QDo you recommend niacinamide to your patients for skin cancer prevention?

Nonmelanoma skin cancers and actinic keratoses are caused primarily by exposure to ultraviolet radiation.1 Nicotinamide is an amide form of vitamin B3 and the precursor of nicotinamide adenine dinucleotide, an essential cofactor for ATP production. Nicotinamide prevents ATP depletion and glycolytic blockade induced by UV radiation, thereby boosting cellular energy and enhancing DNA repair.2

A recent study further evaluating the effectiveness of niacinamide in reducing incidence of NMSC demonstrated a significant reduction (relative difference, 23%; P=0.02) that was attributed to the immunoprotective effects of nicotinamide.3 However, this benefit was not maintained in the postintervention period suggesting that nicotinamide suppresses the progression of nascent, preexisting cancers. Although no significant adverse effects were reported with niacinamide therapy, further studies are needed to determine the long-term effects on reducing NMSC following discontinuation of therapy.

I discuss Niacinamide with patients when asked if there is anything they can do in addition to sun protective measures to reduce the development of additional NMSC. I recommend patients start with 500 mg twice daily and emphasize the importance of not purchasing niacin instead.

References:

1. Armstrong et al. J Photochem Photobiol B 2001
2. Park et al. Photochem Photobiol 2010
3. Chen et al. NEJM 2021