By Karen Kier

Pharmacist on behalf of the ONU HealthWise team

In 1735, Gaspar Casal of Spain described a disease he named mal de la rosa (sickness of the rose), which was spreading across Europe. Then, in 1771, the Italian physician Francesco Frapolli of Milan gave the same disease the name pellagra. At the time, Southern Europe depended on corn as a major food source, especially in the more impoverished populations.  Pellagra was known by the four Ds, including dermatitis (skin rash), dementia, diarrhea and death.  

Pellagra was considered an infection by many due to spoiled corn. However, Dr. Joseph Goldberger, as a physician officer in the United States Public Health Service, proved in 1910 that it was not an infectious cause but rather a dietary deficiency. Dr. Conrad Arnold Elvehjem, a professor of agricultural chemistry at the University of Wisconsin, identified that the dietary deficiency was due to a substance known as niacin or vitamin B3. 

Vitamin B3 is a family of vitamins and can be found in 3 different forms. These include nicotinic acid (niacin), nicotinamide (niacinamide) and nicotinamide riboside.  The body converts all 3 forms into nicotinamide adenine dinucleotide (NAD). This is a lot of chemistry to say that NAD is essential for life and we all need it to sustain cells in the body. Niacin is made by plants and animals from the amino acid tryptophan. 

Due to this, many foods are rich in vitamin B3 including liver, turkey, chicken, beef, pork, tuna, salmon, peanuts, mushrooms, brown rice, avocados, potatoes, peas, whole wheat and fortified products such as cereals. 

Vitamin B3 is a water-soluble vitamin essential for cell energy, normal cell function and to reduce inflammation. A water-soluble vitamin means you need a daily requirement to be ingested because the body does not store the vitamin in the fat tissue. Excess niacin in the body is converted to niacinamide, which is also water-soluble and requires daily ingestion. Since niacinamide is water-soluble, it is easily put into lotions, creams and cosmetics.  

Topical niacinamide is used to treat various skin conditions including wrinkles (anti-aging), acne, melasma (brown patches on skin), psoriasis, rosacea and dermatitis.  Niacinamide can be found in concentrations of 5-10% in most topical products. Thousands of skin care products are commercially available containing topical niacinamide or as a combination with other skin care ingredients. Above 10% within a formulation can cause irritation to the skin. 

Oral niacinamide (nicotinamide) has been studied over the last 20 years, evaluating its impact on the skin. When taking Vitamin B3 as a supplement, it is recommended to take the niacinamide form and not niacin.  Niacin, especially at higher doses, causes a flushing syndrome. Within 10 to 20 minutes of taking the supplement, one’s skin can get warm, sting, burn, flush, or turn red. This effect can last 1-2 hours after it starts.  This is the result of niacin increasing blood flow into the capillaries (small blood vessels) under the skin. The flushing phenomenon can be avoided by using lower doses of niacin, taking it with food, using a slow-release supplement or switching to a niacinamide product. 

A recent study published in JAMA Dermatology evaluated 33,822 United States veterans who took an oral nicotinamide 500mg supplement twice daily. The researchers were evaluating if using nicotinamide had a protective effect and reduced certain skin cancers. The study did not include melanoma as a skin cancer, but did include basal cell carcinoma and squamous cell carcinoma of the skin. The authors concluded that twice daily nicotinamide 500mg reduced the risk of developing both basal cell carcinoma and squamous cell carcinoma with the greatest benefit in squamous cell. 

While there appears to be a benefit for skin cancer, professionals had concerns about a potential increase in heart disease. A November 2025 study published in the Journal of American Academy of Dermatology focused on the impact of niacinamide on heart disease in dermatology patients. This study evaluated 3231 patients over a 5-year period. The researchers found the exact opposite of the heart disease concern.  The study showed niacinamide oral supplementation reduced the risk of heart disease, especially in lowering the risk of a heart attack. 

These studies support oral niacinamide 500mg twice daily to reduce certain skin cancers and to reduce the risk of heart disease. 

Talk to your healthcare provider or your ONU HealthWise pharmacist to select a good vitamin B3 supplement.