- Best ResultsOn going
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistDermatologist
- Duration of ResultsOngoing
- Back to WorkNA
Niacinamide (B3) & Solar Keratosis
Niacinamide or nicotinamide has been shown to reduce the incidence of solar keratosis as well as some forms of skin cancer, namely basal & squamous cell cancer. Oral supplementation with 500 mg of vitamin B3 twice a day is the recommended dosage. The effects can be seen as early as 2 months.
FactsFacts on Nicotinamide B3 & Solar Keratosis
- Oral niacinamide/nicotinamide is more effective than topical niacinamide
- Vitamin B3 can reduce solar keratosis by over one third the baseline
- BCCs, superficially subtypes are reduced by over 20%
- Squamous cell cancers can be reduced by 30%
- B3 works better in high risk patients, including immune suppressed
- It may be possible that B3 can reduce melanoma rates, yet to be determined
- Oral nicotinamide is part of the Cancer Council’s recommendations for skin cancer prophylaxis
What does vitamin B3 do for skin health?
Vitamin A, B and C are the building blocks of any skincare routine. Vitamin B3 is known as niacinamide or nicotinamide. This water soluble vitamin has the following properties-
- Anti-inflammatory, reducing UV induced proinflammatory cytokines.
- Reduces UV induced immune suppression.
- Enhances repair of UV induced DNA damage.
- Replenishes cellular energy due to UV radiation.
- Broad base of nose means nose shaping with dermal fillers.
- Lip ratio different in Asian & ethnics, means different volume of upper vs lower lip (1 to 1 ratio)
Vitamin B3 also reduces water loss, enhancing skin barrier function. B3 also reduces pigmentation as it downregulates transfer of pigment to skin cells.
Does vitamin B3 reduce the incidence of solar keratosis?
Yes, oral supplementation with 500 mg vitamin B3 taken twice a day markedly reduces the numbers of solar keratosis (actinic keratosis). This ground-breaking study was conducted in Brisbane & published nearly a decade ago. Oral vitamin B can reduce the incidence of solar keratosis by as much as 35%
Does niacinamide reduce skin cancer risks?
Yes. Niacinamide 500 mg twice a day can reduce the risks of non-melanoma skin cancers by 23%. To be specific-
- BCCs, superficial BCCs showed a reduction of 20% at 12 months.
- SCCs, both superficial & deep, were reduced by 30%.
Supplementation works best in higher risk individuals– those who have had multiple skin cancers &/or immunosuppressed (transplant patients).
Does Vitamin B3 / Niacinamide reduce melanoma risks?
In theory it does, but more studies are needed. Melanoma, much like other skin cancers & solar keratosis share the same pathology, namely UV induced immune suppression. Supplementation with 500 mg niacinamide twice daily seems sensible. If you would like to be involved in a trial, speak to your dermatologist.
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Who published the landmark paper on prevention of solar keratosis?
The scientific paper published in 2012 in the high-ranking Journal of Investigative Dermatology was due to the work of my colleague, Dr Devita Surjana in Brisbane. It is probably one of the most important papers of the past decade. Devita works with me at Cutis. She is one of the most knowledgeable but humble dermatologists in Australia.
Devita does not talk much about her publications & the impact of her work on the management of skin cancer. She is an expert at managing high risk skin cancer patients.
Who should take vitamin B3?
IMO, the majority of Australians. It should be in the water. Australia has the highest skin cancer rate in the world. Skin cancer is over four times more common than all the other forms of cancer put together. If you are Caucasian, you are more likely to develop skin cancer than not in your lifetime. Two thirds of Aussies will have at least one skin cancer in their lifetime. Fact.
How fast does nicotinamide or niacinamide work?
Very fast, solar keratosis reduction can be seen as early as 2 months. Maximal results are seen at 4 to 6 months. You will require lifetime supplementation. If you stop taking nicotinamide you will not have a rebound, but will regress to the mean.
Does nicotinamide/niacinamide work in everyone?
Nope, medicine is about odds. Every patient represents a number. Oral nicotinamide works best for significant solar damage & patients with multiple basal & squamous cell cancers. It is invaluable as an adjunct for immune suppressed patients, including transplant patients.
*Potential to reduce BBCs & SCCs in up to 35% of renal transplant patients.
What are the side effects of vitamin B3- nicotinamide?
Side effects are extremely rare. GI upset can occur with higher doses exceeding 3000mg daily. Unlike nicotinic acid, niacinamide & nicotinamide does not cause flushing or redness. Topical B3 is also a banal formulation.
Can you get enough vitamin B3 from your diet?
Probably not as the daily intake is around 20 mg. Remember that skin cancer prevention doses are 500 mg twice a day. This means you require an extraordinary amount of legumes, cereals, eggs & nuts. You’re not going to get enough, so supplement with specific B3.
Note that B-complex preparations do not contain adequate vitamin B3 to affect skin cancer risk, you do require 500 mg twice a day. Once a day supplement can be effective, but it is a half assed job. Take two capsules. ‘
Does topical vitamin B3 give the same level of protection?
Probably not, however the initial reports in 1999 suggested that topical vitamin B may have a limited role in the context of chemoprophylaxis. Topical formulations are best to reduce skin inflammation due to acne, rosacea, eczema. Niacinamide can also improve skin barrier function & decrease pigmentation.
Where to buy vitamin B3 - niacinamide?
This vitamin can be bought at all major pharmacies & health food stores. Remember that the optimal dose is 500 mg twice a day. Vitamin B is a water-soluble vitamin, it does not need to be taken with food.
Some cost-effective brands include Blackmores & Nature’s own. Supplementation costs less than fifty cents a day.
What other vitamins can reduce skin cancer & sun damage?
The scientific literature points to vitamin A, B & C as supplements to reduce sun spots, & in some cases certain forms of skin cancer. Retinoids are vitamin A derivatives. Oral supplementation, namely acitretin, can reduce hyperkeratosis (scaliness), solar keratosis, Bowen disease, SCC & in some cases BCCs.
Can supplementation help?
There is limited evidence that fish oil supplementation can help. Antioxidant supplementation such as vitamin E capsules, green tea & other botanical supplements do no harm. In this context placebo can be a good thing. See below for combinations that work.
What is vitamin A & how does it work?
Oral vitamin A has the highest level of evidence. Dermatologists prescribe this medication for high-risk patients. Topical vitamin A, including retinol, tretinoin, tazarotene, retinoic acid, & trifarotene can normalize the epidermis & stimulate collagen.
The best retinoids are prescription, followed by over-the-counter retinol, hydroxypinacolone retinoate & retinaldehyde.
Disclaimer: I do not prescribe retinoids as monotherapy during consultations, please book an appointment with your dermatologist. My work is entirely procedural.
What is the role of topical antioxidants?
Topical antioxidants should be used by everyone as the second layer of defence, after sunscreens. Antioxidants reduce oxidative stress & generation of cancer-causing free radicals. The two main sources of free radicals are UV & environmental pollutants. The antioxidants with the most amount of science include-
- Ascorbic acid or vitamin C (topically & orally)
- Ferulic acid (topically, in combination with C & E)
- Tocopherol (topically & orally)
- Resveratrol (topically & orally)
- Green tea, niacinamide, ginseng (topically & orally)
Tying it all in- how to employ vitamins to reduce solar keratosis?
Based on evidence the only oral supplement required is vitamin B3, the dose is 500 mg twice a day. Your topical supplementation can be as follows-
AM: Ascorbic & ferulic acid with tocopherol. Apply under sunscreen.
PM: Vitamin A either retinol or retinoic acid +/- niacinamide & resveratrol
Davin’s viewpoint on niacinamide- nicotinamide supplementation & sunspots
The work of Australian dermatologists Professor Diona Damien & my colleague Dr Devita Surjam has made a massive contribution to the prevention of skin cancers. Simple supplementation can reduce both solar keratosis as well as skin cancers including basal & squamous cell cancers. As yet, the impact of niacinamide supplementation on melanoma rates are unknown, however there are trails throughout the world.
Oral supplementation with 500mg twice daily is recommended, topical niacinamide is less effective in the context of skin cancers, however can benefit other aspects of UV induced skin changes including inflammation, rosacea, actinic or sun induced redness & potentially reduce inflammation from solar keratosis or even lichenoid keratosis. Simple vitamins & sunscreen can potentially reduce sun spots by up to & beyond 35%. Compare this to actinic keratosis directed treatments like Solaraze or diclofenac gel with a resolution rate of approximately 25% & you can understand how clinically relevant this is.
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