Using Nicotinamide For Skin Conditions

If you are among the one in four Americans impacted by skin disease, you know how distressing these conditions can be. Your skin is the largest organ in your body and is crucial for protecting you from the outside environment, moderating your temperature, and regulating immune responses. 

The overall condition of your skin is impacted by many factors, including nutrition and lifestyle. Your skin requires several nutrients to function optimally, and nicotinamide is one of the most impactful. This form of vitamin B3 has anti-inflammatory properties and can improve skin barrier function, making it an increasingly common addition to topical creams and serums for treating a variety of skin conditions. 

Here is why you may want to incorporate nicotinamide into your skincare routine!

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What is Nicotinamide?

Nicotinamide is derived from vitamin B3 (niacin or nicotinic acid). It is also known as niacinamide, nicotinic acid amide, or vitamin PP. Scientifically, it is called pyridine-3-carboxamide.

Niacin can be consumed in the diet by eating foods such as poultry, fish, nuts, legumes, eggs, beef, and cereal grains and in smaller amounts in green vegetables. It can also be taken via supplementation or used topically on the skin. This water-soluble, active form of the vitamin plays several important roles in the body and medicine. 

Chemically, nicotinamide is an important part of the coenzymes nicotinamide adenine dinucleotide NAD+ and NADH that is needed for oxidation-reduction reactions in the body that convert food into energy in the form of adenosine triphosphate (ATP), your body’s main fuel source. Nicotinamide also helps reduce oxidative stress and support DNA repair, making it useful for mitigating the impacts of UV damage. 

This nutrient also impacts the immune and inflammatory responses that occur in the body and skin. For example, nicotinamide reduces inflammatory cytokines like IL-6 and TNF-alpha that help to fuel inflammation, tissue injury, and cell death involved in inflammatory skin conditions like photoaging and skin cancer.

The Role of Nicotinamide in Cellular Health

One of the most important roles of nicotinamide in the body is acting as the precursor of nicotinamide adenine dinucleotide (NAD+) and nicotinamide adenine dinucleotide phosphate (NADP), which are needed for energy production in the form of ATP. These important cellular substrates are needed for over 400 enzymes involved in metabolic reactions in the body. NAD+ is a key molecule for reactions that transfer energy from carbohydrates, fats, and proteins to ATP from the body to use as its primary fuel source. You also need NAD+ for pathways that synthesize lipids.

Further, NAD serves as an important metabolic regulator of cellular redox reactions and helps to protect skin cells (dermal fibroblasts) from the impacts of oxidative stress. With age, levels of NAD and NADP decrease. This decline can be slowed or reversed with nicotinamide. 

Since NAD serves as a co-factor for the PARP enzymes that play a key role in DNA repair, it has been shown to help protect the skin from precancerous lesions and other consequences of photoaging that occur when UV exposure damages DNA in the skin. Therefore, NAD plays an important role in skin health and preventing skin aging and inflammation. 

Benefits of Nicotinamide for Skin Health

Nicotinamide has anti-inflammatory properties, helps to reduce sebum production, and can improve skin barrier function by helping to decrease the loss of water through the outer layer of the skin (epidermis), helping to keep the skin well hydrated. Due to these properties, nicotinamide is used to treat many skin conditions.

A deficiency of niacin has long been known to cause pellagra, a serious systemic disease that leads to rough, discolored skin (dermatitis), diarrhea, and, if untreated, death. The treatment for pellagra involves restoring levels of this important nutrient with oral nicotinamide.

Since nicotinamide helps to reduce excess inflammation in the skin, it is used to treat bullous (blistering) diseases like bullous pemphigoid. Clinical trials show that 500mg of nicotinamide three times a day combined with tetracycline resulted in the resolution of bullous pemphigoid lesions with less toxicity than traditional treatments like dapsone and prednisone.

Another area where oral nicotinamide has been studied to improve skin health is in reducing the risk of squamous cell carcinoma skin cancer and precursor lesions like actinic keratoses. Studies show that nicotinamide helps to reduce some of the negative impacts of UV radiation from chronic sun exposure, including countering immunosuppression and enhancing DNA repair. Significantly reduced rates of new actinic keratosis lesions, which may develop into skin cancers, were seen when high-risk patients were given 500 mg of oral nicotinamide supplementation twice a day.

Nicotinamide is also increasingly used in topical skin treatments for many conditions. The anti-inflammatory effects of nicotinamide, combined with its ability to reduce sebum production, which contributes to facial shine, non-inflamed comedones, and inflammatory acne lesions, make topical nicotinamide useful in the treatment of acne. Topical nicotinamide (Nicomide®) has been studied for its ability to resolve acne vulgaris as effectively as the topical antibiotic 1% clindamycin gel.

Nicotinamide can also help to even skin tone and improve complexion by reducing excess pigmentation that occurs due to post-inflammatory hyperpigmentation, age spots, melasma, and dark spots, as well as redness that can occur in aging skin or rosacea. 

Since nicotinamide helps to replenish levels of NAD in the skin, it has been studied for reducing skin aging. Many studies show that topical nicotinamide improves wrinkles and fine lines, increases elasticity, and reduces hyperpigmentation that can occur with aging. In addition, nicotinamide helps to increase the skin's production of natural emollients and skin protectants (ceramides), which helps to improve skin hydration.

Studies show that moisturizers containing topical nicotinamide improve skin barrier function in people with rosacea, improving redness and reducing reactions to irritants in cleansers and cosmetics.

How to Incorporate Nicotinamide into Your Skincare Routine

Given all of these benefits, many people are incorporating nicotinamide into their skincare routines. The best nicotinamide skincare product for you depends on your unique skin type, health needs, and preferences. You can work with your healthcare provider to determine what type of formulation might benefit you the most.

Studies have investigated several formulations of nicotinamide both orally and topically. For topical use for conditions like acne, rosacea, UV damage, actinic keratosis, and anti-aging purposes, nicotinamide is available as a cream or gel under the trade name Nicomide®. When used topically, you should notice changes to your skin, such as smoother, toned, and more hydrated skin after about eight weeks of regular use.

For example, 4% nicotinamide gel applied twice daily for eight weeks has been shown to benefit moderate acne without the concern of emerging resistant microorganisms that occur with traditional antimicrobial use. 

Another study found that applying a 2% nicotinamide moisturizer to the face for 4-6 weeks reduced sebum production with significant differences in facial shine and oiliness that may help to reduce acne and skin inflammation.

When using nicotinamide in cosmetic products for its anti-inflammatory effects, improving epidermal barrier function, reducing skin aging, and evening skin tone, common formulations utilize 4% to 5% niacinamide gel applied once daily or 500 milligrams taken orally each day. 

Higher doses may be used for preventing skin cancer. Studies show that oral doses of nicotinamide between 500 and 1500 mg a day are well-tolerated and significantly reduce the immunosuppressive effects of UV exposure without side effects.

There should be caution taken when considering combining nicotinamide with certain other topical skin treatments. For example, when nicotinamide is used in combination with the chemical exfoliants alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs), which are often used for hyperpigmentation, excess irritation can occur since they have different pHs that can counter each other and cause nicotinamide to convert into niacin which can cause flushing and redness.

On the other hand, many of the best nicotinamide skincare products combine this nutrient with vitamin C or retinoids. Since retinoids can often cause irritation, dryness, or redness, nicotinamide may help to lessen these side effects. For example, research suggests that combining retinol cream with niacinamide, hexylresorcinol, and resveratrol can help improve skin tone and signs of aging. Similarly, studies have shown that combining retinol with nicotinamide and 7-dehydrocholesterol is safe and effective for acne.

Potential Side Effects and Precautions

While very high doses of oral nicotinamide can cause nausea in some people, it is usually tolerated well in doses under 3 g/day. Unlike niacin supplementation, it is not associated with flushing. Some reports suggest an increase in sweating, elevated blood sugar, or hypotension may be possible. At higher doses, other potential side effects include headache, fatigue, dizziness, liver toxicity, and an increased risk for low platelets (thrombocytopenia) in patients on hemodialysis for kidney failure. 

People with kidney disease or those taking blood thinners should avoid nicotinamide. There is some suggestion that nicotinamide may increase insulin resistance, so it should be used with caution in those with metabolic syndrome or type 2 diabetes.

Topical nicotinamide is also usually well-tolerated and causes less irritation than alternatives like retinoids or fruit acids. If excessive skin dryness occurs with twice-daily application, it may be resolved by reducing the application to once a day or every other day.

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Summary

Your skin requires nourishment with a balance of nutrients to function properly and look its best. Nicotinamide, which is derived from vitamin B3, is one of the most important nutrients for skin health and is increasingly used to treat a variety of skin conditions.

Whether you deal with acne, rosacea, or bullous skin disease, or you are looking for a way to reverse or prevent UV damage and aging of your skin, nicotinamide may offer a safe and effective strategy. Studies show that this nutrient can be used orally and topically to reduce skin inflammation and aging, improve the skin barrier, even skin tone, and even prevent some skin cancers.