Dr Harshal Ranglani, MD

The role of niacin in overall health has long been known. Pellagra is a well-documented symptom complex of niacin deficiency comprising the 4 D’s : diarrhea, dementia, dermatitis (inflammation) and death. Dermatitis is common, demonstrating how important niacin is for normal skin functioning.

Niacinamide (or nicotinamide) is the active form of vitamin B3 (or nicotinic acid). In the body, it gets converted to a series of molecules which are able to interact with other cell components.

Niacinamide is used for a variety of dermatologic conditions from atopic dermatitis and bullous pemphigoid to something as common as acne. Recently, the cosmeceutical benefits have been a topic of detailed research. Various anti-aging benefits of niacinamide have come to light, making it a frequent ingredient in all kinds of skincare products.

Let’s take a deeper look into the mechanism behind niacinamide and how it interacts with the skin.

The Role of Niacinamide

Two important metabolites of niacinamide are NMN and NAD. NMN stands for nicotinamide mononucleotide. NAD stands for nicotinamide dinucleotide.

In the cells, the process of conversion is as follows:

Nicotinamide → NMN → NAD+

NAD+ is the final active form of niacinamide. It is a coenzyme that converts energy from nutrients in our food to a form of energy called ATP. ATP is energy that can actually be used by cells for essential functions. These include DNA repair, cell metabolism and overall cell health.

The hydrogenated (reduced) forms of NAD (NADH and NADPH) are antioxidants with signaling properties. Thus, niacinamide acts on skin indirectly as a result of its role as a coenzyme precursor.

Sun exposure causes a decline in ATP content of cells. NAD+ restores ATP, allowing skin cells to function optimally. NAD+ also enhances repair of DNA which has been damaged by sun exposure. Sun damage is responsible not only for skin cancers but also more commonly, the visible signs of skin aging like wrinkles and uneven pigmentation.

Another important set of molecules central to cellular health are sirtuins. Sirtuins are linked to telomeres. Telomeres shorten with aging. Ultimately, they become so short that the cells cannot survive and they die. Sirtuins function to keep the telomeres intact, preventing them from rapid shortening.

Sirtuins, in turn, are regulated by NAD+. Once NAD+ interacts with sirtuins, it is depleted and thus unable to continue providing additional benefits to sirtuins. Therefore, the body must continuously produce NAD+ to continue multiple cell processes and prevent cell deterioration. Tissues with high cell turnover, such as the skin, require higher doses of NAD+ to combat DNA damage due to both external and internal factors.

Unfortunately, as we age, our bodies produce less and less NAD+. This is where oral supplements containing NAD+ precursors like niacinamide and NMN come into the picture: the idea is that intake of niacinamide can significantly increase the amount of NAD+ in the body, thereby helping repair cell damage and slow down aging.

It has been shown that treating older skin cells (called fibroblasts) with nicotinamide can restore NAD+ levels to those in younger cells.

Skin Aging

As we age, our DNA accumulates damage - both due to external factors like sun exposure and pollution as well as due to the natural process of cell replication and division. Telomeres shorten and eventually they become so short that cell replication cannot occur.

These changes show up in the skin in various ways. These include:

• Uneven skin tone occurring due to excess and patchy pigment production by the skin cells
• Increased fine lines and wrinkles occurring from loss of collagen and elastin. This makes the skin sallow, yellow, thick and inelastic, as opposed to soft and supple.
• Uneven skin texture due to slow turnover of the skin cells.
• Skin barrier is also damaged with age and cannot hold up as well, making the skin dehydrated.

Together, this is how slowly and subtly at first, signs of aging start to appear.

Niacinamide and anti-aging:

There is evidence to show that niacinamide, after its conversion to NAD+, alters various aspects of skin aging.

These include:

• Antioxidant effects :

Niacinamide increases the reduced forms of NAD, which have potent antioxidant properties. Oxidative damage from sun, pollution, smoking, etc. is responsible for accelerated skin aging.

• Improves epidermal barrier function

Niacinamide reduces loss of water from the skin’s surface and improves the moisture content of the superficial layer, thus correcting dehydration. It does so by increasing production of ceramides in the skin. It also restores the normal skin turnover.

• Decreases yellowing of skin

Niacinamide inhibits oxidative processes, such as protein oxidation, glycation, and the Maillard reaction, which produces Amadori products. Amadori products are yellowish-brown in color and accumulate in skin matrix components, like collagen, in response to oxidative stress as we age. They give aged skin its ‘sallow’ appearance.

• Decreases redness and blotchiness

Increasing barrier function results in less irritation when the skin encounters environmental insults and hence, less redness. It increases overall skin clarity.

• Smoothes out fine lines and wrinkles

It increases collagen and elastin production in the skin while decreasing excess levels of glycosaminoglycans (GAGs). It makes the skin look more plump and younger.

• Hyperpigmentation

It decreases transfer of melanin to the skin cells, thus helping even out the skin tone.

Together, these effects lead to a more youthful appearance of the skin.

Each of these actions also help in inflammatory conditions like acne or in cases of barrier damage such as atopic dermatitis. Niacinamide thus acts on the skin in various ways, making it a multitasking powerhouse.

Niacinamide in skincare

Oral niacinamide has been used in the dose of 250-1000mg per day for its anti-inflammatory effect as well as chemopreventive action (it protects against development of cancer). The mechanism of action is the same as topical niacinamide.

When applied to the skin, niacinamide penetrates the superficial skin layers and is taken up by the cells. Inside, it increases cellular levels of NAD+.

Niacinamide is used topically in creams, face washes, serums and lotions as part of anti-acne treatments. Topical niacinamide is safe, gentle and non-irritating, with minimal side effects. It is available in concentrations ranging from 2.5% to 10%. It is also easily formulated, chemically stable, and compatible with other formulation components, making it an ideal agent for use in cosmetic products.

Niacinamide is a vitamin with a multitude of skin care benefits, ranging from control of inflammation to barrier repair to repair of sun damage. It acts in complex ways which are yet to be fully elucidated.

As a dermatologist, I regularly prescribe niacinamide-containing products to several of my patients, both in the form of creams and serums. Niacinamide is one skincare ingredient that can benefit all kinds of patients and skin types.

• It improves skin hydration which declines as a result of age, acting like a great moisturizer.
• It improves pigmentation, which often coexists in individuals with photodamaged and mature skin.
• It also reduces sebum secretion, being extremely beneficial for acne-prone patients. Acne treatments often tend to be very drying but incorporation of niacinamide in an acne routine can improve oiliness, hydration and blemishes.
• Another excellent use of niacinamide is in case of sensitive skin or skin prone to barrier-dysfunction as in rosacea patients - niacinamide increases ceramide production, helping restore the skin’s natural barrier.

It can easily be combined with other actives without increasing the risk of irritation. It is a multitasking cosmeceutical ingredient that all skin types can benefit from.

Dr Harshal Ranglani, MD

Dr Ranglani is a practising clinical and aesthetic dermatologist currently based in Mumbai, India. She also holds the Specialty Certificate in Dermatology conferred by the esteemed Royal College of Physicians, UK. She believes in a holistic approach to skin care and skin conditions. Understanding that skincare is not 'one-size-fits-all', she individualizes skin care routines and treatments for her patients. Her recommendations are based on evidence-based skin care, backed by scientific studies and data.

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