Vitamin B3, also known as niacin, is one of the 32 essential nutrients in human beings. It’s a water-soluble nutrient which is rapidly removed from the bloodstream and must be consumed daily, which is completely different to fat soluble vitamins like vitamin E. Niacin’s main bodily function is closely related to other B-vitamins: producing enzymes for energy metabolism. In doing so it metabolises both carbohydrates and fat, and has side roles in cholesterol synthesis.
So far then, B3 sounds mostly irrelevant for acne, but its history stretches way back to 1955, when doctors experimented with niacin to cure iodine-induced acne. It didn’t reach the acne underground until the 1990s, and nowadays, vitamin B3 is enthusiastically recommended both as a supplement and a topical treatment, compared to zinc, which is easily most popular as a supplement.
The truth is that as a supplement, niacin is useless for acne, while as a topical remedy, niacin is excellent.
The supplemental powers
For acne, an instant confirmed power of niacin as a supplement is vasodilation, AKA blood flow enhancement.
Firstly, vitamin B3 is well known to reduce the viscosity of blood. Secondly, niacin triggers the release of the chemical prostaglandin D2, which dilates the capillaries, including in the skin. This interesting study found that when supplemented with 100mg of niacin, the faces of anxiety patients became even redder when they were embarrassed.
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That doesn’t sound too appealing, but the benefit will be increased oxygen to the skin, improved blood flow, and potentially more acne nutrients and antioxidants arriving there. Vitamin B3 is also vital for proper skin barrier function and can therefore prevent dry, flaky, and crusty patches of skin.
For a clear illustration of niacin’s importance, look no further than the skin disease pellagra. This is an extreme form of vitamin B3 deficiency seen mostly in Africa, rural South America and Indonesia. Niacin deficiency has three cornerstone Ds: dementia, death, and dermatitis.
Pellagra is Italian for “skin that is rough” but that fails to do it justice. The pictures show snakelike coils of inflamed skin spreading from cheek to cheek. Dry, hard, scaly and cracked skin is a symptom, evolving into unsightly blackened scales the more you hack at them. The greater the deficiency, the freakier the symptoms. Itching and burning are common and rashes often resemble a severe sunburn. The rashes are uniquely symmetrical in pellagra, with a neatly defined boundary between rash and health skin.
Pellagra also affects other parts of the body; it was first discovered in 1772, by a physicist called Gaspar Casal, 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 disaster for your skin, and possibly acne itself. But that’s the real question – is deficiency even common?
The answer is a resounding no, because in the USA, rates among 19 year olds and older are just 2%. In fact, niacin ranks almost at the bottom. Magnesium deficiency affects 61% of people while vitamin B1, plentiful 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 pellagra, he observed that its victims typically ate a high maize diet with very little meat. In the 21st century though, many niacin-rich foods are dinnertime staples, unlike the heaviest magnesium sources.
Oral niacin does have benefits for acne, but they’ll only materialise if you’re very lucky. Factors in the developed world which heighten the risk of niacin deficiency include alcoholism, liver scarring, HIV and cancer.
Unlike vitamin C or vitamin E, niacin megadoses have no hidden benefits for acne. There is one signature effect – the niacin flush. This is a sudden burst of facial redness and heat from niacin dosages at or above 100mg, due to a huge exaggeration of niacin’s blood flow enhancing abilities.
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This flush is only temporary, lasting for 30 minutes to two hours, and is totally harmless. It feels like a burst of heat or mild sunburn. You can even watch the heat migrating down your body, from face to chest to arms.
The question for acne is whether this sudden burst of blood might send nutrients and antioxidants flooding in. Unpleasant as it is, the niacin flush might work excellently as a short, sharp shock for breathing new life and glow into your skin. That’s just speculation, and you should definitely stick to celery and beetroot for your blood flow staples, 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 in the water though, because its potential for acne (which is massive) lies entirely with topical application.
You may notice in your travels that two forms exist: niacin and niacinamide. Niacin is also known as nicotinic acid while niacinamide has the alter ego of nicotinamide.
Naturally, niacinamide is an inactive derivative of niacin created by the body when your dietary B3 gets way too high. While niacin and niacinamide have minor structural differences, the human body can convert between the two almost instantly. Niacinamide is more commonly used in supplements because it doesn’t cause the annoying niacin flush, although niacinamide megadoses have their own side effect of sweating.
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Most importantly, niacinamide is excellently absorbed and effectively fulfils niacin’s duties. It isn’t a failed lab experiment like oral zinc oxide. Now that we’ve dealt with the technicalities, here’s a bunch of studies testing topical niacinamide on acne:
ONE: the study train kicked off back in 1995 with this promising comparison of niacinamide and the topical antibiotic clindamycin. The scientists were enraged with the growing resistance of p.acnes bacteria to their antibiotics (how dare they!), and were therefore comparing an antibiotic to B3. 76 acne patients were ordered to apply either 4% niacinamide gel or 1% clindamycin gel daily.
After 8 weeks, both groups experienced significant improvements in acne, with 82% improvements in the niacinamide group compared to 68% in the antibiotic group.
TWO: a more disappointing study. The methods differed this time, as group 1 took a combination of 4% niacinamide and 1% clindamcyin. Group 2 received clindamycin alone while group 3 received the first combination, but consisted of antibiotic-resistant patients.
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.
THREE: but niacinamide found itself on the road to redemption in yet another showdown with clindamycin. 5% niacinamide was compared to 2% clindamycin in 60 female acne patents. Niacinamide decreased acne counts by 69% in 8 weeks, 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“.
FOUR: an epic final battle resulted in another great study for us. A 4% niacinamide gel enjoyed a 32% fall in acne severity after 4 weeks, followed by 65% after 8 weeks, while a 1% clindamycin group experienced strangely similar falls of 32% and 64%.
None of the niacinamide patients experienced any side effects. The clindamcyin group also experienced none, but the all-too-real side effects of topical antibiotics always show up months down the road – a crippled flora of healthy bacteria and the rise of vicious yeasts like malassezia.
Analysis time
The evidence tilts strongly towards topical niacin being excellent for acne, but we can’t just ignore the negative study either. So what went wrong?
The methods differed slightly, but more importantly, vitamin B3’s precise mechanisms are unknown. Topical niacin is known to have antioxidant powers, and suppress an enzyme called phosphodiesterase with links to psoriasis. Niacin inhibits at least two notorious pro-inflammatory chemicals: neutrophils, which fire out free radicals, and the allergy chemical histamine. There’s also one study where topical niacin improved oily skin in Japanese subjects.
As an essential nutrient, niacin has many biological roles, but the killer power for acne is still a mystery, unlike vitamin E with its fat soluble antioxidant powers.
Therefore, it’s completely possible that B3 will make nary a dent in your acne in certain dietary and lifestyle circumstances. If antioxidants are niacin’s biggest power, then your opportunities will be limited if you’re already using grapeseed oil or scoffing down plenty of fruits. The nature of niacin’s antioxidant properties is equally mysterious.
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If B3 succeeds by suppressing neutrophils, then your luck has run dry if other pro-inflammatory chemicals like TNF-a turns out to be responsible. The participants of the failed study may have experienced these exact scenarios.
If we knew the precise weapon that vitamin B3 has, then we could account for these factors, but we don’t. Alternatively, the antibiotic might have reduced acne so strongly that adding niacin caused little extra improvement, even though it would have been strong in isolation.
Vitamin B3 is riddled with unanswered questions, but it’s undeniably a promising topical treatment.
UPDATE 2020: I’m happy to announce that B3’s main power has finally been pinpointed, after all this time. It’s improving oily skin, and you can read the full report here.
Proven to smooth out dark patches
Meanwhile, niacin has a second big skincare power, and it’s reducing hyperpigmentation. Vitamin B3 was once again compared to a mainstay of pharmaceutical remedies – this time hydroquinone. This widespread remedy reduces the accumulation of melanin, pigment, and dark patches effectively, but has irritating side effects too.
27 volunteers were divided into two groups featuring either 4% concentration niacinamide cream, or 4% hydroquinone, applied to dark patches of skin daily. The niacinamide group improved almost as strongly as the hydroquinone group. Every single patient enjoyed some fading of hyperpigmented patches.
The hydroquinone had a slightly higher rate of excellent to good responses, at 55% vs 44%. The hydroquinone was also faster than niacinamide, taking just one month compared to two months.
However, the vitamin B3 caused dramatically fewer side effects such as burning and irritation. Hydroquinone is the mainstay of anti-hyperpigmentation remedies, but vitamin B3 almost matched it.
This time, the power is fully confirmed: inhibiting melanosome transfer. The melanin that colours your skin is originally manufactured by various enzymes, within special cells called melanocytes. The melanin-containing cells manufactured by melanocytes are called melanosomes. To deposit the melanin in your skin’s outer layers and provide pigment, the melanosomes must be transferred from melanocytes to keratinocytes, the basic skin cells making 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 starkly from other natural treatments. Licorice root inhibits the tyrosine enzyme which converts the amino acid tyrosine into melanin. Argan oil, a secret remedy for hyperpigmentation, inhibits both tyrosine and another melanin enzyme called doapachrome tautomerase. Niacin, meanwhile, had no effect on tyrosine, so if your long cherished dream in life is to get pearly white and immaculately even skin, then a combination of argan oil and topical niacin could be the ultimate solution.
The natural role of B3 in skin pigment is interesting, given that it’s an essential nutrient. We can speculate that the human body normally uses vitamin B3 to control and constrain the transfer of melanin into skin cells, but to a limited degree.
Standard dietary B3 will probably be insufficient to prevent hyperpigmentation caused by too much UV radiation; 98% of people have normal niacin levels, yet it doesn’t save them. However, when you deliver a concentrated burst of niacin locally, it evidently is sufficient.
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Perhaps the human body naturally prevents too much niacin from being funnelled to the skin, since hyperpigmentation is also a bad thing, as it weakens your sun defences. Topical niacin might bypass these natural limits.
Speaking of skin quality and tone, niacin is also a fantastic moisturiser and is proven to reduce signs of ageing. This study on 50 women ordered them to apply niacinamide daily. Eight weeks later, ageing factors such as skin elasticity, smoothness, wrinkles and fine lines all improved, and while we’re at it, hyperpigmentation faded as well.
It works similarly to the bacteria in natural yoghurt. Niacin doesn’t provide any moisture itself, but it does enhance skin barrier function, decreasing any trans-epidermal water loss and locking existing moisture in.
The verdict
Vitamin B3 is a rare acne substance where the mainstream opinion is 100% correct. It’s ineffective as a supplement due to being plentiful in the diet anyway, but excellent as a highly concentrated topical treatment.
Topical remedies are secondary to diet, and among topical remedies, 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 studies is excellent.
We don’t know precisely how it clears acne, so we can’t make any tactical recommendations like with aloe vera being effective for inflammation.
However, topical niacin is a confirmed weapon against hyperpigmentation, if you’re a pale skinned person trapped near the equator or languishing down under in kangaroo land.
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Thanks for reading!
This statistics about niacin deficiency looks suspicious – what was the methodology used? Had they only counted people with pellagra? Even if 21st century diet is high in niacin, it’s also high in sugar, white flour and other empty calories, coffee etc. which are said to “steal” niacin from the body. I’m sure that much more than 2% people would benefit from niacin supplement e. g. when used for depression, sleeplessness, and of course acne.
P. S. Thanks for this post, some time ago I mentioned in the comments how niacin worked for my acne.
Do you have any recommendations for niacin pills or topical niacin?