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.
- Choi J. Diet, “Natural” Treatments, and Maskne. Session F002, AAD VMX 2021, 23-25 April.
- Chen AC, Damian DL. Australas J Dermatol 2014;55(3):169-75.
- Walocko FM, et al. Dermatol Ther 2017;30(5). Epuba 2017 Feb 21.
- Jung GW, et al. J Cutan Med Surg 2013;17(2):114-22.
- Baquerizo Nole KL, et al. J Am Acad Dermatol 2014;71(4):814-21.
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Table of Contents: AAD 2021
Featured articles
Letter from the Editor
Late-Breaking Abstracts
Small molecule effective in moderate-to-severe psoriasis
Bruton’s tyrosine kinase inhibition promising for pemphigus vulgaris
Bimekizumab superior to secukinumab in psoriasis
Etrasimod – a new mode of action for treatment of atopic dermatitis
Women at higher risk for dermatologic side effects during immunotherapy
Novel easy-to-use foam formulation clears scalp psoriasis in one-third of patients
Anti-cholinergic gel demonstrates superior long-term tolerability and efficacy in axillary hyperhidrosis
Psoriasis – The Beat Goes On
Psoriasis: The treatment armamentarium continues to grow
Psoriasis management in times of COVID-19: the knowledge is growing steadily
Lower burden of high-risk atherosclerotic plaques in psoriasis patients treated with biologics
COVID-19: What Dermatologists Need to Know
Psoriasis and hidradenitis suppurativa during COVID-19: keep calm and carry on
COVID-19 in children – cutaneous involvement is common
Cutaneous reactions after COVID-19 vaccination: an update
Novel Developments in Sun Protection
Sunless tanning and other developments in sun protection
What Is Hot in Atopic Dermatitis
Comorbidity is common in adult and paediatric atopic dermatitis patients
Significant improvements in the system armamentarium for AD treatment
Topical pan-JAK inhibitor cream safe and efficacious in atopic dermatitis
Hairy Matters – What Is New in Alopecia
Allergies: an underrated factor in alopecia pathogenesis
Botulinum toxin A: a contradictory role in hair loss
Platelet-rich plasma in androgenetic alopecia – hype or hope?
Acne – New Developments
New therapeutic options add value to current acne treatment
Nicotinamide and probiotics can support acne therapy
Pearls of the Posters
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