Nicotinamide Helps Prevent Skin Cancer for High Risk Patients
By Kyle T. Amber, MD
Many patients ask me, how can I prevent getting another skin cancer? While of course sunscreen and sun avoidance are beneficial, sometimes we can’t undo the sun damage that has already been done. But what if a vitamin could cut down this risk?
Certain patient populations have a very high risk of skin cancer, particularly patients with organ transplants. As these patients have a 65-fold higher risk of skin cancer than the general population, much research has been performed to try to prevent skin cancers in these patients. While several therapies have been studied in the past, they often have significant side effects or are costly which can limit their use, except in the severely high-risk patient. Recent studies evaluating the skin cancer-preventing effects of nicotinamide are promising not just for organ transplant patients, but those patients prone to developing skin cancer.
Nicotinamide, also known as niacinamide, is a modified form of the vitamin B3 (niacin). It is not quite the same, however. While taking niacin can result in flushing, nicotinamide does not. Studies have shown it to be effective at preventing the effect of ultraviolet radiation on keratinocytes, the cells that make up the skin. It is exceptionally safe, and is found naturally in numerous food sources. While in exceptionally high doses liver damage can occur, these doses are far higher than that used for skin cancer prevention.
Several high-quality studies have evaluated the effect of oral nicotinamide on the prevention of skin cancer and actinic keratoses, a precursor to squamous cell skin cancers1, 2. In a landmark study published in the New England Journal of Medicine, the incidence of skin cancer was decreased by 23% after 1 year in patients taking nicotinamide. The number of actinic keratosis was also significant reduced1. Other studies have specifically looked at the effect of oral nicotinamide on actinic keratoses, noting similar findings3,4.
Nicotinamide 500mg twice a day has been shown to effectively reduce the risk of skin cancer. If thinking about visiting your dermatologist makes you cringe due to the fear of getting spots frozen or biopsied, the vitamin nicotinamide could be of benefit to you.
1. Chen AC et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med. 2015 Oct 22;373(17):1618-26.
2. Chen AC et al. A phase II randomized controlled trial of nicotinamide for skin cancer chemoprevention in renal transplant recipients. Br J Dermatol. 2016;175(5):1073-1075.
3. Surjana D et al. Oral nicotinamide reduces actinic keratoses in phase II double-blinded randomized controlled trials. J Invest Dermatol. 2012 May;132(5):1497-500.
4. Drago F et al. Prevention of non-melanoma skin cancers with nicotinamide in transplant recipients: a case-control study. Eur J Dermatol. 2017 May 3.