Vitamin B-3 for Skin Cancer Prevention
Dr. Gerardo Lugo is a dermatologist practicing in Naples, FL. Dr. Lugo specializes in skin cancer and Mohs surgery . Dermatologists evaluate and manage both common and uncommon skin conditions. These conditions include suspicious skin lesions, moles, keratosis, skin cancer, melanoma and nevi, lipomas and other skin tumors... more
Vitamin B-3 found effective for skin cancer prevention
Skin cancer in the United States is occurring at epidemic proportions. By now it is not news that ultraviolet radiation from the sun is a carcinogen and that excessive sun exposure is the principal cause of the skin cancer epidemic. The sad thing is that for some people, despite all of their efforts to follow the advice of their dermatologist and avoid the sun, new skin cancers continue to develop at an alarming rate.
It is believed that these individuals have an increased genetic susceptibility for skin cancer and that sun-induced DNA damage occurred years earlier. This genetic predisposition is the cause of their propensity to develop new skin cancers every year. Up to now, there was not much they could do other than to try to catch the cancers early by having frequent skin exams by their dermatologist. However, there is new research that shows that chemoprevention may help decrease the burden of skin cancer in these high-risk patients.
Chemoprevention refers to the use of a chemical, be it a drug or a vitamin, for the reduction or prevention of disease. Chemoprevention for skin cancer has eluded researchers over the past decades. Drugs, such as ibuprofen and retinoic acid, and vitamins, such as vitamins A, C, D, and E have shown some promise and have been studied. However, in the end, the results have been disappointing. Recently, a new letter in the alphabet of vitamins has finally shown positive results. The amide of Vitamin B-3, also known as nicotinamide or niacinamide has become a promising agent for the prevention of nonmelanoma skin cancer, which includes the two most common and costly forms of cancer of the skin, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
Recent research in Australia, where the incidence of skin cancer is also of epidemic proportions, showed that patients taking nicotinamide were about 25 % less likely to develop new nonmelanoma skin cancer than the placebo group. They also had a reduction in the formation of new actinic keratoses, the precancerous precursor of squamous cell carcinoma, albeit to a lesser degree. Nicotinamide significantly reduced new basal cell and squamous cell carcinomas during the 12 months the study lasted.
The benefits were noted as early as after the first three months of therapy. However, the benefits waned after the vitamin pills were discontinued. It seems that indefinite use of the vitamin is needed for it to be effective. The good news is that nicotinamide seems to have an excellent safety profile and it is an inexpensive over-the-counter vitamin supplement that is readily available. The dose used in the study was one 500 mg pill in the morning and one in the evening. The vitamin was very well tolerated and there was no difference in adverse events or blood tests between the placebo group and those taking the real vitamin.
How nicotinamide works is still not completely understood. Laboratory studies have shown it enhances repair in the DNA that is damaged by ultraviolet radiation and also curbs ultraviolet radiation-induced immunosuppression. There are several caveats to this research: First, the results of this study apply only to patients at high risk for nonmelanoma skin cancer. That is, adults who have had 2 or more basal cell or squamous cell carcinomas in the past 5 years. It is not recommended for the population at large and may be contraindicated in some people, especially children, pregnant women, or women contemplating pregnancy as no studies have been done in these groups. Second, nicotinamide, which is also called niacinamide is not the same as niacin. These are two forms of vitamin B-3 but their profiles are very different.
Niacin, also called nicotinic acid is used for lowering fats in the blood and has well-known side effects, such as headaches, flushing, low blood pressure, and itching. Niacin does not affect skin cancer prevention and should not be confused with nicotinamide(niacinamide). Be careful not to take pills that include both forms in one formulation. Be sure to use the pure version which only contains the amide form of vitamin B-3. Third, if this story sounds too good to be true, it might be.
Those of us who have practice medicine long enough have been presented with studies with great promising results, just like this one, too many times before just to be disappointed in the end. However, based on the excellent safety profile of nicotinamide, the low cost, and the potential benefit to persons at high risk for skin cancer, many dermatologists in Florida and across the country are recommending it to their high-risk patients.
Nevertheless, it is prudent to stay alert to further studies that might validate or refute the findings of the initial research. The recommended dose is nicotinamide 500 mg twice a day. More is not better, and before starting it consult with your primary care doctor and your dermatologist.
Finally, let’s not forget what has been proven for years to work for skin cancer prevention. That is sensible sun-safe behavior. In other words, avoid the mid-day sun, seek shade, wear long sleeves, long pants, a wide-brim hat, and sunglasses, and apply a broad-spectrum sunscreen of SPF 30 or higher whenever outdoors. And don’t forget to check your skin regularly, and if a lesion looks suspicious call your dermatologist.
Dr. Lugo is double board-certified in Dermatology and Micrographic Dermatologic Surgery (Mohs surgery). He has with special interest and expertise in the early diagnosis and treatment of skin cancer. He has been in private practice in Naples since 1992.
