Nicotinamide (Vitamin B3)

7 June

What It Is, When It May Help & What To Know

What Is Nicotinamide?

Nicotinamide (also called niacinamide) is a form of vitamin B3.

It differs from niacin because it does not typically cause flushing and has different metabolic effects.

Nicotinamide plays a role in:
• Cellular energy production
• DNA repair pathways
• Skin barrier function
• Inflammatory regulation

Why Is Nicotinamide Used?

1. Skin Cancer Prevention (High-Risk Groups)
The ONTRAC trial (NEJM, 2015) found that nicotinamide 500 mg twice daily reduced rates of new non-melanoma skin cancers in high-risk individuals.

2. Actinic Damage & Field Cancerisation
It may be considered in people with significant sun damage, recurrent actinic keratoses, or recurrent non-melanoma skin cancers.

3. Acne & Inflammatory Skin Conditions
Topical niacinamide may support barrier repair, reduce inflammation, and reduce oil production.

Who Might Consider Nicotinamide?

• Individuals with recurrent actinic keratoses
• Significant chronic sun damage
• History of multiple non-melanoma skin cancers
• Some inflammatory skin conditions under medical guidance

Why It May NOT Be Appropriate

Caution may be required in:
• Significant liver disease
• Severe renal impairment
• Pregnancy and breastfeeding
• Individuals taking multiple supplements with overlapping ingredients

Higher doses are not necessarily better.

Possible Side Effects

• Nausea
• Headache
• Gastrointestinal upset
• Fatigue
• Mild liver enzyme elevation at higher doses
• Rare allergic reactions

Unlike niacin, nicotinamide generally does not cause significant flushing.

Interactions & Considerations

Potential considerations include:
• Overlapping B-vitamin supplementation
• Hepatotoxic medications
• Alcohol excess
• Polypharmacy in older adults

Patients often underestimate how many supplements contain hidden B vitamins.

How Do We Monitor?

Monitoring depends on:
• Dose
• Duration
• Individual risk factors
• Existing medical conditions

Monitoring may include:
• Medication review
• Liver function testing
• Renal function assessment
• Review of total supplement burden

Balanced Perspective

Nicotinamide is one of the more evidence-supported supplements in dermatology.

However:
• It is not a replacement for sun protection
• It is not risk-free
• It is not appropriate for everyone

The goal should be thoughtful, evidence-based intervention with a clear rationale.

Dr Nicole Chater
Mind Body Skin Institute
Doctor-led skin, health & longevity care