Skin Cancer, Preventative Tips, Wellbeing
Recent Australian research shows that nicotinamide, a form of Vitamin B3, may reduce the risk of non-melanoma skin cancers and sun damage (actinic keratosis). For those with a high risk of skin cancer, it could be a game changer.
The studies show that Vitamin B3 may help to not only prevent non-melanoma skin cancers such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), it may support the treatment and prevention of sunspots (solar keratoses).(1,2) But like everything, it pays to do your homework before rushing out and buying shelf-loads of Vitamin B3 supplements and topical creams.
This article explains everything you need to know about Vitamin B3 (nicotinamide) and skin cancer - who should take it, the benefits, dosage, treatments, and any potential side-effects.
Vitamin B3 – what is it and how does it work?
One of the eight ‘B’ vitamins, vitamin B3 is an important nutrient needed by every part of your body to function properly. There are two main chemical forms of vitamin B3 (also called niacin) and each has a different effect on your body:
Nicotinic acid: As a supplement, nicotinic acid is a form of niacin used to reduce cholesterol levels and lower the risk of heart disease.3
Nicotinamide or Niacinamide: Nicotinamide doesn’t lower cholesterol, but studies show that it may help treat skin conditions such as psoriasis and importantly, reduce your risk of non-melanoma skin cancer. (1,2)
is the form of vitamin B3 we’re focusing on in this article: the new ‘wonder vitamin’ in the field of skin cancer treatment.
Above: New Australian research1 shows that nicotinamide may help to reduce the risk of skin by replenishing cellular energy.
How does Vitamin B3/nicotinamide reduce skin cancer risk?
When your cells are working as they should, your DNA instructs your skin’s cells to grow normally. However, if this DNA is damaged by UV radiation from the sun, the damage can interfere with your cells’ immune system, plus your cells have less energy to repair that damage. The result: uncontrolled cellular growth and skin cancer3.
The good news is that new Australian research1 shows that nicotinamide may help to reduce the risk of skin by replenishing cellular energy, which also enables faster and more efficient DNA repair following exposure to the sun.
What is most exciting about this ground-breaking research is that Vitamin B appears to be an effective and low-risk treatment that works best in people with the highest levels of risk, i.e. those who have had many non-melanoma skin cancers in the past2.
In a recent large-scale Phase 3 trial2, a group of high-risk people who have already had a non-melanoma skin cancer (basal cell carcinoma and/or squamous cell carcinoma) were given a dose of 500mg twice daily, taken for a year. The results were astounding:
Above: Professor Damien, who led the Australian research, says that nicotinamide is a high-dose treatment for those at high-risk of skin cancer.
What are the benefits of taking vitamin B3/nicotinamide?
For those who have already been diagnosed with non-melanoma skin cancers such as BCC and SCC in the past, the benefits of vitamin B3 could, literally, be life-changing.
In another landmark skin cancer prevention clinical trial led by Professor Diona Damian for the Cancer Council NSW, 386 patients were randomly assigned to receive either a twice daily dose of nicotinamide or a placebo for one year. All the patients were at high risk of developing more cancers, as all had been diagnosed with at least two non-melanoma skin cancers in the previous five years.
The results made international headlines when Professor Damian and her team found that after 12 months, the rate of non-melanoma skin cancers was 23% lower in the nicotinamide group than in the placebo group1. Not only that, the number of pre-cancerous lesions was also 13% lower among the people taking nicotinamide compared to those not taking nicotinamide1.
I’m at high risk of skin cancer – should I take vitamin B3?
If you’re considered high risk because you’ve been diagnosed with skin cancers or solar keratoses in the past, ask your dermatologist, general practitioner or MoleMap Melanographer whether nicotinamide is right for you.
Note that using nicotinamide to prevent skin cancer is recommended as a high-dose treatment rather than a supplement. “This treatment is only for people with a defined medical condition: those who have multiple skin cancers,” says Professor Damian. “It’s not suitable for the general population, as we do not have any evidence that it would be beneficial in a lower risk setting.”
Above: The recommended dose is one 500mg tablet taken twice daily1.
What if I’m low risk and want to take vitamin B3 for prevention?
To date, Vitamin B3 has not been shown to reduce the risk of skin cancers in people who are at lower risk (i.e. people who have never had a previous skin cancer or solar keratosis)3. Skin cancer doctors don’t routinely recommend it as a skin cancer prevention measure – but there is more research to come on the benefits of vitamin B3 and skin cancer, so watch this space!
What dosage of Vitamin B3 should I take?
The recommended dose is one 500mg tablet taken twice daily1. However – and this is important - vitamin B3 has not yet been shown to reduce the risk of skin cancer or sun spots in people who are lower risk i.e. who haven’t had them before.
Note also that protection from vitamin B3 only lasts while it is being taken - the benefit in high- risk skin cancer patients ends within weeks of stopping this supplement5. In other words, for long term reduction of non-melanoma skin cancer, it needs to be taken indefinitely.
Above: Even a balanced diet rich in these foods wouldn’t give you a high enough intake to reduce your risk of ongoing skin cancer.
Can I get enough Vitamin B3 through food to help prevent skin cancer?
Nicotinamide or niacinamide is the water-soluble active form of Vitamin B3 (not to be confused with its precursor, nicotinic acid). It occurs naturally in small quantities in lean meats, yeast, meat, fish, eggs, milk, nuts, legumes and cereals and the average daily requirement is 15-20mg.1
However, even a balanced diet rich in these foods wouldn’t give you a high enough intake to reduce your risk of ongoing skin cancer - the amount shown to help reduce skin cancer risk is about 50 times this amount and can’t be achieved by dietary intake alone.
Multivitamins and B-complex preparations won’t make a difference either: for the prevention of recurring SCC, BCC and pre-cancerous sun spots, the recommended dose of Vitamin B3 is as a nicotinamide 500mg tablet, twice daily.1
Above: Lotions and moisturisers that include vitamin B3 have also been shown to reduce visible signs of sun damage and ageing.
What are the benefits of vitamin B3 creams and moisturisers?
Professor Damian’s team showed that nicotinamide may be highly effective in providing immune protection - either as a topical lotion or a daily tablet1.
Topical creams, lotions and moisturisers that include vitamin B3 (niacinamide) have also been shown to reduce visible signs of sun damage and ageing, such as pigmentation and fine wrinkles, as well as reducing blotchiness and increasing elasticity, and improve skin’s ability to heal after excisions.(7,8,9,10)
Niacinamide has also been added to some sunscreens, but note that because it’s water soluble, the benefits can be lost with exposure to water and sweat.
Where can I buy vitamin B3 products in Australia?
In Australia, nicotinamide tablets are available from selected pharmacies. Typically, they cost less than $20 for a month’s supply.
Nicotinamide is also included in many topical skin preparations, including Solar care vitamin B3 cream. For people with sun-damaged skin and a history of BCC, SCC or solar keratoses, SunSense Ultra SPF 50+ sunscreen may be helpful, as it contains nicotinamide.
Above: dose of 500mg twice daily, nicotinamide has been shown to reduce solar keratoses by about 35 per cent.
Are there any side effects of taking vitamin B3 tablets?
Before taking vitamin B3 (nicotinamide), we recommend checking with your doctor, dermatologist or MoleMap Melanographer to see whether it’s suitable for you.
Nicotinamide is well tolerated but very high doses (over 3000 mg a day) can cause nausea. It’s also very important that you take the amide form of vitamin B3, nicotinamide - and not the nicotinic acid form, which has a range of unpleasant side effects, including flushing, headache and low blood pressure.
It is important to remember that vitamin B3 does not protect against sunburn, and should never be used as a substitute for a broad-spectrum, SFP30+ sunscreen and following the latest sunscreen guidelines. Nor is it a substitute for having a regular Full Body MoleMap every year, especially if you’re high risk and/or have had skin cancer before (you can check your risk level here).
What about sun spots? Does Vitamin B3 treat those too?
Studies have also shown that Vitamin B3 may also support the treatment and management of solar keratoses (pre-cancerous, scaly sun spots): it may help to not only treat pre-existing solar keratoses, but also assist with the prevention of new solar keratoses5.
At a dose of 500mg twice daily, nicotinamide has been shown to reduce solar keratoses by about 35 per cent following two months of treatment5. A lower dose of 500mg once daily may also be effective, resulting in a 29 per cent reduction after four months of treatment5.
Experts recommend that people with advanced or multiple solar keratoses should take vitamin B3 supplements alongside other treatments such as prescriptions creams/ointments.
Above: You can expect to see more and more skincare and sunscreen brands including vitamin B3 in their products.
What’s next for vitamin B3 and skin cancer?
While the protective effects of vitamin B3 should theoretically also work against melanoma, there isn’t yet evidence of this in studies – to date.
Professor Diona Damian, who led the pioneering University of Sydney study, says that the next step for her team is to determine whether the immunoprotective effects of nicotinamide might help prevent melanoma skin cancers, as well as non-melanoma.
“Laboratory studies so far have provided encouraging results, but we now need a large-scale clinical trial in people at high risk of melanoma,” she explains. The team will also investigate whether nicotinamide can help people who are at risk of aggressive skin cancers because they have a chronically supressed immune system.
In topical treatments, you can expect to see more and more skincare and sunscreen brands including vitamin B3 in their products – just look for ‘niacinamide’ on the ingredients list.
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References: 1. Damian, Diona L. Nicotinamide for skin cancer chemoprevention. Australasian Journal of Dermatology. [Online] 20 March 2017. [Cited: 21 May 2019.] https://doi.org/10.1111/ajd.12631 2. Chen, Andrew C, et al. A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention. The New England Journal of Medicine. [Online] 22 October 2015. [Cited: 19 May 2019.] https://www.nejm.org/doi/full/10.1056/NEJMoa1506197 3. Cancer Council Australia: https://www.cancercouncil.com.au/blog/the-role-of-vitamin-b3-in-reducing-non-melanoma-skin-cancer/ 4. Heathline: https://www.healthline.com/nutrition/niacin-benefits 5. Surjana, D, et al. Oral nicotinamide reduces actinic keratoses in phase II double-blinded randomized controlled trials. Journal of Investigative Dermatology. [Online] May 2012. [Cited: 26 May 2019.] https://doi.org/10.1038/jid.2011.459 6. Snaidr, Victoria A, Damian, Diona L and Halliday, Gary M. Nicotinamide for photoprotection and skin cancer chemoprevention: A review of efficacy and safety. Experimental Dermatology. [Online] 30 January 2019. [Cited: 19 May 2019.] https://onlinelibrary.wiley.com/doi/10.1111/exd.13819 7. Kimball, A B, et al. Reduction in the appearance of facial hyperpigmentation after use of moisturizers with a combination of topical niacinamide and N‐acetyl glucosamine: results of a randomized, double‐blind, vehicle‐controlled trial. British Journal of Dermatology. [Online] 13 January 2010. [Cited: 21 May 2019.] https://doi.org/10.1111/j.1365-2133.2009.09477.x9. 8. Fu, J J J, et al. A randomized, controlled comparative study of the wrinkle reduction benefits of a cosmetic niacinamide/peptide/retinyl propionate product regimen vs. a prescription 0·02% tretinoin product regimen. British Journal of Dermatology. [Online] 15 February 2010. [Cited: 21 May 2019.] https://doi.org/10.1111/j.1365-2133.2009.09436.x 9. Bissett, D L, Oblong, J E and Berge, C A. Niacinamide: A B vitamin that improves aging facial skin appearance. Dermatologic Surgery. [Online] 21 March 2006. [Cited: 21 May 2019.] https://doi.org/10.1111/j.1524-4725.2005.31732 10. Esfahani, S A, et al. Topical nicotinamide improves tissue regeneration in excisional full-thickness skin wounds: a stereological and pathological study. Trauma Monthly. [Online] November 2015. [Cited: 21 May 2019.] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727459/
Note: This quick questionnaire is designed to give you an idea of your personal skin cancer risk factors.
It isn’t intended to be a substitute for medical advice or diagnosis – please contact us if you have any questions about your skin cancer risk.
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