BIOTIN 



45. C. P. Rhoads and J. C. Abels, /. Amer. Med. Assoc, 1943, 121, 



1261. 



46. I. I. Kaplan, Amer. J. Med. Sci., 1944, 207, 733. 



47. H. E. Kline, J. A. Miller and H. P. Rusch, Cancer Res., 1945, 5, 



641. 



48. M. A. Pollack, A. Taylor, A. Woods, R. C. Thompson and R. J. 



Williams, ibid., 1942, 2, 748. 



10. EFFECT OF BIOTIN DEFICIENCY IN MAN 



The symptoms of biotin deficiency in human beings were first 

 reported by V. P. Sydenstricker et al.^ Four volunteers were fed on 

 a diet containing minimal amounts of biotin and 30 % of the total 

 calorie intake in the form of egg white. During the third and fourth 

 weeks, all developed " a fine scaly desquamation without pruritis ", 

 which disappeared spontaneously in seven to ten days. Nothing 

 further happened imtil the seventh week, when one man developed a 

 maculosquamous dermatitis of the neck, hands, arms and legs. 

 During the seventh and eighth weeks all showed a pronounced 

 greyish pallor of the skin and mucous membranes, which was out of 

 all proportion to the blood picture. No capillary engorgement 

 occurred as in pellagra or aribofiavinosis, the tongues remaining pale. 

 During the ninth and tenth weeks the skin became increasingly dry 

 with marked reticulation and a return of the fine branny desquamation. 

 After the fifth week, symptoms resembling vitamin B^ deficiency were 

 observed, mild depression followed by extreme lassitude, somnolence, 

 muscle pains and hyperaesthesia. After the tenth week anorexia with 

 occasional nausea was evident. Two patients showed definite electro- 

 cardiographic changes. The blood picture was characterised by a 

 diminution in the haemoglobin, erythrocytes and volume of the 

 packed red cells, together with a slight increase in the bile pigments 

 and a large rise in the serum cholesterol. After seven to eight weeks 

 the luinary excretion of biotin was 3-5 to 7-3 /xg. per day as compared 

 with 29 to 52 fjLg. per day on a normal diet. When biotin was given 

 at a level of 75 to 300 /xg. per day by injection there was prompt relief 

 of the symptoms in three to five days and the urinary excretion at 

 once rose to 55 /xg. per day. 



Three cases have been described ^ of infants with a mild skin 

 lesion on the face which resembled that observed in artificially produced 

 biotin deficiency. Raw egg white made the lesions worse, whilst 

 biotin methyl ester brought about inunediate improvement with 

 complete disappearance of the lesions in three weeks. A case of 

 biotin deficiency resulting from a diet consisting solely of raw eggs 

 has already been referred to (page 427). 



432 



