I prescribed a patient Niacinamide for prevention of actinic keratosis (premalignant tissue) as per a study done in the NEJM in December 2015. “First of all, they look like horse pills,” the patient said. “How does this work? Is it really necessary?”
Niacinamide is structurally related to Niacin (Vitamin B3), and is converted into other substances (NAD, NADPH). These substances are crucial in regulating cellular energy levels. NAD is bound by the enzyme poly-ADP-ribose-polymerase 1 (PARP-1). This enzyme has important roles in DNA repair and expression of inflammatory messengers.
Niacinamide exerts an anti-cancer effect after it converts to NAD and activates PARP-1. Whether all patients who have significant history of skin cancer and premalignant tissue should take niacinamide is not clear. If a patient is niacin deficient, then they are more likely to develop a wide range of cancers. Giving individuals excessive Niacin levels may not accomplish anything as is often the case with”supra physiologic” doses of vitamins.
Australas J Dermatol. 2014 Aug;55(3):169-75. doi:10.1111/ajd.12163.
J Med Chem. 2016 Jul14. [Epub ahead of print]
J Nucleic Acids 2010 July 25