Niacinamide is a form of vitamin B3. Taken by mouth it prevents and treats deficiency; applied to skin it is one of the better-evidenced skincare ingredients, used for acne, redness, pigmentation and barrier repair. It is also used at high doses to reduce skin cancer recurrence.
What is Niacinamide?
Niacinamide — also called nicotinamide — is one of two forms of vitamin B3. The other is nicotinic acid (niacin), and the difference between them is practically important:
| Form | Also called | Key difference |
|---|---|---|
| Niacinamide | Nicotinamide | No flushing; no cholesterol effect |
| Nicotinic acid | Niacin | Causes flushing; used at high dose for cholesterol |
Nicotinic acid causes flushing — intense heat and redness of the face and upper body — at higher doses. Niacinamide does not, which is why it is the form used in supplements and skincare where flushing would be unwelcome.
The reverse is also true: niacinamide does not lower cholesterol. If you were prescribed niacin for lipids, niacinamide is not a substitute.
In the body, vitamin B3 becomes NAD and NADP — coenzymes involved in a very large number of reactions, including energy production and DNA repair. Deficiency causes pellagra, with dermatitis, diarrhoea and dementia.
It is a food supplement and cosmetic ingredient rather than a registered medicine, so it does not appear in the medicine price register as a standalone product. It appears there as a component of multivitamins.
What is Niacinamide commonly used for?
In skincare — where most current interest is:
- Acne, reducing inflammatory lesions. Evidence is reasonable, and it is gentler than benzoyl peroxide or retinoids.
- Redness and blotchiness, including in rosacea.
- Hyperpigmentation and dark marks, by reducing pigment transfer to skin cells.
- Skin barrier repair, by increasing ceramide production — useful in dry, sensitive or eczema-prone skin.
- Oil control and pore appearance.
- Fine lines, modestly.
Typical concentration is 4–5% in cosmetic products, which is what most studies used. Higher concentrations — 10% and above — are marketed as stronger and are more likely to irritate without clearly working better.
By mouth:
- Preventing and treating vitamin B3 deficiency and pellagra.
- Reducing non-melanoma skin cancer recurrence. This is the most striking oral use — a well-conducted trial found that 500 mg twice daily reduced new basal cell and squamous cell skin cancers by around 23% in people who had already had several. That is a real, medically recognised use, particularly relevant in South Africa, and it should be discussed with a doctor or dermatologist rather than self-started.
- Bullous pemphigoid and some inflammatory skin conditions, in specialist combinations.
- Kidney disease, to lower phosphate, under specialist care.
Who commonly looks for Niacinamide and why
- People with acne, particularly wanting something gentler than retinoids.
- People with rosacea, redness or sensitive skin.
- People with pigmentation or dark marks after acne — a common concern, and one where niacinamide is genuinely useful.
- People building a skincare routine, since it appears in a great many products.
- People who have had skin cancers, or who have had many sun-damaged spots treated — a substantial group in South Africa.
- People confused between niacin and niacinamide, often after being prescribed one and buying the other.
- People taking a B-complex supplement, wondering what it does.
What to check on the label before taking Niacinamide
For skincare:
- The concentration. 4–5% is the well-studied range. Higher is more likely to irritate, not more likely to work.
- Where it sits in the ingredient list, which indicates roughly how much is present.
- What else is in the product. Niacinamide is generally well tolerated alongside most actives; the old advice not to combine it with vitamin C has largely been overstated, though some people find the combination irritating.
- Whether it is a serum, cream or cleanser — a cleanser is rinsed off and does far less.
For supplements:
- Which form it is — niacinamide or nicotinic acid. They are not interchangeable.
- The amount per dose. Adult requirements are roughly 14–16 mg daily, and most multivitamins cover that comfortably.
- Whether other supplements already contain it, since B-complex products and multivitamins usually do.
- Third-party testing and a contactable distributor.
Safety, interactions and when to seek professional advice
Niacinamide is well tolerated. At supplement doses side effects are uncommon; higher doses can cause nausea, stomach upset and headache.
High oral doses — 3 g daily and above — have been associated with liver toxicity, which is why the skin cancer studies used 500 mg twice daily and not more.
On skin, the usual problems are mild stinging, redness or irritation, more likely at higher concentrations or on already-compromised skin.
Speak to a doctor or pharmacist before taking oral niacinamide beyond multivitamin amounts if you:
- Have liver disease, or a history of liver problems.
- Have diabetes — high doses may affect blood sugar control, so monitor more closely.
- Have gout or high uric acid.
- Have kidney disease, or are on dialysis.
- Have a stomach ulcer or gallbladder disease.
- Take carbamazepine, or medicines affecting the liver.
- Are pregnant or breastfeeding — normal dietary and multivitamin amounts are fine; high doses should be discussed.
- Are considering the skin cancer dose — that should be a doctor’s decision, with the reasoning and monitoring explained.
Stop and seek advice for persistent nausea or abdominal pain, yellowing of the skin or eyes, dark urine, or unusual tiredness.
For skincare, stop if the product stings, burns or worsens redness, and reduce frequency rather than pushing through.
See a doctor rather than self-treating if:
- Acne is moderate or severe, scarring, or not responding. Proper treatment works considerably better and prevents permanent scarring, which is far easier to prevent than to fix.
- Facial redness and flushing persist — that may be rosacea, which has specific treatment.
- A skin lesion is changing in size, shape or colour, or a spot bleeds, crusts and does not heal. In South Africa that should be checked promptly.
- You have had skin cancers before and want to discuss whether the preventive dose is appropriate for you.
Related supplement guides
Frequently asked questions
What is niacinamide used for? In skincare, for acne, redness, pigmentation and barrier repair. Taken by mouth, for vitamin B3 deficiency and — at specific doses — to reduce recurrence of non-melanoma skin cancer.
Is it the same as niacin? No. Both are vitamin B3, but nicotinic acid (niacin) causes flushing and lowers cholesterol; niacinamide does neither. They are not interchangeable.
What concentration should I use on skin? 4–5% is the well-studied range. Higher concentrations are more likely to irritate without working better.
Does it help acne? Yes, reasonably — it reduces inflammatory lesions and is gentler than benzoyl peroxide or retinoids. Moderate or severe acne still needs proper treatment.
Can I use it with vitamin C? Generally yes. The old advice against combining them has largely been overstated, though some people find the combination irritating.
Does it prevent skin cancer? A trial found 500 mg twice daily reduced new basal cell and squamous cell cancers by around 23% in people who had already had several. Discuss it with a doctor rather than self-starting.
Is it safe at high doses? Doses of 3 g daily and above have been linked to liver toxicity. The studied preventive dose is 500 mg twice daily.
Do I need a supplement? Most people get enough from diet and any multivitamin. Deficiency is uncommon outside malnutrition or alcohol dependence.