Niacinamide

We use Niacinamide in custom prescription strength creams and gels for acne, pores, dark spots and ageing skin. It is a form of vitamin B3 that strengthens the skin barrier, slows the transfer of pigment into surface skin cells and reduces inflammation. Niacinamide is also sold over the counter in hundreds of products at fixed strengths and formulations. In our custom formulas your doctor chooses the optimal strength of Niacinamide alongside key actives to target your skin concerns.

What Is Niacinamide and How Does It Work?

Niacinamide, also called nicotinamide, does three things at once. Its anti-inflammatory action is the part that matters in acne and rosacea, where the redness and the bumps come from an immune response rather than a blockage. It drives up the skin’s own production of ceramides and the other fats that seal the surface, so the barrier holds water and skin feels less tight and flaky. On hyperpigmentation, it works a bit differently from popular pigment fading actives like Hydroquinone. Melanin is made inside pigment cells, then handed to the skin cells around them. Niacinamide interrupts that handover, so less of it reaches the surface and existing marks fade. It leaves the melanin-making enzyme alone, which is the part Hydroquinone blocks. This versatility means that Niacinamide may provide the following benefits:

• Calmer skin: less redness and irritation, which suits rosacea and reactive skin.
• Fading of dark marks: works on the pigment left behind by acne, melasma and sun damage.
• A stronger barrier: more of the fats that hold moisture in, so skin feels less tight and copes better with stronger actives alongside it.
• Fewer breakouts: an anti-inflammatory action licensed in its own right for mild to moderate acne.
• Refined pores and less shine: improvement in how pores look and how oily skin feels through the day.

How City Skin Clinic Uses Niacinamide

Niacinamide is one of the most versatile actives we use and your doctor may include it in any of our skin treatments. It appears most often in our custom treatments for:

• Acne
• Rosacea
• Hyperpigmentation
• Melasma
• Skin Ageing

Despite its many benefits, Niacinamide is usually a supporting ingredient as it does its best work next to stronger actives that directly target specific skin concerns. Your doctor may combine Niacinamide with one or more of the following:

• Tretinoin: speeds up cell turnover, smooths texture, treats acne and fades pigment faster. It can also sometimes leave skin dry and peeling in the early weeks. Niacinamide can help alleviate these side effects by supporting the skin barrier as well as helping support the effects of Tretinoin on acne, skin tone and texture.
• Hydroquinone: the strongest pigment suppressor we use for hyperpigmentation, melasma and age spots. It blocks melanin at the point of manufacture whilst Niacinamide slows what is already made from reaching the surface.
• Azelaic acid: a gentle multi-tasker that clears breakouts, calms redness and fades dark marks, and one of the few actives considered safe in pregnancy.
• Tranexamic acid: quietens the signals that switch pigment cells on and is useful in melasma treatment.
• Spironolactone: blocks the androgens driving oil production in hormonal acne.
• Clindamycin: an antibiotic for inflammatory acne.
• Metronidazole: a long-standing rosacea treatment that reduces inflammation.
• Ivermectin: kills the Demodex mites that may drive some rosacea flares.
• Hydrocortisone: a mild steroid added to some hyperpigmentation and melasma formulas to reduce inflammation, which drives pigment production.

How Do You Get Niacinamide in the UK?

There are three routes, and which one you need depends on what you are treating and on what else has to go into the formula.

• A compounded formula: your doctor prescribes a cream or gel made up for you alone, combining Niacinamide with the other actives your skin needs at the strengths your doctor sets. Compounded formulas are unlicensed medicines, made individually for each patient according to a prescription rather than manufactured in batches.
• Over the counter: Niacinamide is a cosmetic ingredient, so you can buy it over the counter in a variety of serums, moisturisers and cleansers. It is available across a wide range of strengths and prices.
• A licensed medicine: one licensed topical Niacinamide product exists in the UK, a 4% gel for mild to moderate inflammatory acne, sold as Freederm. It is a pharmacy medicine, so a pharmacist can sell it to you without a prescription.

To access our custom skin treatments, you will need to complete the online consultation form or book a virtual video consultation with one of our doctors first. Your doctor will assess your skin, design a formula around what it needs and look after you afterwards. The same doctor stays with you, adjusts the treatment course by course and answers your questions by email.

There is no subscription and no auto-renewal. Each course is a single order you place yourself.

Over the Counter, Licensed or Compounded Niacinamide

If you are considering Niacinamide, you have three routes in front of you. You can buy a cosmetic product over the counter, buy the licensed 4% gel from a pharmacy or have a formula compounded and made for you. For many people an over-the-counter product is enough. A compounded formula is worth considering when one active on its own has not settled the problem, or when what you are treating needs actives that are not sold over the counter. This is how the three compare:

How Effective Is Niacinamide?

Niacinamide is used in our formulas for acne, pigmentation, skin ageing and a weakened skin barrier. Its effects build over a course of months. This is what the evidence shows for each concern:

• Acne: Niacinamide reduces the inflammation behind red, sore spots. In fact, the UK regulator has licensed a 4% gel for mild to moderate inflammatory acne on the strength of it. It is not an antibiotic, so it does not carry the resistance problem that comes with them.
• Hyperpigmentation and melasma: by slowing the handover of pigment into surface skin cells, Niacinamide can lighten dark patches and even out tone over a course of months. It works through a different mechanism from Hydroquinone and Tranexamic acid, so your doctor can combine it with either for greater effectiveness.
• Skin ageing: in studies of sun-damaged skin, 5% Niacinamide improved fine lines, dark spots, blotchiness, sallowness and elasticity across twelve weeks. Those studies were in white women. A separate Japanese trial found the same for wrinkles and skin roughness using 4% over eight weeks.
• Damaged barrier: more ceramides and less water loss in dry skin, which is why it is often added to formulas built around harsher actives.
• Oiliness and pores: 4% Niacinamide on its own reduced pore counts and unevenness at eight weeks in a split-face clinical trial. It works on the oil that stretches a pore as well, lowering the amount measured on the face in two further studies. Most oil-control products absorb oil once it has reached the surface rather than changing how much is made.
• Redness: its anti-inflammatory action helps settle general redness and blotchiness.

Whilst the data on Niacinamide is very encouraging, it is worth noting that it mainly comes from small studies, typically involving thirty to a hundred participants over four to twelve weeks. Also several were run by the companies that make the ingredient. They also tend to show that it produces a gradual change rather than a dramatic one. That is why Niacinamide is usually prescribed alongside stronger actives.

What Strengths Does Niacinamide Come In?

Over the counter, most Niacinamide products use between 2% and 10%, usually in a serum or moisturiser form. The licensed acne gel is 4%. Interestingly, nearly all the published work uses strengths at the lower end of that range. The oil studies used 2%. Most of the rest ran at 4% or 5% with pore counts, wrinkles and skin roughness all improving at 4%. Much of the hyperpigmentation and ageing work was done at 5%. There is little published evidence of extra benefit by using strengths above that.

In a compounded formula the strength depends on what else is going into the cream or gel, what is being treated and how your skin behaves. People with reactive skin or those whose formulas contain several actives often do better starting low and building up in strength as needed. Your doctor will aim for the one you can use consistently.

What Are the Side Effects of Niacinamide?

Most people can use Niacinamide and tolerate it. There are, however, a few situations that need care:

• Dryness: the most frequently reported effect, and the one most likely to show up early.
• Itching, redness, burning or stinging: less common, and usually confined to where you apply it.

If your skin gets dry or starts to peel, dropping to once a day or every other day is usually enough. Tell your doctor either way, because it may mean the formula wants adjusting.

One thing worth pointing out is that Niacinamide and niacin are often confused with each other. Flushing is caused by niacin, also called nicotinic acid, which is a different molecule with a similar name. The licensed UK label records that the flushing and headache seen with nicotinic acid have not been observed with Niacinamide. If a product leaves your skin hot and red after using Niacinamide, it is more likely to be irritation.

Who Should Not Use Niacinamide?

Most people can use Niacinamide and tolerate it. There are however a few situations that need care including:

• A previous reaction to Niacinamide or vitamin B3: true allergy is uncommon, but if you have had one, do not use it again.
• Very reactive or barrier-damaged skin: not a reason to avoid it. It is a reason to start low and build up.
• Pregnancy and breastfeeding: Niacinamide is generally considered safe in pregnancy and while breastfeeding though caution is advised as with any medicine especially in the first trimester. Always speak with your doctor before starting anything.