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    The anti-aging effects of niacinamide

    Patti Farris, M.D.Pellagra is a vitamin deficiency caused by a lack of cellular niacin or its precursor tryptophan. First described for its dermatological symptoms by Gaspar Casal in Spain, Pellagra is characterized by dermatitis, diarrhea and dementia and can be seen in children with malabsorption, adolescents with anorexia nervosa or in patients with chronic alcoholism. The skin lesions in this vitamin deficiency are triggered by sun exposure and appear on the face, neck and extremities.  The eruption presents as a marginated erythema with scaling or blisters. Casal’s necklace is a broad collarette seen around the neck in patients with pellagra and is pathognomonic for this condition. It is through the study of patients with niacin deficiency that we have gained an understanding of the importance of vitamin B and its precursors for skin health.

    Vitamin PP

    Niacinamide (nicotinamide) or vitamin B3 is a water-soluble amide of nicotinic acid historically referred to as vitamin PP for its ability to prevent pellagra. It is a precursor for co-factors NAD(H)and NADP(H) that are important in a variety of cellular pathways that affect skin physiology. NADH and NADPH decrease with age giving rise to the notion that supplementing skin with niacinamide can provide anti-aging benefits. In their reduced forms, NADH and NADPH act as antioxidants that can mitigate oxidative stress associated with intrinsic aging and photoaging.  Additionally, niacinamide stimulates keratinocyte differentiation, believed to be a result of increased intracellular NADPH.  Niacinamide has broad anti-inflammatory activity.  It inhibits nuclear factor kappa B (Nf-kB), reduces production of a variety of inflammatory cytokines, like IL-1 and IL-12, prevents degranulation of mast cells and inhibits leukocyte migration into the skin.

    READ: Honey's use in skin therapy

    Both oral and topical forms of niacinamide have been used to treat inflammatory skin conditions.  Nicotinamide has been used in combination with tetracycline for treating bullous pemphigoid. In a comparative study, 2g/day tetracycline plus 1.5g/day of nicotinamide performed equal to prednisone therapy offering a steroid-free option for BP patients. Topical niacinamide has been studied alone and in combination with calcipotriene for the treatment of patients with psoriasis.  Fifty percent of the combined group achieved total or nearly total clearing by week 12, while only 25% of those treated with 1.4% niacinamide alone and 31.5% treated with calcipotriene alone showed a response.  The authors suggest that topical niacinamide may provide additional benefits and be useful as a steroid-sparing substitute.  

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