When we published a recent article about vitamin B3 helping to prevent recurrence of basal cell and squamous cell skin cancers, we were flooded with questions from readers. The most common issue? Confusion between niacin and nicotinamide—two very different forms of vitamin B3 that serve different purposes. There is evidence published in a highly reputable journal, JAMA Dermatology (Sept. 17, 2025), that dermatologists have used nicotinamide for skin cancer prevention.
This Reader Was Taking the
It is easy to understand why so many people are confused about vitamin B3. There is niacin, nicotinamide and niacinamide. First, let’s clear up confusion about niacinamide and nicotinamide. They are identical. Both are derivatives of vitamin B3…amide forms of nicotinic acid. Niacinamide is frequently found in topical skincare products whereas nicotinamide is found in oral formulations. But they are the same chemical compound.
The reader who was confused captured the frustration of many people She saw the word vitamin B3 but did not understand it was about nicotinamide for skin cancer prevention rather than niacin:
Q. You wrote about the use of niacin against basal cell and squamous cell skin cancers. I would like to try this, but I’m having trouble with the flushing. To avoid this, I have to take the pill after a full meal. Even then, I can manage only 125 mg. How can I build up a tolerance?
This confusion is understandable, but here is the straight and skinny on nicotinamide for skin cancer prevention:
Niacin (Nicotinic Acid):
- Causes uncomfortable flushing (red, hot, itchy skin)
- Can lower cholesterol
- Does NOT prevent skin cancer recurrence
- May trigger gout attacks in susceptible people
Nicotinamide (also called Niacinamide):
- Does NOT cause flushing
- Does NOT lower cholesterol
- DOES help prevent non-melanoma skin cancer recurrence
- Generally well-tolerated at recommended doses
As we explained in our newspaper column response:
“Niacin, which may also be called nicotinic acid, can lower cholesterol, but it causes flushing that can be quite uncomfortable. Niacinamide, also known as nicotinamide, does not cause flushing.”
You can read more about the pros and cons of niacin against heart disease in this article:
“Do Niacin Side Effects Outweigh the Benefits of Lower LDL & Higher HDL Cholesterol?”
Nicotinamide for Skin Cancer Prevention:
The research report in JAMA Dermatology was finally published in a physical journal on November 1, 2025. The investigators examined 12,287 patients who took 500 mg of oral nicotinamide twice daily for more than a month. The results showed a significant reduction in skin cancer risk, particularly in those who had already experienced at least one skin cancer.
Here is how these researchers introduced their study:
“Nicotinamide is a vitamin B3 derivative that is sold as an over-the-counter (OTC) medication and has shown promise in skin cancer chemoprevention, with up to 75% of dermatologic surgeons reporting using nicotinamide for this indication. In 2015, a phase 3, double-blind randomized clinical trial with 386 participants demonstrated that nicotinamide, 500 mg, twice daily was associated with a reduced number of new skin cancers in a population with a history of skin cancer. Following this study, dermatologists began using OTC nicotinamide for skin cancer chemoprevention, particularly in patients at high risk of skin cancer development.”
The authors offer these results from their research:
“In this retrospective cohort study, nicotinamide use was associated with reduced skin cancer risk in those with at least 1 prior skin cancer. This risk reduction was greatest when nicotinamide was initiated after the first skin cancer, with gradual attenuation of the protective effect when initiated after each subsequent skin cancer. The benefit was greatest for cSCC [cutaneous squamous cell carcinoma], but also was seen for BCC [basal cell carcinomas] when initiated after the first or second skin cancer.
“Our results aligned with the risk estimates previously reported that showed a 30% to 50% reduction in risk of skin cancer.”
How does nicotinamide work? It facilitates DNA damage repair, reduces inflammation, and helps counteract the oxidative stress that drives aging and cancer development. Think of it as giving your skin’s repair mechanisms the tools they need to fix sun damage before it becomes cancerous.
Why Don’t More Dermatologists Recommend Nicotinamide for Skin Cancer Prevention?
Here is a puzzle: We have heard from a number of people who have had a basal cell or squamous cell cancer removed from their skin by a dermatological surgeon. They have told us that none of these doctors recommended nicotinamide for skin cancer prevention of a recurrence.
Instead, the dermatologists recommended frequent skin exams. If there were a recurrence, the doctors said that they would order Mohs surgery to have the new cancer or the cancer recurrence removed. For those who are unfamiliar with Mohs surgery, it involves very precise and gradual removal of skin layers until the surgeon is satisfied that she has removed all cancerous cells.
We do not understand why some dermatologists seem dismissive of nicotinamide for skin cancer prevention of a recurrence. The recent report in JAMA Dermatology seems to indicate that the sooner this B vitamin is initiated after a first skin cancer is removed, the less likely it will recur.
Real Reader Experiences: Success Stories and Concerns
Nancy’s Success:
“My dermatologist prescribed Niacin (flush free) for me two years ago. I take it twice a day. After 21 MOHS procedures for squamous cell cancer mostly on my legs and feet, I have not had any new appearances for several months. It is working.”
Nancy mentions “flush free” niacin, which is actually nicotinamide—the correct form for skin cancer prevention. Her dramatic results after 21 previous procedures speak volumes about the potential benefit.
Joan’s Price Confusion:
“I am confused about Niacin vs Nicotinamide. I can find Niacin very reasonably priced and Nicotinamide very expensive. Do I have to buy the expensive product or is Niacin effective in preventing recurrence of basal cell carcinoma?”
Joan’s question reveals another common problem: price shopping without understanding the difference. The answer is clear—you need nicotinamide specifically. While it may cost more than basic niacin, it’s still quite affordable compared to repeated dermatology visits and skin cancer treatments. Shop around, as prices vary considerably between brands and retailers.
Understanding Potential Side Effects:
Joyce’s Digestive Troubles: Joyce experienced severe diarrhea when taking nicotinamide 500 mg for rosacea:
“I had such terrible diarrhea from it that I couldn’t be away from my bathroom at all! I suffered with this for weeks!”
Her experience highlights an important point: while nicotinamide is generally well-tolerated, it can cause digestive upset in some people. Common side effects include:
- Heartburn
- Nausea
- Vomiting
- Diarrhea
- Flatulence
- Fatigue
- Headache or dizziness
If you experience severe side effects like Joyce did, contact your doctor immediately. Don’t suffer in silence for weeks. Some people may need to start with a lower dose and gradually increase, or the supplement simply may not be right for them.
Steve’s Gout Concern:
“I have heard of this remedy but I do have occasional bouts of gout, maybe once or twice per year. I read that niacin can spark a gout attack.”
Steve is right to be cautious—but again, this concern applies to niacin (nicotinic acid), not nicotinamide. Niacin can indeed trigger gout attacks because it may increase uric acid levels. Nicotinamide does not have this same effect and is generally considered safe for people with gout. However, anyone with a history of gout should discuss this with their physician before starting any new supplement.
Could Nicotinamide Help Other Conditions Too?
Frances’s Intriguing Question: Frances noticed a comment from another reader named Mike who resolved his osteoarthritis using large amounts of niacinamide on a doctor’s recommendation.
She wondered:
“As long as you are working with a doctor and having liver enzymes tested, would the niacinamide work as well for the basal and squamous cell cancer preventions?”
This is a fascinating question that deserves attention. Recent research published in Medicina (Kaunas) in February 2025 noted that doctors do prescribe nicotinamide for various inflammatory skin conditions including eczema, rosacea and acne.
In their own words the authors conclude:
“In conclusion, nicotinamide emerges as a versatile, well-tolerated, and clinically relevant molecule with broad applications in dermatology and beyond…The anti-inflammatory properties that help with these conditions—and potentially with osteoarthritis—are related to the same mechanisms that help prevent skin cancer: DNA repair, inflammation modulation, and reduction of oxidative stress.”
The dose used for osteoarthritis may be quite different from the 500 mg twice daily used for skin cancer prevention. Anyone considering nicotinamide for multiple conditions should work closely with their healthcare provider to determine the appropriate dose and monitoring schedule.
What You Need to Know Before Starting Nicotinamide:
The Recommended Protocol:
- Dose: 500 mg twice daily (morning and evening)
- Form: Nicotinamide (also called niacinamide)—NOT niacin
- Duration: At least 12 months for prevention benefits
- Availability: Over-the-counter, no prescription needed
Safety Monitoring: Even though nicotinamide is available without a prescription, medical supervision is strongly recommended:
- Liver enzyme monitoring: Have your doctor check liver function periodically, especially if you have any history of liver problems
- Blood sugar monitoring: People with diabetes should track blood glucose carefully, as nicotinamide may affect blood sugar control
- Bleeding risk: Anyone taking anticoagulants should have more frequent testing
- Kidney function: People with kidney disease should consult their physician before starting nicotinamide
Who Benefits Most: The research shows the greatest benefit in people who have already had at least one basal cell or squamous cell skin cancer. The JAMA Dermatology study found that “the greatest effect [was] seen when initiated after the first skin cancer.”
If you’ve had multiple skin cancers removed, like Nancy with her 21 MOHS procedures, nicotinamide may be especially valuable.
Finding Quality Nicotinamide Supplements:
Frances mentioned checking ConsumerLab.com for information about nicotinamide quality. This is a smart approach. When shopping for nicotinamide:
- Look for products specifically labeled “nicotinamide” or “niacinamide”
- Avoid products labeled “niacin,” “nicotinic acid,” or “flush-free niacin” unless they clearly state they contain nicotinamide
- Check for third-party testing (USP, NSF, or ConsumerLab verification)
- Compare prices between retailers—costs can vary significantly
Other Skin Cancer Prevention Strategies:
While nicotinamide shows promise, it’s not a substitute for other protective measures:
- Regular dermatology check-ups (every 6 months for high-risk individuals)
- Daily sun protection with broad-spectrum SPF 30 or higher
- Protective clothing, hats, and sunglasses
- Avoiding tanning beds
- Being aware of medication interactions—some drugs like hydrochlorothiazide (a blood pressure medication) may increase skin cancer risk
The Bottom Line on Nicotinamide for Skin Cancer Prevention:
If you’re experiencing flushing while trying to prevent skin cancer recurrence, you’re almost certainly taking niacin when you should be taking nicotinamide. As we told our newspaper column reader: “You may want to consider trading in your bottle of niacin for nicotinamide instead.”
The research supporting nicotinamide for skin cancer prevention is solid and growing. The November 1, 2025 JAMA Dermatology study included over four times more participants than previous analyses and confirmed the 30% to 50% reduction in skin cancer risk.
For people like Nancy who have battled multiple skin cancers, nicotinamide offers real hope for breaking the cycle of repeated procedures. For those who have had their first basal cell or squamous cell carcinoma, starting nicotinamide early may help prevent future occurrences.
Remember: while nicotinamide is available over-the-counter, this is a therapeutic use that requires medical supervision. Work with your dermatologist to develop a comprehensive skin cancer prevention plan that includes regular monitoring, sun protection, and appropriate supplementation.
If you found this article helpful, please share it with friends and family who have dealt with skin cancer. Understanding the difference between niacin and nicotinamide could save someone from unnecessary discomfort—or more importantly, help prevent their next skin cancer.
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Have you tried nicotinamide for skin cancer prevention? Share your experience in the comments below. Your story could help others make informed decisions about their skin health.
Citations
- Breglio, K.F., et al, "Nicotinamide for Skin Cancer Chemoprevention," JAMA Dermatology, Nov. 1, 2025, doi: 10.1001/jamadermatol.2025.3238
- Camillo, L., et al, "Nicotinamide: A Multifaceted Molecule in Skin Health and Beyond," Medicina (Kaunas), Feb. 1, 2025, doi: 10.3390/medicina61020254
