What is nicotinamide?

Nicotinamide (also called niacinamide) is a form of vitamin B3. It is an over-the-counter supplement shown to reduce the risk of basal cell skin cancer and this squamous cell skin cancer.

How does it work?

Nicotinamide enhances the skin’s ability to repair UV-induced DNA damage and helps prevent UV-related immune suppression. Unlike niacin, it does not cause flushing.

Recommended dose

500 mg twice daily. Check labels for “nicotinamide” or “niacinamide.” Avoid “niacin,” which causes flushing and is not the same. See below for QR code link to purchase.

Safety

Nicotinamide is generally well tolerated and has not been associated with cardiovascular risks or major side effects at the recommended dose.

Niacinamide After the First Skin Cancer: What Newer Data Suggest

Patients who develop one non-melanoma skin cancer (basal cell or squamous cell carcinoma) are at substantially increased risk for additional skin cancers in the following years. This elevated risk persists even with good sun protection.

Niacinamide (nicotinamide) has emerged as a practical secondary-prevention strategy in this setting.

What the evidence shows

• The strongest data come from the ONTRAC trial, which included patients with a history of multiple non-melanoma skin cancers.
• Subsequent analyses and real-world adoption suggest that benefit is not limited to patients with many prior cancers.
• Dermatology consensus increasingly supports starting niacinamide after the first documented skin cancer, rather than waiting for multiple recurrences.

Why earlier initiation makes sense!

• UV-induced DNA damage and immune suppression continue after the first cancer, driving future tumors.
• Niacinamide improves DNA repair and reduces UV-related immune suppression, addressing the ongoing carcinogenic process, not just existing lesions.
• It is inexpensive, safe, and does not interfere with other preventive strategies.

Who should consider it after a first skin cancer

• Patients with a first basal cell or squamous cell carcinoma
• Individuals with extensive actinic damage
• Fair-skinned patients with significant cumulative sun exposure
• Patients motivated to reduce future procedures and biopsies

Practical takeaway

While niacinamide is not a substitute for sun protection or surveillance, starting 500 mg twice daily after the first non-melanoma skin cancer is increasingly viewed as reasonable and proactive, given the low risk and potential to reduce subsequent tumors.

Bottom line

Waiting for multiple skin cancers before initiating niacinamide is no longer necessary. Early secondary prevention—starting after the first skin cancer—aligns with current evidence, risk biology, and dermatologic practice trends.

Heliocare provides extra UV protection especially in those with photo sensitivity and includes Niacinamide.

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