulmage additionally serves as affiliate director of dermatology and director of the Oncodermatology Clinic at The Ohio State College Complete Most cancers Middle – Arthur G. James Most cancers Hospital and Richard J. Solove Analysis Institute.
As senior writer of the examine, Dulmage investigated how biotin supplementation can intervene with generally used laboratory testing and outlined safer, evidence-based approaches to managing cancer-related hair loss. She sat down with CURE to debate her analysis and its implications.
CURE: Why achieve this many sufferers who’re experiencing cancer-related hair loss flip to biotin dietary supplements? What are the frequent misconceptions about their security throughout remedy?
Many sufferers flip to biotin dietary supplements due to their perceived security. They’re simple to acquire from the complement aisle at an area drugstore; it looks like there’s not numerous danger related to them. Most cancers sufferers are sometimes on the lookout for issues which are decrease danger relating to the potential for interplay with their remedies. They’re usually cautious about including extra prescription medicines to their routine as a result of they’re already present process remedy with chemotherapy, immunotherapy or different therapies. This may occasionally trigger hesitation towards prescription medicines, whereas dietary supplements usually appear to be decrease danger and are perceived to be extra pure.
How can biotin intervene with routine blood exams? Why is that this dangerous for sufferers present process lively most cancers remedies?
Biotin doesn’t change hormone ranges within the physique; it doesn’t trigger your physique to provide kind of of a hormone. As a substitute, when blood is drawn, biotin can bind to a number of the reagents (the chemical compounds added to the check tube) and intervene with the lab outcomes. This could trigger some readings to look too excessive and others to look too low.
Among the most pertinent interferences happen with thyroid hormone ranges, which will be misestimated. It could actually result in falsely low prostate-specific antigen (PSA) ranges, that are a marker of prostate most cancers. Moreover, it will probably result in misinterpretations of intercourse hormones like testosterone and estradiol, a sort of estrogen. These are necessary as a result of oncologists could use these labs to trace response to remedy. Within the case of PSA, it’s used to trace the danger or presence of recurrence.
These labs are used to make remedy selections. For a girl present process breast most cancers remedy, estradiol ranges are measured to find out if she is pre- or post-menopausal, which can dictate the remedy she receives for hormone-receptor-positive breast most cancers.
Moreover, biotin interferes with labs that monitor the unwanted effects of most cancers remedy. Thyroid operate, specifically, is commonly impacted by varied sorts of immunotherapy. In case your thyroid hormone ranges are misrepresented, it could seem as if you’re or are usually not having a response to immunotherapy when the alternative is true.
Can biotin doubtlessly alter remedy selections?
Even when it doesn’t alter remedy selections, it has the potential to result in extra pointless exams or imaging. If a affected person had been to obtain falsely incorrect lab values, they could have to endure extra pointless labs or imaging to additional work up these false outcomes.
What safer evidence-based choices do you advocate for sufferers who’re involved about hair loss or modifications to pores and skin and nails throughout remedy?
So far as hair loss is worried, one among our protected, available choices is minoxidil, which is obtainable over-the-counter, usually as a foam or an answer. It’s protected when utilized topically, besides when utilized by pregnant or breastfeeding girls. Aside from for that affected person group, minoxidil may be very protected for almost all of sufferers and is available as an over-the-counter possibility.
Past that, there are some oral medicines that could be choices relying on the kind of most cancers and the kind of hair loss being handled. These would usually be prescribed by a dermatologist or somebody who’s comfy managing completely different types of hair loss. There are some prescription medicines that we keep away from in sufferers who’ve hormone receptor-positive cancers, specifically, breast most cancers. Due to this fact, for every particular person affected person, it is very important decide their most cancers sort and their hair loss sort, as there are completely different patterns and types of hair loss, after which in the end unite these two elements to resolve on a protected and efficient medicine plan.
What conversations ought to sufferers have with their oncology workforce earlier than beginning any over-the-counter dietary supplements, even those who appear innocent?
I feel a few issues are necessary. First, you wish to know if the complement you’re taking or plan to take has proof to help its use. Within the case of biotin, not solely does it have the potential to intervene with lab outcomes, however there’s little or no proof that it’s really useful for hair development. There aren’t any goal research utilizing measures of hair regrowth over time that present any demonstrated profit to biotin.
Whereas very small research present that sufferers could subjectively really feel higher on it, there isn’t any proof that it really helps develop hair. Comparatively not too long ago, inside the previous couple of years, the American Academy of Dermatology acknowledged that we have to cease telling sufferers to take biotin as a result of it doesn’t have a confirmed profit, and this is applicable to all sufferers, not simply these with most cancers.
On high of that, it carries the danger of interfering with blood work. Importantly, you wish to know if a complement has any demonstrated profit for the particular aspect impact you’re planning to deal with. One other necessary consideration is whether or not there’s a danger of interference past simply blood work. Dietary supplements could alter the best way remedy medication are metabolized. Some dietary supplements could intervene with how your physique breaks down different medicines, resulting in ranges of these medicines which are both too excessive or too low.
Most oncology groups embrace a scientific pharmacist who can overview a deliberate complement alongside a affected person’s medicine listing. They’ll spotlight any “crimson flags” or dangers for drug-drug interactions, the place the 2 substances work together with one another.
What dangers does biotin pose past cancer-specific laboratory testing?
There are two different sorts of labs that biotin interferes with. It will not be as instantly related for most cancers sufferers, however they’re necessary. One is that it interferes with troponin ranges, that are a marker of whether or not somebody is having a coronary heart assault. Quantity two is that it interferes with numerous commercially out there being pregnant exams. So, they will intervene with the probability of getting a constructive being pregnant check if somebody is pregnant.
The explanation why I level these two issues out, the troponins, is as a result of within the paper we speak about how if a affected person knew they had been taking biotin and wished to proceed it, and knew they’d blood work arising, they may maintain the biotin for 72 hours earlier than the blood work, and that would cut back any impact the biotin would have on the blood work. The issue with troponins is that nobody plans to have a coronary heart assault, so nobody thinks, “I’m going to have a coronary heart assault, so I higher maintain my biotin for 72 hours earlier than the center assault.” And that’s problematic, as a result of should you present up on the hospital and you’re presumably having a coronary heart assault, they verify these troponin ranges, they’re going to doubtlessly be altered by the biotin, and you’d have had no thought that you just had been supposed to carry it.
I feel that’s one other necessary interplay to level out, though that’s not particular to most cancers sufferers. The opposite factor I might simply add is that I used to be pushed to jot down this paper and to form of deliver this to mild as a result of one of many most important elements of my apply is caring for sufferers with hair loss from most cancers. Sufferers who’re coping with hair loss from breast most cancers therapies, and numerous them are available on biotin at their very first go to. In case you ask what they’ve tried for hair loss, dietary supplements are the primary factor folks have tried if they’ve tried one thing earlier than they got here in. Just about the entire dietary supplements which are marketed as hair, pores and skin or nail nutritional vitamins or dietary supplements comprise biotin.
I had this dialog over and over and over with new sufferers, and I wished to jot down a paper that will attempt to be directed on the oncology viewers, as a result of sufferers who’re present process most cancers remedy are sometimes going to speak to their oncologists earlier than they ever make it to a dermatologist. And I wished to be sure that oncologists had been conscious of this danger, as a result of I feel many oncologists assume that biotin is comparatively protected as a result of it’s available and it’s a B vitamin, and that there’s not numerous danger in it.
We wished to deliver this potential impact on lab values to mild.
References
- “Most cancers Sufferers Warned Widespread Complement Could Intrude with Therapy,” by The Ohio State College Complete Most cancers Middle. Information launch; Jan. 2026.
- “Biotin Dietary supplements for Hair and Nail Regrowth: A Warning for Oncologists,” by Layna Mager, et al. JCO Oncology Observe.
Transcript has been edited for readability and conciseness.
For extra information on most cancers updates, analysis and training,
