Oral Nicotinamide Reduces Actinic Keratoses in Adults with Sun-Damaged Skin

ABSTRACT

Background: Actinic keratoses (AKs) are skin lesions primarily caused by ultraviolet (UV) exposure. They are precancerous lesions and can develop into non-melanoma skin cancer. Exposure to UV radiation leads to the development of AKs by several mechanisms. UV radiation damages cellular DNA, depletes cellular energy levels, and suppresses the immune system. Nicotinamide is a form of vitamin B3. Topical nicotinamide increases cellular energy levels and protects against immunosupression in humans. The question arises, could oral nicotinamide mitigate the harmful effects of UV radiation, and be useful in the reduction of AKs?

Methods: An exhaustive literature search was conducted using MEDLINE – Ovid, Web of Science, and Google Scholar. The search terms nicotinamide and actinic keratosis were used. Applicable articles were assessed for quality using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results: Two studies met eligibility criteria and were included. Both were randomized, controlled, double-blinded trials. One trial included two cohorts, with different doses of nicotinamide used. Cohort 1 found that the number of AKs were 35% less in the nicotinamide group at 2 months (95% confidence interval (CI): 23-45%; p<0.0001) and at 4 months (95% confidence interval (CI): 18-48%; p=0.0006). Cohort 2 found that the number of AKs were 15% less in the nicotinamide group at 2 months (95% confidence interval (CI): 0-28%; p=0.046) and 29% less at 6 months (95% confidence interval (CI): 11-44%; p=0.005). In the second study, the number of AKs were 11% lower in the nicotinamide group at 3 months (p=0.01), 14% lower at 6 months (p<0.001), 20% lower at 9 months (p<0.001), and 13% lower at 12 months (p=0.001).

Conclusion: The two studies reviewed demonstrated a reduction in AKs in patients taking oral nicotinamide. Providers should consider oral nicotinamide supplementation in patients with sun-damaged skin. Further research is needed to explore the action of nicotinamide on the prevention of AKs and NMSC.

Keywords: Nicotinamide and actinic keratoses

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REVIEWED STUDIES:

Surjana D, Halliday GM, Martin AJ, Moloney FJ, Damian DL. Oral Nicotinamide Reduces Actinic Keratoses in Phase II Double-Blinded Randomized Controlled Trials. J Invest Dermatol. 2012;132:1497-1500.

Chen AC, Martin AJ, Choy B, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med. 2015;373:1618-1626.

AUTHOR: Stacy Legg is currently completing her second year in the School of PA Studies at Pacific University, Oregon.  She will graduate with an MS degree in August, 2016.