Vitamin B3, also known as niacin, is one of the 32 essential nutrients in humans. It’s a water-soluble vitamin which is removed from the blood rapidly and must be consumed each day, unlike fat soluble vitamins such as vitamin E.
Niacin’s history in acne stretches back to 1955, where doctors used it to protect patients from acne induced by iodine, but it didn’t catch on more widely until the 1990s. Vitamin B3 is recommend by the acne clearing community both as a supplement and a topical treatment, compared to zinc which is most popular as a supplement.
The truth is that for one method, niacin is useless for acne, while for the other, niacin is excellent.
The supplemental powers
The main role of vitamin B3 in the body is closely related to other B-vitamins: producing enzymes for energy metabolism. It metabolises both carbohydrates and fat and has side roles in producing the enzymes used for cholesterol synthesis.
For acne, a confirmed power of niacin is vasodilation, or blood flow enhancement. Firstly, vitamin B3 is known to reduce the viscosity of blood.
Secondly, niacin triggers the release of a chemical called prostoglandin D2, which dilates the capilleries. PGD2 triggers vasodilation very effectively in the skin too. This study even found that when supplemented with 100mg of niacin, anxious patients’ faces became redder after they were embarrassed, because of the blood flow.
The benefit will be more oxygen to the skin and improved blood flow, and more acne nutrients and antioxidants. Vitamin B3 is also needed for proper skin barrier function and can therefore prevent dry, flaky, crusty patches of skin.
For a clear illustation that niacin is important, look no further than the disease pellegra. This is a form of extreme vitamin B3 deficiency seen mostly in Africa, rural South America and Indonesia. Its main side effects are dementia and death, but dermatitis, one of the three Ds of niacin deficiency, is another.
Pellagra has similarities to acne, but is much, much worse. Pellegra is Italian for “skin that is rough” but that fails to do it justice. While not an official symptom, the pictures show snake-like coils of inflamed skin spreading from cheek to cheek. Dry, hard, scaly and cracked skin is a symptom, evolving into blackened scales the more you hack at them. The greater the deficiency, the freakier the symptoms get. Itching and burning is common and the rashes resemble a severe sunburn. A clear difference to rashy skin diseases like rosacea is that the rash is symmetrical in pellegra, with a neatly defined boundary between the rash and healthy skin.
Pellagra also affects other parts of the body; pellagra was discovered by a physicist named Gaspar Casal back in 1772, and the peasants he observed had pellagra in their hands and feet. Pellagra is yet another of the countless skin conditions in the world and niacin deficiency is exclusively to blame.
Can you take advantage of them?
We can therefore confirm that niacin deficiency is a nightmare for your skin, if not acne, but that’s the real question – is deficiency even common?
The answer is a resounding no, because in the USA, the rate among 19 year olds and over is just 2%. In fact, niacin ranks almost at the bottom. Magnesium deficiency is is found in 61% of people while vitamin B1 (thiamine), common itself, is lacking in 7% of people. Zinc stands at 12% while vitamin B6 weighs in at 15%.
Some of the richest foods in vitamin B3 are…
Turkey meat – 34% of the RDA per 100 grams.
Chicken breast – 69% per 100 grams.
Mushrooms – 18% per 100 grams.
Tuna – 66% per 100 grams.
Peanuts – 68% per 100 grams.
When Gaspar Caval first discovered pellegra, he observed that its victims typically ate a high maize diet with very little meat. In the 21st century though, many of the niacin rich foods are staples, unlike richer foods in magnesium.
Oral niacin has benefits for acne, but you cannot take advantage of them unless you’re very lucky. Factors in the developed world which heighten the niacin deficiency risk include alcoholism, liver scarring, and HIV and cancer.
Unlike vitamin C or vitamin E, megadoses of niacin achieve nothing beneficial for acne. There is one signature effect – the niacin flush. A sudden burst of redness and heat in the face from doses of above 100mg, due to a huge exaggeration of niacin’s blood flow enhancing abilities.
The niacin flush is temporary, lasting for 30 minutes to two hours, and is harmless. It feels like a burst of heat or mild sunburn. You can even watch the heat migrating down from your face to your chest and arms.
The interesting question for acne is whether this sudden burst of blood might enhance nutrient and antioxidant delivery. Unpleasant as it might be, the niacin burst might be excellent as a short, sharp shock for breathing life and glow into your skin. That’s just speculation, and you should stick to normal blood flow enhancing tricks like eating celery and beetroot, but it remains interesting. Disclaimer: I definitely do not recommend the above trick.
Oral niacin has benefits for acne, but its ubiquity removes the opportunity.
Topical niacin – unproven, but promising for acne
Niacin isn’t dead though, because the potential of vitamin B3 for the everyday acne-clearing enthusiast lies entirely with topical application.
When reading articles and experimenting with vitamin B3, you’ll notice that two forms exist: niacin and niacinamide. Niacin is also known as nicotinic acid while niacinamide is also called nicotinamide.
Naturally, niacinamide is a form of niacin created by the body when you eat too much dietary vitamin B3. Technically it’s a derivative of niacin, but while niacin and niacinamide have minor structural differences, the human body can convert them into each other highly effectively. Niacinamide is more commonly used in supplements due to not causing the niacin flush, although niacinamide megadoses have their own side effect of sweating.
Unlike alternative zinc forms like zinc oxide, niacinamide is effective for both absorption into the body and for health and acne. It’s not a failed lab experiment like many synthetic vitamins. With that out of the way, here’s a bunch of studies on topical niacinamide and acne:
STUDY ONE: the studies began back in 1995 with this comparison of clindamycin and niacinamide. Clindamycin is a topical antibiotic used to treat acne by eliminating p.acnes bacteria, sold widely in gel or cream form. The scientists were enraged with the growing resistance of p.acnes to their antibiotics, and were therefore comparing one to vitamin B3. 76 patients were ordered to apply either 4% niacinamide gel or 1% clindamycin gel daily.
After 8 weeks, both patients experienced significant improvements in acne, with a 82% improvement in the niacinamide group compared to 68% in the antibiotic group.
STUDY TWO: our next study was disappointing. The methods differed as group 1 was given a combination of 4% niacinamide and 1% clindamycin. Group 2 received clindamycin alone, while group 3 consisted of antibiotic-resistant acne patients who received the first combination. 75 patients were tested, and after 8 weeks, the addition of niacinamide was judged to have achieved nothing. The raw data showed a very slight improvement in group A, with 17.5% enjoying an excellent response compared to 13.79% in group B.
STUDY THREE: but niacinamide found itself on the road to redemption in yet another confrontation with clindamycin. 5% niacinamide was compared to 2% clindamycin for eight weeks in 60 female patients. The niacinamide and the clindamycin reduced acne with equal effect, leading to the glorious conclusion that “five percent nicotinamide gel is as effective as 2% clindamycin gel for treatment of mild to moderate acne vulgaris“. Niacinamide decreased acne by 69% in 8 weeks.
STUDY FOUR: a final battle between the two resulted in another great study. 4% niacinamide gel was compared to 1% clindamycin in two groups of 40 and the result was a 32% fall in acne severity after 4 weeks in the niacinamide group, followed by a 65% fall after 8 weeks. The antibiotic group experienced falls of 32% and 64%. The results were strangely similar.
None of the niacinamide patients experienced any side effects. The clindamycin group didn’t experience any either, but the all too real side effects of topical antibiotics show up months down the road – a crippled flora of healthy bacteria and the rise of yeasts like malassezia.
The balance of the evidence tilts towards topical niacin being excellent for acne, but the negative study can’t be ignored either. So what was different?
The methods differed slightly, but the fact about vitamin B3 which is both interesting and negative is that its precise mechanism is unknown. Topical niacin is known to have antioxidant powers, and suppress an enzyme called phosphodiesterase which is linked to psoriasis and atopic dermatitis. It inhibits at least two strong immune system pro-inflammatory chemicals: neutrophils, which churn out free radicals, and the allergy chemical histamine, in addition to blocking its receptors. There’s also one study where topical niacin lowered sebum production in Japanese subjects.
Given that niacin is an essential nutrient, it has numerous roles, but the killer one for acne is unconfirmed, unlike vitamin E with its fat soluble antioxidant properties.
Therefore, it’s very possible that vitamin B3 will have no effect on your acne in certain lifestyle and dietary circumstances, which was why one study failed. What if its antioxidant powers are the main factor? Your opportunity maybe limited if you already use grapeseed oil with its vitamin E or eat plenty of fruits and herbs.
If B3 works its magic through inhibiting neutrophil output, then if other pro-inflammatory chemicals like TNF-a and interleukin-6 are elevated, but not neutrophils, you’ll be doomed. The participants of the failed study might have experienced something like this. If we knew the precise weapon that vitamin B3 has, we could account for these factors, but we don’t. However, it could have also been that in the weak study, the antibiotic reduced acne by so much that the addition of B3 caused little extra improvement, even though it would have been strong on its own.
There’s more unanswered questions with vitamin B3 than others, but it remains a promising topical treatment for acne.
Proven to smooth out dark patches
The second big skincare power of niacin is reducing hyperpigmentation. Vitamin B3 was once again compared to the mainstay of pharmaceutical remedies – hydroquinone. This widespread treatment reduces accumulation of melanin, pigment and darkness effectively, but has irritating side effects too.
27 people were divided into two groups which applied either 4% concentration niacinamide cream or 4% hydroquinone to dark patches on their skin, every single day for 8 weeks. The niacinamide group improved almost as strongly as the hydroqinone group. Every patient enjoyed some fading of hyperpigmented patches.
The hydroquinone had a slightly higher rate of excellent to good responses, at 55% vs 44%. The benefits of hydroquinone also took just one month to take effect versus the niacin at two months.
However, the vitamin B3 had a much lower rate of side effects such as burning and irritation. Hydroquinone is the mainstay of anti-hyperpigmentation remedies, and vitamin B3 almost matched it.
This time, the power is confirmed: inhibition of melanosome transfer. The melanin found in your skin is originally manufactured in the skin by various enzymes, within cells called melaninocytes. The melanin-containing cells manufactured by melanocytes are called melanosomes. To deposit the melanin in your skin’s layers and provide pigment, the melanosomes must be transferred from melanocytes to keratinocytes, the basic cells which make up the epidermis.
This is the process of melanosome transfer, and according to this study, topical niacin was able to decrease melanosome transfer by 35-68%.
Vitamin B3’s hyperpigmentation powers differ from other natural treatments. Licorice root inhibits the tyrosinase enzyme which converts the amino acid tyrosine into melanin. Argan oil, a secret remedy for hyperpigmentation, inhibits both tyrosinase and another enzyme behind melanin formation called dopachrome tautomerase. Meanwhile, niacin was found to have no effect on tyrosinase, so if your dream in life is to get pearly white and even skin, a combination of argan oil and topical niacin could be the ultimate solution.
The natural role of vitamin B3 in skin pigment is interesting, given that it’s an essential dietary nutrient. We can speculate that the human body normally uses vitamin B3 to constrain and control the transferral of melanin into skin cells, but to a limited extent.
Even if normal dietary levels are healthy, vitamin B3 will probably be insufficient to prevent hyperpigmentation caused by too much UV radiation; normal people have normal niacin levels, yet it doesn’t save them. However, when you deliver a concentrated burst topically, it clearly is sufficient.
Maybe the human body naturally prevents too much niacin from being funnelled to the skin, since hypopigmentation is also a bad thing, as it weakens your skin defences. Topical niacin or niacinamide might bypass any natural limits.
Speaking of skin quality and tone, niacin is also an effective moisturiser and is proven to improve signs of ageing. This study on 50 women told them all to apply niacinamide daily. Eight weeks later, age related factors such as skin elasticity, smoothness, wrinkles, and fine lines all improved. While we’re at it, hyperpigmentation faded as well.
It works like the bacteria in natural yoghurt. Niacin doesn’t provide any moisture itself, but does enhance the skin barrier function, decreasing trans-epidermal water loss and keeping any existing moisture locked in.
If you’ve simply read the article, then the verdict is clear. Vitamin B3 is a rare acne substance where the mainstream opinion is correct. It’s ineffective as a supplement due to being plentiful in the diet anyway, but excellent as a concentrated topical treatment.
It’s not completely proven, and topical treatments are second to diet regardless. Among topical treatments, vitamin E from natural sources like grapeseed oil is superior since its greatness is proven: preventing squalene oxidation and clogged pores. Niacin is more mysterious, but the balance of the studies is excellent.
Since we don’t know precisely how it clears acne, we can’t make any specific recommendations, like with aloe vera being effective for inflammation. However, topical niacin is definitely a useful treatment for hyperpigmentation, if you’re a pale skinned person trapped near the equator or stuck in kangaroo land.
Thanks for reading!