Biotin

Biotin, also known as vitamin B7, B8 or vitamin H, is essential for life. The major biological function of biotin is to act as a covalently bound cofactor for the biological activities of five mammalian biotin-dependent carboxylases. These biotin-dependent carboxylases play a crucial role in essential biological processes, including fatty acid synthesis, gluconeogenesis, and amino acid metabolism. Biotin helps to trigger the reactions needed to convert food into energy. It also boosts the enzyme production that supports the metabolisation of fat and carbohydrates. Biotin injections support healthy cell growth and the creation of amino acids. Amino acids are essential for creating protein, so they have the ability to repair and maintain skin, hair and nail health.

The daily recommended amount of biotin is usually satisfied by diet. Humans are unable to produce their own biotin; however, bacteria found in our intestines have the capability to produce biotin. Nutritional deficiency is rare, but consuming raw eggs in products like mayonnaise or Caesar dressing on a regular basis may cause a biotin deficiency. A protein called avidin, present in raw eggs, strongly binds to biotin, making it unavailable for intestinal absorption. Cooking eggs denatures avidin and makes biotin available for absorption.

Like other members of the vitamin B complex, biotin is water-soluble and non-toxic. It is not stored on the body for very long.

History of Biotin

The discovery of biotin occurred in response to research investigating the cause of what was then known as ‘egg white injury’. It dates back to 1927 when it was observed that rats fed egg white developed dermatitis and lost hair.

There was an observation that the consumption of eggs in the diet is toxic to mammals and that the skin lesions caused by the diet could be cured by treatment with a heat-stable factor from yeasts or liver.

In 1924 three factors were identified as necessary for the growth of microorganisms. They are named bios II, vitamin H and coenzyme R. It eventually became clear that all three factors were the same water-soluble, sulphur containing vitamin, biotin.

In 1932 Koegl and Toennis isolated the vitamin from egg yolk. In 1936 they gave the name of biotin as the substance that was isolated from the yolk. It was the first time that they recognised that egg white injury could be healed by biotin supplements.

Between 1940 and 1943, the structure and properties of biotin were established, and the first chemical synthesis was completed by Harris and Associated of the Merck Company in 1943.

Sources of Biotin

Biotin is synthesised by intestinal bacteria, but there is a lack of evidence about how much biotin they provide. Biotin is stable at room temperature and is not destroyed by cooking. Some of the best sources of biotin in the diet include:

• Brewers yeast
• Soybeans
• Beef liver
• Split peas
• Sunflower seeds
• Green peas/lentils
• Butter
• Peanuts/walnuts
• Pecans
• Eggs

Factors that affect biotin production and absorption

Those that have relatively low levels of biotin include:

• Alcoholics
• Epileptics
• Elderly individuals
• Athletes
• Pregnancy and lactation
• Gastroenteritis issues
• Smoking
• Genetic causes
• Long-term dieting
• Intravenous feeding
• Use of certain medications
• Vegetarians

Symptoms of biotin deficiency

• Red rashes on the skin
• Brittle hair
• Insomnia or difficulty sleeping
• Depression
• Muscle pain
• Seizures
• Upset stomach
• Fatigue
• Dry eyes
• Dry of scaly skin
• Loss of appetite
• Nausea
• Burning or prickling sensation in the hands or feet
• Cracking in the corners of the mouth
• Difficulty walking

Benefits of biotin

Hair growth – biotin is associated with healthy hair growth. Hair loss can be contributed with a biotin deficiency.

Weight loss – biotin is vital for breaking down fatty acids and glucose and can assist in weight loss.

Lowering cholesterol – biotin regulates cholesterol levels in the body.

Cognitive function – biotin is critically involved in the synthesis of myelin, which is a substance that coats and protects the components of your nervous system. Multiple sclerosis is a condition that destroys the myelin sheaths around your neurons, which leads to nervous system breakdown and severe pain. One study found that biotin administration improved symptoms in 90% of patients with multiple sclerosis.

Anxiety – the right balance of biotin helps soothe anxiety.

Blood pressure – biotin is claimed to regulate blood pressure.

Depression – a chronic deficiency of biotin can be associated with depression.

Aids digestion – the intake of biotin facilitates the digestion of food.

Diabetes – biotin helps to regulate blood sugar levels.

Fertility – adequate levels of biotin boosts fertility.

Prevents grey hair – biotin protects the natural hair pigment and prevents premature greying.

Heart health – the lowering of blood pressure and the reduction of cholesterol levels caused by an increase of biotin are vital for the optimum functioning of the heart. The reduction of triglycerides in the body prevent heart disease.

Joint pain – biotin reduces inflammation in the joints reducing joint pain.

Menstrual cycle – regulates the menstrual cycle.

Nail growth – the stimulation of protein from the increase of biotin is vital for nail growth and can prevent splitting.

Pregnancy – biotin levels can drop in pregnancy. Adequate biotin levels can reduce and prevent birth defects. It can also reduce the risk of miscarriage and premature birth.

Vitiligo – Vitiligo is an autoimmune disorder, and, in some cases, it can be caused by nutrition deficiency such as deficiency of the B complex vitamin like biotin.

Wound healing – biotin accelerates the wound healing process.

Indications for treatment

• Hair damage, breakage or thinning
• Hair discolouration
• Weak or brittle nails
• Energy boost
• Skin ageing or dehydration due to a reduction of the lipid barrier
• Immune system support
• Weight loss alongside a healthy diet and exercise

Side effects of too much biotin

• Bowel discomfort, cramping, diarrhoea.
• Respiratory problems
• Increased inflammation
• Multiple sclerosis
• Acne
• Acid reflux
• Thyroid issues
• Side effect or reaction to other medications
• Skin flushing, itchiness or rashes

Treatment

When offering vitamin injections to clients, it is important to remember that we are not treating medical conditions. Treatment should only be offered as a boost to improve physical condition such as hair, skin, nails or energy. Biotin injections are a great add -on service to PRP or Carboxy hair restoration or alongside anti-ageing skin treatments.

If using biotin for hair growth, the dosage of biotin should be 3 per week for six weeks, then twice a week for six months. Biotin for improving skin or nail conditions should be given as a course of 1-2 injections per week for six weeks. If symptoms persist, leave a break of a month before proceeding with a further course for six weeks.

Client Consultation

A client consultation is a one to one talk with your client. During this time, you will find out very important and confidential information that will allow you to advise and provide the best treatment for the client.

It is important to always introduce yourself to the client as this removes any barriers and relaxes them. Consultations should always be undertaken in a private room or area where you cannot be overheard by others.

A client should first fill out a client consultation which helps identify any contra-indications that may mean you have to alter the treatment or be unable to treat them at all. If their form shows no reason why they cannot proceed with the treatment, then you can move onto verbal questioning.

Verbal questions would be to establish why the client has visited the salon and what their expectations and outcome of the treatment may be. Asking what they want ensures you can provide customer satisfaction as the client should be pleased with the outcome of their treatment. It is good practice to speak to the client in front of a mirror and explain the treatment to them and see if that meets their requirements.

Once you have established what the client is after, then a physical examination should be undertaken. This allows you to further check for any undeclared contra-indications and get a better overview of any issues that you may face during the procedure.

Allow around 15 minutes for the client's first salon visit. Ideally, you should sit face to face or next to the client to create an open atmosphere. Avoid barriers such as a couch or table between you.

Use open questions to tactfully encourage the client to give you information that you may need rather than using interrogating questioning techniques. Use the consultation form to work from and record anything you may discuss.

Record Keeping

Records must be maintained and updated for a number of reasons.

• They provide contact details in case you need to alter or cancel an upcoming appointment.
• So that you can track client’s progression.
• To record the products used and timings so you can use these at further visits and adjust the treatment plan if required.
• Tracks any aftercare you provide the client.
• Records patch test history.
• As a backup in case, the client has an adverse reaction to treatment.
• For legal reasons if the client brings a claim against you.

Client records can be stored electronically or filed away manually and should be updated at every visit. If consultation forms are not updated and do not contain a history of services and dates, then you may find your insurance invalid.

Forms should be kept for the timeframe suggested by your insurance company. This may be for up to six years. If a client is under 21 at the time of service, then it is recommended to keep the forms for six years past their 21st birthday.

Client confidentiality must be protected at all times. Forms need to be locked away in a secure cabinet, and electronic records should be held on a password-protected computer. You may also need to register with the ICO as a data controller.

• All information must be accurate and necessary for the service or treatment being performed.
• Individual client records must be available for the clients to view if requested.
• Data should not be passed on or sold without the client’s prior written permission.

The following details should be recorded on the client consultation form:

• Personal details – name, address, contact details
• Results of any patch tests
• Contra-indications
• Contra-actions
• Reasons for the treatment
• Any reactions to treatments/previous treatments
• Home care advice/suggested retail items.
• Any sales
• Treatment timings/products used etc.
• Next appointment or recommendations

Any contra-indications and possible contra-actions should be identified and discussed prior to the treatment. In the case of a medical referral, the therapist should keep a copy of the GP's letter with the client's record card.

Consultation forms must be signed and dated to prove that you have covered everything and given the correct advice and treatment plan.

Contra-indications

A contraindication is the presence of a condition which may make the client unsuitable for the treatment. The treatment may not be able to take place, or the treatment will need to be adapted.

When treating a client, if they show any signs of contra-indications, you should tactfully refer them to their GP for treatment or advice. You should never make a diagnosis even if you are certain of the condition as you may be wrong.

If you are unsure about any contra-indications, then do not treat the client and refer them to their GP.

Be careful if you deal with a contra-indication, and they can often be contagious. Make sure you clean the work area and any implements between clients to prevent cross-infection.

Contra-indications

• Chemotherapy patients ( antioxidants such as Vit C can reduce the drug effect)
• Pregnancy and breastfeeding
• Known allergies or sensitivity to biotin
• Kidney/liver problems
• Skin rashes
• Upset stomach
• Unrealistic expectations
• Sickle cell anaemia
• Hormone tablets (Vit C can increase Oestrogen further)
• Protease inhibitors
• Warfarin (high Vit C levels may reduce effect)

Contra-actions post-treatment

• Infection at the injection site
• Fainting
• Stinging
• Burning
• Bruising
• Erythema
• Oedema

Dosage

One injection every 2-3 days for a loading dose period over two weeks. Maintenance treatment every four weeks. For specific hair or skincare rejuvenation, please see earlier treatment advise.

Equipment Needed

• 2.5ml Syringe
• 23g, 30mm blue needle
• 21g, green drawing needle
• 2ml Biotin 0.5%
• Antiseptic skin wipes
• Gauze or cotton wool
• Gloves
• Kidney dish
• Glass ampoule opener

Intramuscular Injections

Intramuscular (IM) injections deposit medications into the muscle fascia, which has a rich blood supply, allowing medications to be absorbed faster through muscle fibres than they are through the subcutaneous route. The IM site is used for medications that require a quick absorption rate but also a reasonably prolonged action. Due to their rich blood supply, IM injection sites can absorb larger volumes of solution. In addition, muscle tissue is less sensitive than subcutaneous tissue to irritating solutions and concentrated and viscous medications.

Intramuscular injections must be done carefully to avoid complications. Complications with IM include muscle atrophy, injury to the bone, cellulitis, sterile abscesses, pain, and nerve. With IMs, there is an increased risk of injecting the medication directly into the patient’s bloodstream. In addition, any factors that impair blood flow to the local tissue will affect the rate and extent of drug absorption.

Sites for intramuscular injections include the ventrogluteal, vastus lateralis, and deltoid site. There is sufficient evidence that the ventrogluteal IM site is the preferred site whenever possible. The ventrogluteal site is free from blood vessels and nerves and has the greatest thickness of muscle when compared to other sites. A longer needle with a larger gauge is required to penetrate deep muscle tissue. The needle is inserted at a 90-degree angle perpendicular to the client’s body or at as close to a 90-degree angle as possible. Use a quick, darting motion when inserting the needle.

Aspiration refers to the action of pulling back on the plunger for 5 seconds prior to injecting medication. The current practice is to aspirate IM injections to checking for blood return in the syringe. Lack of blood in the syringe confirms that the needle is in the muscle and not in a blood vessel. If blood is aspirated, remove the needle, discard it appropriately, and re-prepare and administer the medications.

The dorsogluteal site

The dorsogluteal (buttock) site is not routinely used due to its location near major blood vessels and nerves, as well as having an inconsistent depth of adipose tissue. Many injections in this site do not penetrate deep enough under the skin to be correctly administered in the muscle.

Since the dorsogluteal site is in close proximity to the sciatic nerve, significant injury, pain, and temporary or permanent paralysis can occur if medication damages the sciatic nerve. Damage can occur if the injection site is not mapped correctly.

IM injection into the Gluteus medius site (buttock)

• Find the trochanter. It is the knobbly top portion of the long bone in the upper leg (femur). It is the size of a golf ball.
• Find the posterior iliac crest. Many people have ‘dimples’ over this bone.
• Draw an imaginary line between the two bones
• After locating the centre of the imaginary line, find a point one inch toward the head. This is where (X) to insert the needle.
• Stretch the skin-tight
• Hold the syringe like a pencil or dart. Insert the needle at a right angle to the skin
• Up to 3ml of fluid can be given in this site.

The ventrogluteal site

Giving an IM injection into the ventrogluteal site

The Ventrogluteal site provides the greatest thickness of gluteal muscle (consisting of both the gluteus medius and gluteus minimus), is free of penetrating nerves and blood vessels, and has a narrower layer of fat of consistent thinness than is present in the dorsogluteal.

Giving an IM injection into the ventrogluteal site

• Find the trochanter. It is the knobbly top portion of the long bone in the upper leg (femur). It is about the size of a golf ball.
• Find the anterior iliac crest
• Place the palm of your hand over the trochanter. Point the first or index finger toward the anterior iliac crest. Spread the second or middle finger toward the back, making a ‘V’. The thumb should always be pointed toward the front of the leg. Always use the index finger and middle finger to make the ‘V.’
• Give the injection between the knuckles on your index and middle fingers.
• Stretch the skin-tight
• Hold the syringe like a pencil or dart. Insert the needle at a right angle to the skin (90°)
• Up to 3ml of fluid may be given in this site.

The deltoid site

The ease of access, especially in an outpatient setting, possibly adds to the frequency with which the deltoid site is used for IM injections. This site is used for immunisations/non-irritating medications; hence vaccines that are usually small in volume tend to be administered into the deltoid site. This is a relatively small area and muscle mass, especially in atrophied clients compounded by the close proximity of the radial nerve, brachial artery and bony processes to this site, means that more substantial injuries can occur.

• Find the knobbly top of the arm (acromion process)
• The top border of an inverted triangle is two finger widths down from the acromion process
• Stretch the skin and then bunch up the muscle
• Insert the needle at a right angle to the skin in the centre of the inverted triangle

Caution: This is a small site – give only 1-2ml or less of fluid in this site

• Prepare everything, ensure you have your syringe, drawing needle, injection needles and vitamin vile ready, along with your sharps bin.
• Open your syringe and drawing needle, keeping the packaging on where possible in order to not contaminate the needle.
• We recommend using a 21g Gauge drawing.
• Attach the drawing needle onto the syringe, leaving the protection cap on the needle.
• Open your vitamin ampoule. Break the top off the ampoule from the dot and dispose of the top.
• Take the top protection cap off the drawing needle and draw up from the ampoule the correct dose as recommended or suggested by your prescriber.
• Dispose of the single-use ampule, do not use any further product from it.
• Open the packing for your injection needle; we recommend the 23 Gauge needle.
• Take your syringe and untwist the drawing needle with the cap off, and put it in your sharps bin.
• Put your injection needle with packaging left on onto the syringe; once secured, remove the packaging and push up all the air out of the syringe until you hit your dosage marker on the syringe.
• Clean the injection area using an alcohol wipe once you have located it.
• Dart the needle into the muscle and push in relatively quickly.
• Press and wipe the area with an alcohol wipe and dispose of your injection needle into the sharps bin.