X. EFFECTS OF 1)1 .FK'I KXCY GU.J 



"Siiu'o adoloscoiu'o tlio patient lind l)eoii extremely lOiul of raw e^Mis, putting one 

 or two into eaeli jtlass of wine tliat lie took. For several decades he had druid< wine or 

 whiskey almost (>very da>'. Durinj^ the six years preceding admission, he had di'Uidv 

 from 1 tot ((uarts of wine <lail\-. In ord(>r to have a sufficient nunilier of eggs for his 

 drinks, he deseilcd his faniil\ and niox'cd 1 o t he couiil i y sn thai he could m;iiiitaiti his 

 own chicken far in. Duiing this period of time he ate from two to six dozen law eggs 

 l)(>r week. lie did not eat at any I'egular time. Sometimes he ate only one or two meals 

 a day, and sometimes he drank nothing luit wine and eggs foi- 1 or 2 days. His choice 

 of foods was narrow and consisted chieli\ of r.inned goods; rarely did he drink milk 

 oi' eat liver (sources of hiotin). 



' So long as he could remember, his skin had liccii (|uilc red, l)ut 5 years previously 

 the redness increased and many scales were noted. A mild conjunctivitis had iieen 

 jiresent for several months. These changes persisted, and 3 moid lis before .admission 

 there was an increase in their severitw There was not much fluctuation in the nature 

 of the rash. Tliei'e was iie\-er aii\' itching, vesicles, bullas or evidence of skin infec- 

 tion; nor w ;is there di;irrhea, sore tongue. luMiralgia, clieilosis. night blindness or 

 h(>morrli;igic phenomena ." 



The patient with his mafked exfoliative dermatitis has undergone a 

 partial, and later a more radical, amputation of the penis becaii.se of a 

 carcinoma. 'I'his was followed by prolonged infection of the lu'inary tract 

 and pneimionia, treated in the hospital. During his hospitalization the 

 patient received a well-balanced, rich diet with supplements of vitamins. 

 The exfoliati\-e dermatitis, with all its manifestations, improved rapidly, 

 and the skin regained its outwardly normal appearance An attempt to 

 reactivate the dermatitis by gi\'ing the patient a diet low in biotin failed. 



UiKiuestionably this patient must have consumed for several years a diet 

 conducixe to the production of biotin dehciency. In raw whole egg, which, 

 in atldition to wine, comi)ri.sed the bulk of the patient's daily diet, avidin, 

 the natural aiitibidtin, is present in excess of biotin.^' The e.xfoliative der- 

 matitis which the patient exhibited for several years is consistent with an 

 underlying deficiency of biotin. IIowe\er, in the absence of a specific thera- 

 peutic response and in \iew of the failure to reactivate the disease after it 

 subsided, the diagnosis of liiotin dcliciency in this case cannot be main- 

 tained with certainty. 



The claim that egg white injiii>' in rats as manifestation of biotin defi- 

 ciency is the analog of acrodynia ("pink disease") seen in infants and in 

 3'oung children''- is not supported by clinical comparison or by any other 

 available criterion, including therapeutic tests. 



The similarity of the cutaneous manifestations seen in experimental biotin 

 deficiency in animals, especially in rats, with the .syndrome of seborrheic 

 dermatitis and— in its most pronounced form with Leiner's disease (eryth- 

 roderma des([uamati\tim or exfoliati\-e dermatitis) in young infants has 



" P. GyOrgy and C. S. Rose, Proc. Sue. Exptl. Biol. Med. 49, 2!I4 (1942). 

 " L. M. Findluy and R. O. Stern, Arch. Disease Childhuud 4, 1 (1!)29). 



