Nicotinamide for the prevention of non-melanoma skin cancer

Nicotinamide, also known as niacinamide, is a water-soluble form of vitamin B3 that has been shown to enhance the repair of UV-induced DNA damage. Recently, nicotinamide supplementation has been found to achieve reduce the risk of developing squamous cell skin cancer and basal cell carcinoma by 23% compared with with placebo after one year, among patients at risk of skin cancer. In addition, some studies have shown efficacy in reducing actinic keratoses (premalignant skin lesions). 

Nicotinamide or vitamin B3 logo for skin cancer prevention

What will I talk about in this article?

How was it established that niacinamide could have a protective effect on the skin?

It all started in 2008, when the Cancer Council of Australia awarded a research grant to Professor Diona Damian and her team at the University of Sydney. Over the next few years, the researchers aimed to find new ways to treat and prevent skin cancer, which is very common in this country.

Professor Damian had already tested a number of compounds that could prevent this sunlight-induced immunosuppression, and she found that one form of vitamin B3, called nicotinamide, had the greatest potential for skin cancer prevention. Ref

Non-melanoma type skin cancer

Non-melanoma skin cancers are known to be caused primarily by UV radiation from the sun or tanning booths. Non-melanoma skin cancer refers to all cancers that occur on the skin and are not melanomas.

The most common types are basal cell carcinoma and squamous cell carcinoma.Treatment of non-melanoma skin cancer will depend somewhat on the subtype and usually involves surgery to remove the cancerous cells.

However, one of the major problems faced by patients with non-melanoma skin cancer is the possibility that more may appear in the future. Preventive treatments that can reduce this risk have been sought for years and recently it has been seen that nicotinamide could have a very good potential in patients at risk. 

Here are some examples in photos of different non-melanoma skin cancers. 

Studies of nicotinamide in non-melanoma skin cancer

Oral nicotinamide supplementation has been shown to be effective for proven to reduce the rate of actinic keratosis and new non-melanoma skin cancers compared to placebo after one year in patients who had previously had skin cancer.Ref

Study: Clinical trial in patients at high risk of developing skin cancer

In the Phase 3 study published in 2015 by Dr. Damian, a randomized, controlled trial of 386 patients who had had at least two non-melanoma skin cancers in the previous 5-year period. Oral nicotinamide 500 mg administered twice daily for a period of 12 months. significantly reduced the number of new non-melanoma skin cancers by 23% versus those receiving placebo.Ref

Subsequently, another clinical trial published in 2016 in healthy individuals was intended to assess whether they could decrease actinic keratoses (pre-malignant lesions) in patients with sun damage. It showed a 35% relative risk reduction of this type of injury.Ref

Study: nicotinamide in immunocompromised patients

Patients with immunosuppression are a high-risk group for developing this type of non-melanoma skin cancer. That is why it is very important to look for prevention strategies in this group. 

In a study with 38 solid organ transplant recipients (8 hepatic and 30 renal), it was observed that the group treated with nicotinamide 500 mg per day for 6 months presented a reduction in the number and size of actinic keratoses and no squamous cell carcinoma was detected during the study period. While in the untreated control group 91% showed an increase in actinic keratoses and 7 lesions progressed to skin carcinoma.Ref 

How should nicotinamide be used?

The recommended dose of nicotinamide as vitamin B3 is 500 mg twice a day. There are no significant side effects from long-term use; however, nicotinamide should not be used in patients with end-stage renal disease or chronic kidney disease. 

Nicotinamide crosses the placenta and should not be used in pregnancy, as it has not been studied in pregnant populations.

Recommended dosage

Nicotinamide 500 mg every 12 hours

Where is nicotinamide found in the diet?

Nicotinamide naturally occurring in meat, fish, nuts, cereals and legumesand is a key component of the glycolysis pathway, as it generates nicotinamide adenine dinucleotide for the production of adenosine triphosphate.

Nicotinamide not to be confused with niacin (nicotinic acid).which has been used to treat high cholesterol and cardiovascular diseases. 

Nicotinamide is not a substitute for sun protection

We must make it clear to our patients that nicotinamide is not an oral sunscreen. and that the protective effects of this vitamin against UV exposure does not mean that it protects against sunburn.Avoiding the sun, using adequate sun protection and maintaining annual skin cancer screenings remain the cornerstones of skin cancer prevention.  

However, given nicotinamide's safety profile and protective effects, Should all of our skin cancer patients take nicotinamide daily? I believe that in the patients at high risk of developing carcinoma such as those with chronic sun exposure are candidates for this supplement. 

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Sebastian Podlipnik - Skin cancer

Sebastian Podlipnik

Dermatology Blog

I am a dermatologist and cum laude MD and author of multiple research studies. I specialize in skin cancer, laser technologies and cosmetic dermatology. The intention of this blog is to bring you closer to topics of interest in dermatology and research.

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