Review

Oral nail growth supplements: a comprehensive review

Jenna Yousif1, BS, Mehdi Farshchian2, MD, PhD and Geoffrey A. Potts2, MD

1
Wayne State University School of Abstract
Medicine, Detroit, MI, USA, and As the cosmeceutical market for nail products is growing, there is an emerging need for
2
Department of Dermatology, Wayne State
dermatologists to provide patients with evidence-based information regarding over-the-
University, Detroit, MI, USA
counter products and supplements for nail growth. By law, there is no required efficacy and
Correspondence safety assessment by the Food and Drug Administration prior to these products being
Mehdi Farshchian, MD, PHD made available to consumers. This carries financial and health consequences for patients
Department of Dermatology seeking affordable and effective over-the-counter products to improve their nail conditions.
Wayne State University
In this comprehensive review, we discuss available oral nail growth products, their
18100 Oakwood Blvd., Suite 300
Dearborn, MI 48124
mechanisms of action, and side effects.
E-mail: mfarshch@med.wayne.edu

Conflict of interest: None.

Funding sources: None.

doi: 10.1111/ijd.15807

for dermatologists to recognize the evidence of benefit, or lack

Introduction
Nail growth is a multifactorial phenomenon under the control
of many factors including hormonal changes (e.g., thyroid),
pregnancy, genetic predisposition, medications (e.g.,
methotrexate, azathioprine), and environmental factors (e.g.,
ambient outdoor temperature).1 Additionally, nutrition plays a
key role, and this has been known for more than 80 years.
In 1939, Gilchrist’s study that included 379 school students
showed that although there is a considerable individual varia-
tion in nail growth, the nails of poorly nourished children grew
more slowly.2
The market surrounding oral nail supplements has become
popular amongst consumers in recent years. They are normally
marketed as “skin, hair, and nail” supplements; however, there
are also products solely targeted toward nails. These products
are easily accessible to individuals, and most do not require a
prescription or extra added costs. Unfortunately, the number of
over-the-counter products and supplements for nail growth is
overwhelming to consumers, which creates a disconnect for
those who may not understand the products they are purchas-
ing.3 In addition, there is lack of regulation by the Food and
Drug Administration (FDA) regarding dietary supplements.4
Manufacturers are not required to disclose the safety and effi-
cacy of their supplements. Therefore, the process is less of a
barrier to market and to the public compared with pharmaceuti-
cal products, for which the FDA requires evidence of safety and
916 efficacy before reaching approval for sale.5 Thus, it is important
thereof, for ingredients in these products to provide the best
care and management for their patients.
There are a multitude of papers that describe nail growth
supplementation. However, no research group, to our knowl-
edge, has compiled these studies into a systematic review. Our
goal in this article is to provide a thorough review of the current
research pertaining to oral nail growth supplementation.
Materials and methods
We performed a comprehensive electronic search on oral nail
supplements in PubMed/MEDLINE, Embase, Cochrane Central,
and Google Scholar (Table S1). The level of evidence for each
study was determined according to the Oxford Center for
Evidence-Based Medicine (OCEBM)6 (Table S1).
Biotin
Biotin, also known as vitamin B7, coenzyme R, and vitamin H,
is a water-soluble vitamin and a cofactor for five carboxylase
enzymes (propionyl-CoA carboxylase, pyruvate carboxylase,
methylcrotonyl-CoA carboxylase, and two forms of acetyl-CoA
carboxylase). These carboxylases are involved in the
metabolism of fatty acids, amino acids, and glucose.7 Although
biotin is a popular supplement amongst consumers, it is found
in its natural form in egg yolks, nuts, grains, and milk. The Food
and Nutrition Board of the Institute of Medicine recommends a
biotin intake of 30 ug/day, and individuals are rarely deficient in
this vitamin due to eating a biotin-rich diet.8

International Journal of Dermatology 2022, 61, 916–922 ª 2021 the International Society of Dermatology.
Yousif, Farshchian, and Potts
Biotin was first studied in biotin-deficient rats that developed
alopecia, dermatitis, seizures, and hypotonia—some of the
more common symptoms of biotin deficiency.9 Biotin deficiency
is rare in humans; however, it has become popular as a
supplement amongst the public for skin, nail, and hair growth.
The rationale behind the discovery of biotin to treat human
nails began with its use in pigs and horses. Human nails and
animal hooves are both composed of keratin. Thus, the
addition of biotin in the diets of biotin-deficient swine improved
their brittle and weak nails, as well as the strength and
hardness of nails in pigs that were not biotin deficient.10 This
vitamin aids in keratin biosynthesis and holds keratinocytes
together to provide tension and strength to the nail.11 Reilly
et al. evaluated how dietary biotin supplementation can affect
12
the growth of pony hooves. At a dose rate of 0.12 mg/kg,
there was a statistically significant difference between the
mean hoof growth of the ponies that received biotin
supplements compared with the control group of ponies.
Following 5 months of supplementation, the mean hoof growth
measured from the midline center of the hoof capsule was
35.34 mm compared with 30.69 mm in the control animals. In
addition, biotin-treated animals had a 15% higher growth rate
of hoof horn.12
Biotin is available at many stores as an over-the-counter and
affordable supplement. In 1989, Floersheim et al. led a clinical
trial that evaluated the effects of biotin supplementation on
brittle nails, which is a broad category for symptoms that
includes splitting, frail, soft, or thin nails secondary to trauma or
vascular insults. A daily oral dose of 2.5 mg of biotin was
administered in an open-label manner to 71 patients diagnosed
with brittle nails of unknown etiology. Of the 45 patients that
followed up for rating efficacy, 41 (91%) demonstrated a definite
improvement in the firmness and hardness of fingernails over
an average treatment time of 5.5  2.3 months.13 The term
“definite improvement” was not defined, and thus the clinical
significance of this improvement is difficult to ascertain.
Regardless of the clinical efficacy of 2.5 mg of biotin in the
Floersheim trial, even lower doses of biotin have shown the
ability to increase nail growth. In a study by Fanian et al., 60
healthy female volunteers received a multivitamin/mineral
formula containing multiple fat and water soluble vitamins,
magnesium, zinc, copper, as well as 45 µg of biotin.14 After
90 days of supplementation, subjects in the treatment group
had significantly greater growth than subjects in the placebo
group (5.23 mm vs 5.15 mm, P < 0.001). Although it cannot be
fully determined that biotin—and not the other components of
the formula—was responsible for this increase in growth, results
from this study suggest that biotin could be efficacious not only
in diseased nails but also in healthy ones.
Additional evidence of biotin in reducing nail brittleness was
found in a study by Hochman et al. They found that in a group
of 35 subjects with clinically determined brittle nails, 22 showed
clinical improvement of nail health.15
ª 2021 the International Society of Dermatology.
Oral nail growth supplements Review 917
The safety and toxicity of biotin have been well-studied. It is
safe, non-toxic, and not contraindicated with other medications
including herbals.16 However, it is important to note that
smoking and pregnancy increases metabolism of biotin, thus
this group of individuals may need to increase their dosage.17
In addition, exogenous intake of biotin can interfere with certain
laboratory values. It can cause false negative or false positive
test results. For instance, high doses may result in a false
positive TSH receptor antibody and a Graves disease-like
presentation in patients who may have no clinical signs or
symptoms of the disease.18,19 In addition, exogenous intake of
biotin may result in a falsely low troponin value, leading to a
possible and unfortunate missed diagnosis of a myocardial
infarction.19
Capsule summary
Although largely popular in the supplement world, there is no
strong evidence claiming biotin alone may have a clinically sig-
nificant effect on nail growth. However, it is known to be benefi-
cial for treatment of nail disorders such as brittle nails. Biotin is
a safe and non-toxic oral supplement that is not contraindicated
with other medications. Clinicians should advise their patients to
be cautious with exogenous biotin intake due to possible inter-
ference of troponin and TSH receptor antibody values.
Collagen peptides
Collagen is the most abundant protein in the body as it makes
up connective tissues such as bone, skin, tendons, ligaments,
and cartilage. Most refer to collagen as a building block as it
provides structure and support to the body. The protein is com-
posed of three chains wound together in a tight triple helix. Col-
lagen peptides are broken-down elements of the longer protein
chain. In this form, they have an increased bioavailability.20
In recent years, the market for collagen peptides has sky-
rocketed amongst individuals, mostly women, for the proposed
advantages of skin elasticity and hydration. A systematic review
published by Bolke et al. demonstrated that oral collagen pep-
tides can aid in the aging process and improve skin moisture,
increase collagen density in the dermis, and improve wrinkles,
roughness, and elasticity of the skin without causing any
adverse effects.21 However, Hexsel et al. discovered there is no
evidence to support collagen peptides for the improvement of
nail growth and thus sought to address this further.22
Hexsel et al. investigated whether daily supplementation of
oral bioactive collagen peptides are effective for improving nail
growth rate and improving the appearance of brittle nails in an
open-label, single-center trial.22 The bioactive collagen peptides
used in this study are derived from the breakdown of porcine
type I collagen. The study included 25 women aged 26–
50 years old who demonstrated at least one sign or symptom of
brittle nails. Brittle nails were defined as nails that have lamellar
splitting of the free edge, fissuring of the distal nail plate, or lon-
gitudinal ridging/grooves. Participants were screened a month
International Journal of Dermatology 2022, 61, 916–922
918 Review Oral nail growth supplements
prior to baseline, over 24 weeks with a daily oral dose of
2.5 grams of bioactive collagen peptides, and 1 month after the
end of treatment. The 2.5 grams of collagen peptides were dis-
solved in water and ingested daily. Photographs, nail growth
rate, frequency of broken nails, and clinical assessments were
completed prior to beginning treatment. Two different assess-
ments were used for evaluation: brittle nails and nail growth.
Sherber et al. suggested a grading scale consisting of “none,
slight, moderate, and severe” to be used at each visit to assess
the severity of the brittle nail symptoms. To evaluate nail
growth, the nails of the middle fingers were marked at the edge
of the lunula 4 weeks before treatment and were marked and
measured at each subsequent visit.22
Evaluation of 24 of 25 participants was performed at the end
of the trial. After 12 weeks of treatment with the peptides, the
nail growth rate of the participants increased significantly from
the basal nail growth rate of 2.65  0.42 mm/mo to
2.90  0.47 mm/mo (P < 0.05). The growth rate continuously
improved over time. At 24 weeks, the rate increased by 12%,
and 4 weeks after the last treatment, the rate of growth
increased by 15%.22 Le Vu et al. explored how administration of
bioactive collagen peptides upregulates specific genes (Gprc,
Krt, Krtap) associated with epidermal proliferation in the forma-
tion and differentiation of the nail matrix, nail plate, and hair.23
Nail peeling, one of the symptoms of brittle nails, was mea-
sured among the participants. At the start of the study, prior to
peptide treatment, 16 participants were classified as having
“moderate” or “severe” nail peeling. Following 12 weeks of
ingestion, there were eight participants who received a grade of
“moderate” or “severe,” and after 24 weeks, this number
improved to six participants.22
Global clinical improvement of brittle nails was based on a
grading scale established by Sherber et al., which was defined
as “excellent, good, fair, no improvement, or worse.” Pho-
tographs of each subject’s nails were taken at baseline and
after each of the three visits. Hexsel et al. used this scale to
compare nail symptoms. Sixty-four percent of subjects experi-
enced a global clinical improvement of excellent/good/fair in brit-
tle nails after 24 weeks of treatment, and 88% of subjects
achieved excellent/good/fair improvement 4 weeks post-
treatment during the washout period.22
Although outside factors, such as behaviors of participants,
lack of blinding, and biases have to be considered with this clin-
ical trial, the participants and the investigator reported improve-
ments. Overall, 80% of participants were satisfied with the
results of bioactive collagen peptides for the improvement of
nail growth and appearance. In addition, 75% of the participants
felt their nails became stronger as a result of the treatment, and
71% noticed an increase in their nail growth.22 However, future
studies should have larger sample sizes, longer treatment peri-
ods, and a control group for more accurate results.
No adverse events were reported during this trial.22 However,
there are few and uncommon adverse effects associated with
International Journal of Dermatology 2022, 61, 916–922
Yousif, Farshchian, and Potts
collagen supplements such as diarrhea, abdominal fullness,
heartburn, and headache. In addition, there is limited evidence
exploring the use of collagen peptides in pregnant and lactating
women. Thus, it is recommended to this specific population to
avoid this product.24
Capsule summary
Patients who suffer from slower nail growth and brittle nails may
benefit from the ingestion of bioactive collagen peptides. There
was a considerable clinical improvement in nail growth rate and
a decrease in the frequency of broken nails in the participants.
There is weak evidence supporting the use of bioactive collagen
peptide intake on nails, as this study was the first clinical trial to
do so.
Solubilized keratin
Solubilized keratin has become popular in the cosmetic industry
in recent years. It is a patented bioavailable form of keratin that
provides the body with the keratin that is normally lost in one’s
skin, hair, and nails as a result of aging. Since keratin is a pro-
tein that contributes so heavily to the strength and structure of
skin, hair, and nails, the aging process frustrates patients. For
instance, the loss of keratin is associated with the presence of
wrinkles, hair loss, hair thinning, weak and brittle nails, and nail
discoloration. Specifically, solubilized keratin has shown signifi-
cant improvement in nail appearance and strength mostly due
to its high bioavailability.25 This theoretically allows the keratin
to be delivered to the parts of the body that need it most, espe-
cially the skin, hair, and nails.25
In a randomized, double-blind, placebo-controlled trial, Beer
et al. set out to compare nail strength between two groups of
women aged 40–71 years old who were randomized to either
receive two capsules of keratin (500 mg) plus vitamins and min-
erals (contained solubilized keratin, vitamin B3, B5, B6, B8,
zinc, and copper) (n = 25) or two placebo capsules of maltodex-
trin (n = 25) per day for 90 days.25 A dermatologist evaluated
the participant’s tendency of nails to break at baseline and at
three time periods (30, 60, and 90 days). Subjects randomized
to the placebo drug showed no significant improvement in ten-
dency for nails to break over 90 days. However, patients ran-
domized to solubilized keratin showed slight to moderate
improvement concerning their tendency to break over 90 days.
In addition, at each of the three time periods throughout the
study, there was a statistically significant improvement in nail
strength compared with the subjects who received the placebo
drug.25
Beer et al. exemplified statistically significant results in the
benefits that solubilized keratin plus vitamins and minerals may
have on nail health.25 A high tendency of nails to break is asso-
ciated with poor strength, which makes it more difficult for nails
to grow. Thus, using a highly bioavailable supplement contain-
ing solubilized keratin will provide the body with the keratin it
needs for nail growth.
ª 2021 the International Society of Dermatology.
Yousif, Farshchian, and Potts
The oral supplement of solubilized keratin was found to be
safe and non-toxic. Throughout the trial, there were no adverse
events reported.25 Although the results of the study were per-
suasive, further studies of solubilized keratin on nail growth
should include a larger sample size, a longer period of time, as
well as the addition of men.
Capsule summary
Based on current literature, there is mild evidence supporting
the use of solubilized keratin as a complementary supplement
to support nail growth and nail health. Further clinical trials are
necessary to validate the results it may have on nail growth.
Choline-stabilized orthosilicic acid
The element silicon ranks among one of the most abundant
trace elements in the body and represents 1 to 10 parts-per-
million (ppm) in nails, hair, and epidermis.26 It is available in
many different chemical forms such as silicon dioxide, orthosili-
cic acid, and silicic acids.27 Research has shown that silicon
plays a role in collagen synthesis as well as slows skin aging
and improves elasticity through activation of hydroxylating
enzymes.28 Silicon has also been linked to the improvement of
hair and nail conditions. It is associated with a lower rate of hair
loss, increased hair brightness, and improvements in nail fragi-
lity and nail brittleness.29
Among the few forms of silicon supplements available,
orthosilicic acid is the main readily bioavailable source of silicon.
It is easily absorbed through the small intestine due to its small
size and neutral charge.28 It has been shown to increase colla-
gen type 1 synthesis and maintain connective tissue.30 Addition-
ally, it may improve the cross-linking of glycosaminoglycan
structure in the dermis and the keratin structure in hair and
nails.31 Choline-stabilized orthosilicic acid is a variant of silicon.
According to the Food and Nutrition Board, choline is consid-
ered an essential nutrient. Thus, choline-stabilized orthosilicic
acid has high bioavailability in humans compared with other
forms of silicon supplements.29
Barel et al. investigated the effects of choline-stabilized
orthosilicic acid per day on skin, hair, and nails in a randomized,
double-blind, placebo-controlled study composed of 48 women
with photoaged skin. Over a 20-week period, women received
10 mg of choline-stabilized orthosilicic acid per day (n = 24) or
a placebo (n = 24). The degree of nail and hair brittleness were
measured on a four-point visual analog scale (VAS): “0” no brit-
tle nails, “1” slight, “2” moderate, or “3” severe at baseline and
at 20 weeks following supplementation. VAS scores for nail brit-
tleness in the orthosilicic acid group were significantly lower at
20 weeks when compared with baseline scores. There were no
significant differences in VAS scores in the placebo group at
the 20-week period compared with baseline.29
No adverse events were reported with the 10 mg dose of
choline-stabilized orthosilicic acid given to participants, although
little is known about the safety of long-term use.29
ª 2021 the International Society of Dermatology.
Oral nail growth supplements Review 919
Capsule summary
There is mild evidence supporting the use of choline-stabilized
orthosilicic acid, a bioavailable form of silicon, as an oral sup-
plement for the improvement of nail growth. However, due to
the insufficient amount of evidence available, additional
research is necessary to further validate the results of the study
of Barel et al.29
Methylsulfonylmethane
Methylsulfonylmethane (MSM) is a naturally occurring sulfur
compound found in the environment that is used for its anti-
inflammatory and antioxidant properties as well as for arthritis
and muscle pain. In recent years, it has become a well-known
dietary supplement for the improvement of hair, skin, and nail
disorders. MSM has been known to maintain normal keratin
levels in nails, which provides most of the nail plate structure.
The sulfur in MSM strengthens the disulfide bridges found in
the keratin protein.32
Muizzuddin and Benjamin enrolled 63 healthy middle-aged
women in a double-blind study over 16 weeks. Subjects either
ingested 1 gram or 3 grams of MSM per day, and the effects of
MSM on nail health were evaluated. Trained experts visually
graded nails in terms of overall appearance. For both doses,
there was a statistically significant improvement in overall nail
appearance. In addition, the majority of the participants agreed
that MSM supplementation made their nails feel stronger and
healthier.32
MSM is a non-toxic supplement that is generally well-
tolerated by most at a maximum dose of 4 mg/day and has very
few known and mild side effects.33
Capsule summary
MSM appears to benefit skin, hair, and nails, but there is mild
evidence supporting the use of this supplement as a comple-
mentary treatment for nail health. Thus, more clinical trials are
necessary to further validate these results to ensure proper
usage.
Summary
There are multiple supplements currently on the market which
have been shown to promote nail growth and improve overall
nail health. However, these supplements, as well as others tar-
geted for hair and skin are not regulated by the FDA, meaning
there may not be much or any evidence at all to determine the
mechanism of action, safety, and efficacy of these products. It
is important for physicians to be up-to-date and well-informed
about supplements to prevent the spread of misinformation to
their patients, who may become influenced by outside factors.
This systematic review highlighted the following oral nail growth
supplements summarized in Table 1. However, some supple-
ments, vitamins, and minerals covered in this review require
additional extensive research with larger sample sizes.
International Journal of Dermatology 2022, 61, 916–922
920 Review Oral nail growth supplements Yousif, Farshchian, and Potts

Table 1 All reviewed oral nail growth supplement ingredients

Improves Improves hardness/ Increases Decreases nail peeling Improves clinical Patient-perceived
strength Decreases brittleness Nail Growth or broken nails appearance improvement

Vitamins
Biotin (B7) X10 X10,13,15 X12,14
Minerals
Magnesiuma X14
Zinca X14
Coppera X14
Sulfur (MSM) X32 X32
Silicon X29 X29
(Orthosilicic
acid)
Collagen X22 X22 X22 X22
Solubilized X25 X25
keratin

a
A mix supplement of vitamins and minerals.

Biotin is a popular vitamin in today’s world, and it is known to A Solubilized keratin

have a positive impact on brittle nails. However, there is insuffi-
cient clinical evidence to support the use of biotin alone as a
supplement to increase nail growth. A multivitamin formula
including biotin and minerals (magnesium, zinc, copper) has
demonstrated a positive impact on nail growth.
Ingestion of bioactive collagen peptides showed improve-
ments in nail growth rate and the appearance of brittle nails in
terms of a decline in nail peeling. However, the mild evidence
requires more research to validate these results.
Solubilized keratin and MSM demonstrated improvement in
the clinical appearance of nails, and choline-stabilized orthosili-
cic acid improved nail strength and brittleness; however, further
research is necessary to support these claims due to the mini-
mal amount of evidence available today.
Questions (answers provided after
references)
1 Which of the following is beneficial for the treatment of brittle
nails?
A Zinc
B Biotin
C Methylsulfonylmethane
D Copper
2 Excessive consumption of biotin can interfere with which of
the following lab values?
A TSH
B Troponin
C ALT/AST
D A&B
3 Which of the following has been proven to improve broken
nails?
B Magnesium
C Zinc
D Copper
4 Which is a common side effect of bioactive collagen pep-
tides?
A Hair loss
B Joint pain
C Diarrhea
D Dry skin
5 True or False: An oral supplement of solubilized form of ker-
atin provides the body with the keratin that is normally lost
from aging.
6 True or False: Choline-stabilized orthosilicic acid increases
collagen type 1 synthesis.
7 True or False: Choline-stabilized orthosilicic acid is a variant
of silicon and has a low bioavailability compared with other
silicon supplements.
8 True or False: Methylsulfonylmethane is a naturally occur-
ring compound used for arthritis, muscle pain, as well as
health and strength of nails.
9 True or False: Bioactive collagen peptides improve nail
growth but have no effect on brittle nails.
10 True or False: Patients who smoke or are pregnant are
advised to decrease their dosage of biotin.
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lmedicinejournal.com/journal/2019-11/beneficial-effects-sulfur-
containing-supplement-hair-and-nail-condition
33 Butawan M, Benjamin RL, Bloomer RJ. Methylsulfonylmethane:
applications and safety of a novel dietary supplement. Nutrients
2017; 9: 290.
Answers to questions
1 Answer: B. Biotin has been found to be effective for the
treatment of brittle nails.
2 Answer: D. Exogenous intake of biotin may interfere with
laboratory values of TSH receptor antibody and troponin,
creating a false positive TSH receptor antibody and a falsely
low troponin value.
3 Answer: A. Solubilized keratin supplement has been proven
to decrease nail peeling and broken nails.
4 Answer: C. Diarrhea is a side effect of collagen peptide
ingestion. Other side effects include headache, heartburn,
and abdominal fullness.
5 Answer: True. An oral supplement of solubilized keratin pro-
vides the body with the keratin that is normally lost from
aging, and according to Beer et al., it has promoted nail
strength and nail health.
6 Answer: True. Choline-stabilized orthosilicic acid increases
collagen type 1 synthesis.
7 Answer: False. Choline-stabilized orthosilicic acid is a vari-
ant of silicon and has a high bioavailability compared with
other silicon supplements.
8 Answer: True. Methylsulfonylmethane is a naturally occur-
ring sulfur compound that has many uses. One of which is
for reducing inflammation associated with arthritis and mus-
cle pain. Another use is improving appearance, overall
health, and strength of nails.
International Journal of Dermatology 2022, 61, 916–922
922 Review Oral nail growth supplements Yousif, Farshchian, and Potts

9 Answer: False. Bioactive collagen peptides improve Supporting Information

nail growth and also can be used for treatment of brittle
Additional Supporting Information may be found in the online
nails.
version of this article:
10 Answer: False. Patients who smoke or are pregnant are
Table S1. Summary of studies on oral nail supplements with
advised to increase their dosage of biotin because smoking
level of evidence.
and pregnancy increase the catabolism of biotin.

International Journal of Dermatology 2022, 61, 916–922 ª 2021 the International Society of Dermatology.