Nicotinamide and probiotics can support acne therapy

An increasing number of acne patients asks for natural treatment options. Prof. Juliana Choi (Penn Dermatology Perlman, PA, USA) gave recommendations for adjunctive treatments in acne.

Niacinamide is a form of vitamin B3 that has demonstrated anti-inflammatory, anti-ageing, anti-carcinogenic, and moisturising properties, the latter by increasing the synthesis of ceramides [1]. Unfortunately, there are few randomised controlled studies evaluating topical treatment. In one study, 4% niacinamide had comparable efficacy with 1% clindamycin. Side effects were mild burning, pruritus, and erythema. No studies tested oral niacinamide as a single agent. However, 2 studies with combination products containing nicotinamide, zinc, copper, and folic acid led to a significant improvement of acne with no side effects: doses of the combinations were between 600 and 2,400 mg. Prof. Choi recommended topical niacinamide, particularly for patients with sensitive skin, as efficacy is similar to topical clindamycin without the concern for antibiotic resistance and side effects are minimal. “I recommend 4–5% nicotinamide or higher,” she said. Prof. Choi advocates oral niacinamide supplements for patients who prefer ‘natural’ options or who may benefit from the anti-carcinogenic effect. For these cases, 500 mg 1–3 times daily is appropriate. “In contrast, I do not recommend zinc to my acne and rosacea patients,” she said. Reasons for this are the mixed efficacy for acne, and the distinct gastrointestinal side effects.’

Another adjunctive treatment for acne Prof. Choi favours are probiotics. Probiotics are live microorganisms that benefit the host by improving its microbial balance. Unfortunately, few studies have assessed oral probiotics for acne patients, but a trend has been observed towards improvement. In an open-label study including 45 female acne patients, probiotics and minocycline had similar efficacy. Of those treated with minocycline, 13% developed vaginal candidiasis but not a single patient in the probiotic group did [4]. Evidence exists for the capability of probiotics to reduce antibiotic-associated diarrhoea: a meta-analysis of 19 studies found a 52% reduction with probiotic use [5]. “Therefore, I recommend oral probiotics as adjunctive treatment in otherwise healthy patients being prescribed oral antibiotics with antibiotic-associated diarrhoea or vaginal candidiasis,” concluded Prof. Choi.

1. Choi J. Diet, “Natural” Treatments, and Maskne. Session F002, AAD VMX 2021, 23-25 April.
2. Chen AC, Damian DL. Australas J Dermatol 2014;55(3):169-75.
3. Walocko FM, et al. Dermatol Ther 2017;30(5). Epuba 2017 Feb 21.
4. Jung GW, et al. J Cutan Med Surg 2013;17(2):114-22.
5. Baquerizo Nole KL, et al. J Am Acad Dermatol 2014;71(4):814-21.

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Posted on 7 June 202123 April 2024