Journal of the American Academy of Dermatology

4 Research-Backed Supplements to Boost Your Hair, Skin, and Nails

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fish oilCollagen. Biotin. Shark cartilage. Frankincense. Even… placenta? Every day, patients in my dermatology practice ask about supplements claiming to restore or improve the skin, hair, or nails. But do they, really?

Unlike medicines, which are regulated by the Food & Drug Administration, over-the-counter supplements are subject to little oversight. There is no guarantee that their claims or ingredients are backed by science (or that the ingredients on the label are actually even in the tablet) – making the supplement aisle the wild west of every pharmacy. While no vitamin or supplement should ever be taken without consulting a physician first, there are a few that are backed by scientific research showing that they may have a positive effect on our strands, skin, or nails. Here are some of them.

For skin cancer prevention: Vitamin B3, also called nicotinamide, has been shown to lower the risk of nonmelanoma skin cancers (such as basal cell carcinoma or squamous cell carcinoma) and precancerous growths (called actinic keratoses). In a 2015 New England Journal of Medicine study of more than 600 patients with a history of skin cancer, 500mg of B3 taken twice daily led to a 23% drop in new cancerous growths over 1 year. Sun protection remains the most important way to lower skin cancer risk – but those stats aren’t too shabby, for a vitamin.

For brittle nails: Biotin (also called vitamin H or B7) was shown to increase nail plate thickness by 25% in patients with brittle nails, while reducing splitting and improving nail smoothness, according to studies from the Journal of the American Academy of Dermatology (JAAD) and Cutis. The optimal dose isn’t known, but dermatologists have suggested 2.5mg daily for those with delicate nails. Just be sure to let your doctor know if you take biotin, and consider holding off on the vitamin prior to any bloodwork: In 2017, the FDA issued a warning that it can interfere with certain lab tests, including some measuring cardiovascular and thyroid levels.

For thinning hair: As a dermatologist, I never used to recommend dietary supplements for patients with sparse or shedding hair, unless there was a specific nutritional or medical issue to correct. Now I sometimes do for patients with male or female pattern hair loss – the gradual thinning many of us are prone to later in life. Small, randomized, double-blind, placebo-controlled studies of men and women with thinning hair, published in the Journal of Cosmetic Dermatology and Dermatology Research and Practice, showed a significant increase in hair density with reduced shedding over 3 to 6 months on a marine supplement called Viviscal. And the plant-based Nutrafol led to an increased number of hairs, with increased thickness, volume and growth rate in women over 3 to 6 months, according to a May 2018 study from the Journal of Drugs in Dermatology. This supplement contains ingredients said to reduce inflammation, antioxidants to help guard against cell-damage, and saw palmetto, which may inhibit hormonal factors that can contribute to hair thinning.

For psoriasis: Fish oil supplements may help to alleviate rashes in those suffering from psoriasis – a chronic condition of scaly, pink skin that often affects the elbows, knees, scalp, and other areas. A 2014 meta-analysis published in JAAD showed a moderate benefit in psoriasis – reduced area of rash, and improved thickness and redness of psoriasis – after supplementing with omega-3 polyunsaturated fatty acids from fish oils (eicosapentanoic acid, EPA, and docosahexanoic acid, DHA). The study authors suggested doses of 0.45 to 13.5 grams of EPA and up to 9 grams of DHA daily – and explained that the supplements are expected to be most helpful when used along with established psoriasis medications.

For whatever ails you: If there’s a supplement you believe in, it might just work – due to the powerful placebo effect. Decades of research have shown that the expectation of results is sometimes enough to actually see results. That’s one reason I don’t discourage vitamins that have a decent safety profile, if a patient truly believes in them.

But before starting any supplement, be sure to talk to your doctor to find out if it’s right for you and whether it’s safe to take with other medicines.

Oral Antibiotic Rx Remain High

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Despite recommendations to limit the use of oral antibiotics, dermatologists continue to prescribe them in high numbers, according to a large, retrospective analysis of U.S. prescribing trends from 2004 to 2013.

However, spironolactone prescriptions increased nearly fourfold over that same time period, which is a good sign that alternatives may be gaining traction, the researchers said, writing in the Journal of the American Academy of Dermatology.

 “Given concerns about antibiotic resistance and other complications associated with oral antibiotic use, it is encouraging to observe an increase in the use of alternative agents such as spironolactone for the treatment of acne in female patients,” said John S. Barbieri, MD, MBA, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues.

The number of spironolactone prescriptions marched steadily upward over time in the analysis, which was based on review of claims data representing 12 million to 14 million annual covered lives.

Dermatologists prescribed 2.08 courses of spironolactone per 100 acne patients in 2004, increased to 4.10 courses per 100 patients in 2010 and 8.13 courses in 2013.

However, oral antibiotic usage remained much higher over the entire study period, the results showed. Dermatologists prescribed 26.24 courses of antibiotics per 100 acne patients in 2004. That number appeared to dip slightly to 22.90 courses per 100 patients in 2010, but returned to 27.08 courses in 2013.

“Whereas we initially observed a slight decrease in oral antibiotic use, this trend has reversed in recent years,” the researchers said.

It is uncertain why oral antibiotic use seemed to decrease but then increase again, although the team noted that the shift upward followed the “dramatic decrease” in use of drospirenone-containing combined oral contraceptive pills starting in 2009: “It is possible that because of concerns about the safety of drospirenone-containing combined oral contraceptive pills, clinicians shifted their prescribing behavior toward the use of more oral antibiotics.”

Use of combined oral contraceptive pills dominated the group of systemic oral agents in this claims dataset, from 34.31 courses per 100 acne patients in 2004, which declined somewhat to approximately 30 courses per 100 patients in 2010 and 2013.

The analysis included a total of 594,776 courses of oral antibiotic treatment, 527,288 courses of combined oral contraceptives, 61,042 courses of spironolactone, and 108,664 courses of isotretinoin. The study also includes prescribing data for non-dermatologists.

The authors suggested that dermatologists identify patients who might benefit most from alternatives to oral antibiotics, including spironolactone, isotretinoin, and oral contraceptives.

Oral antibiotics are among the most commonly prescribed treatments for acne that cannot be managed with topical therapies, the researchers noted. In fact, dermatologists are the highest prescribers per capita of antibiotics compared with any other medical specialty.

 Excessive use of antibiotics persists throughout medicine despite ongoing concerns about excessive use of antibiotics due to emerging antibiotic resistance, as well as adverse effects that include pharyngitis and inflammatory bowel disease, Barbieri et al wrote.

Guidelines from the American Academy of Dermatology (AAD) and others recommend that the oral antibiotic treatment duration be limited to 3 to 6 months, although a subset of patients may require longer treatment.

The duration of oral antibiotic therapy in the analysis by Barbieri and colleagues was indeed a median of 126 days for patients receiving care from dermatologists, and 129 days for those treated by non-dermatologists. However, the sheer numbers of prescriptions were a cause of concern, with the authors calling for “judicious use” and “stewardship” of antibiotics.

“Like the authors of prior studies, we observe that prescribing behavior for oral antibiotics and the use of concomitant topical retinoids are not well aligned with current guidelines, although additional research is needed to understand the optimal duration of therapy with oral antibiotics.”

Despite concerns over current levels of antibiotic use, Barbieri et al said they were hopeful that use of antibiotic alternatives will “continue to grow,” particularly following recent data suggesting that routine potassium monitoring may be unnecessary for healthy women taking spironolactone for acne.

 “Increasing the use of concomitant topical retinoids, and additional work to identify those patients who would benefit most from alternative agents such as spironolactone, combined oral contraceptive pills, or isotretinoin represent potential opportunities to improve the care of patients with acne,” the team concluded.