Niacinamide, an amide of nicotinic acid (also known as vitamin B3), is a water-soluble vitamin found most commonly in wheat, meat, and fish. Niacinamide acts as an antioxidant but also possesses biological activities, making it an important emerging cosmetic ingredient.Due to the anti-inflammatory action, skin lightening properties, and decrease in sebum production, vitamin B3 may be beneficial to patients with rosacea.

Effect

Rosacea patients who do not tolerate conventional therapies may benefit from botanical interventions and some studies suggest that natural therapies may be used as alternatives to conventional treatments. A prospective cohort study of 198 patients with acne vulgaris and/or rosacea analyzed the clinical use of oral pharmacologic doses of nicotinamide and zinc. Patients taking an oral supplement containing a mixture of nicotinamide, zinc, copper, and folate responded equally well to a single topical therapy as they did to multiple topical therapies.

Also, adding an oral antibiotic to the nicotinamide supplement did not significantly improve treatment outcomes. Given this, the authors suggest that oral nicotinamide/ zinc/copper/folate might be an alternative to oral antibiotic therapies. Furthermore, they report that 82% of participants who had previously received antibiotic therapy considered nicotinamide/zinc/copper/ folate tablets to be as effective or superior to previously trialed antibiotics. Trials directly comparing nicotinamide and antibiotics are lacking.

Potential mechanisms of action

Nicotinamide and zinc have a variety of potential mechanisms of action contributing to the outcome of the study, including:

(1) an anti-inflammatory effect via inhibition of leukocyte chemotaxis, lysosomal enzyme release, lymphocytic transformation, and mast cell degranulation; 

(2) bacteriostatic effect against Propionibacterium acnes; 

(3) inhibition of vasoactive amines; 

(4) preservation of intracellular coenzyme homeostasis; 

(5) decreased sebum production.