Oral nicotinamide and actinic keratosis: a supplement success story
Nicotinamide has shown potential as a safe and effective intervention for the prevention of malignant and premalignant skin lesions. Recent studies have shown that nicotinamide, in both oral and topical forms, is able to prevent ultraviolet-induced immunosuppression in humans [1,2,3] and mice [4,5]. Immunosuppression is a known factor for the progression of premalignant lesions, such as actinic keratosis . Murine studies have shown that nicotinamide is also able to protect against photocarcinogenesis [4,5]. Preliminary human studies suggest that nicotinamide may help prevent skin cancers and enhance the regression of actinic
Niacinamide for Actinic Keratoses [Dr. Alan Gaby]
A man in his mid-60s presented with extensive actinic keratoses
on his forehead and scalp. He had male pattern baldness and
a history of frequent sunburn of the scalp. He had undergone
surgery on four separate occasions for invasive squamous cell
carcinoma of the scalp. The patient had previously been treated
with photodynamic therapy and with topical ingenol mebulate.
Both of these treatments produced good results, but the lesions
recurred. He was then tried on topical retinoids but developed
erosive pustulosis of the scalp, and the treatment was stopped. In
April 2019 the man was started on niacinamide (500 mg twice a
day), and there was a dramatic decrease in the number of actinic
keratoses. Niacinamide was continued and during the next eight
months no new lesions appeared.
Comment: Previous studies have shown that oral niacinamide
can decrease the number of actinic keratoses and prevent
the progression of actinic keratoses to non-melanoma skin cancer.1,2 Niacinamide may work in part by preventing ultraviolet light-induced immunosuppression. In the previous research,
the beneficial effect of niacinamide wore off after treatment
was discontinued. In the present case report, the benefits of
niacinamide therapy persisted with continued treatment. Thus, ongoing treatment with niacinamide may be necessary to maintain
the beneficial effects against actinic keratoses and non-melanoma
skin cancer. A niacinamide dose of 500 mg twice a day is generally
safe, although larger doses (such as 3,000 mg per day or more) has
occasionally caused liver damage.
Paugam C, Dreno B. Is nicotinamide a sustainable therapy for resistant actinic keratoses? J Eur Acad
Dermatol Venereol. 2020;34:e624-e626.