Key takeaways
- Niacinamide and nicotinamide are the same form of vitamin B3, and topically it doesn’t cause the flushing linked to niacin.
- Small 8-week trials found 4% nicotinamide gel performed comparably to 1% clindamycin gel, but those trials had only 76 and 80 people.
- A 2017 review concluded its effect on acne is unclear because the evidence is so limited.
- 2% niacinamide reduced oil production in one placebo-controlled trial, and lab studies show it boosts barrier ceramides.
- It isn’t among the topical therapies recommended in the 2024 AAD acne guideline.
- Its best role is as a gentle add-on that may make retinoids and benzoyl peroxide easier to tolerate.
Niacinamide (also called nicotinamide, a form of vitamin B3) is a gentle, well-tolerated skincare ingredient that may modestly help acne by calming inflammation and reducing oil. The catch: the acne trials are small, several are more than a decade old, and it isn’t among the treatments recommended in the 2024 American Academy of Dermatology (AAD) guideline. Think of it as a supportive, barrier-friendly extra, not a replacement for proven acne treatments.
What is niacinamide?
Niacinamide is the amide form of vitamin B3. In research papers it’s usually called nicotinamide; on skincare labels it’s usually niacinamide. It’s the same molecule. DermNet notes that, unlike its precursor nicotinic acid (niacin), nicotinamide “does not cause flushing or gastrointestinal upset.”
Topically it shows up in serums, moisturizers and gels. DermNet mentions a 4% gel studied for acne, a 2% moisturizer studied for oiliness, and 5% formulations studied for skin aging. In the US, niacinamide is a cosmetic ingredient, not an approved acne drug.
How might niacinamide help acne?
Researchers point to three possible mechanisms:
- Anti-inflammatory effects. A 2017 review in Dermatologic Therapy describes nicotinamide as a vitamin with “potent anti-inflammatory properties,” which is why it has been studied for red, inflamed spots.
- Less oil. A 2006 study found 2% topical niacinamide significantly reduced sebum excretion rate in a 4-week, double-blind, placebo-controlled trial of 100 Japanese participants. In a separate 6-week split-face study of 30 Caucasian participants, surface oil levels fell slightly, but the difference did not reach statistical significance (p=0.055) and the sebum excretion rate did not change; only investigator-rated shine and oiliness improved significantly.
- A stronger skin barrier. In lab and skin studies published in 2000, nicotinamide increased ceramide production 4.1- to 5.5-fold in cultured skin cells, and topical application increased ceramides and free fatty acids in the outer skin layer and reduced water loss in dry skin.
Note what’s missing: niacinamide doesn’t have the pore-unclogging evidence of a retinoid or the antibacterial action of benzoyl peroxide. Its possible benefits are more about calming and supporting skin.
What does the evidence show?
Honestly: some encouraging small trials, no strong conclusions. The 2017 review found 10 clinical studies. Six of the eight topical studies showed a significant reduction in acne from baseline or performed similarly to a standard treatment, and no major side effects were noted. But the authors concluded that nicotinamide “has an unclear effect on acne vulgaris due to the limited nature of the available literature.”
| Study | Participants and length | What was compared | Result |
|---|---|---|---|
| Shalita et al., 1995 | 76 people, 8 weeks | 4% nicotinamide gel vs 1% clindamycin gel | 82% improved with nicotinamide vs 68% with clindamycin; comparable efficacy |
| Khodaeiani et al., 2013 | 80 people, 8 weeks | 4% nicotinamide vs 1% clindamycin | Comparable overall; nicotinamide did better in oily skin, clindamycin in non-oily skin |
| Draelos et al., 2006 | 100 people (4 weeks) + 30 people (6 weeks) | 2% niacinamide vs placebo | Less oil production in the first group; less surface oil in the second |
| Tempark et al., 2024 | 40 people, 8 weeks, split-face | Ceramide + niacinamide moisturizer vs plain cream, both with benzoyl peroxide 5% and adapalene 0.1% | Greater lesion reduction on the niacinamide-moisturizer side; barrier measures improved on both sides with no significant difference |
Topical niacinamide for acne: the key facts
| What it is used for | Red inflamed spots, Dark marks |
|---|---|
| How you get it | Over the counter |
| Guideline position (AAD 2024) | Evidence judged insufficient |
| Certainty of evidence | — |
| How long before it works | 8–12 weeks if at all |
| Use in pregnancy | No known pregnancy concern. |
| The main catch | The guideline found the evidence insufficient to make any recommendation, for oral or topical. |
How does topical niacinamide compare to the alternatives?
| Treatment | Guideline position | Certainty of evidence | How you get it | Time to work |
|---|---|---|---|---|
| Adapalene + benzoyl peroxide (fixed dose) | Strong | Moderate | OTC and prescription strengths | 4–12 weeks |
| Adapalene 0.1% (OTC retinoid) | Strong | Moderate | Over the counter | 8–12 weeks, often worse before better |
| Benzoyl peroxide | Strong | Moderate | Over the counter | 4–12 weeks |
| Azelaic acid | Conditional | Moderate | OTC 10% and prescription 15–20% | 4–12 weeks; longer for marks |
| Topical niacinamide this page | Evidence judged insufficient | — | Over the counter | 8–12 weeks if at all |
Ratings come from the 2024 AAD acne guideline (Reynolds RV et al.). A conditional recommendation does not mean weak evidence; two treatments in the full table have the best evidence on the site and are conditional purely on cost. All 58 treatments, with sources: the acne treatment evidence map.
Two caveats about those clindamycin comparisons. First, they’re small and short. Second, the comparison drug was topical clindamycin used on its own, and current guidance discourages that: the NICE-based pathway summarized by NHS Scotland advises against topical antibiotic monotherapy. “As good as clindamycin alone” is therefore not the same as “as good as today’s recommended treatments.”
It’s also telling what the major guideline says. The 2024 AAD guideline’s recommended topical therapies are benzoyl peroxide, topical retinoids, topical antibiotics, clascoterone, salicylic acid and azelaic acid. Niacinamide isn’t on the list, and the AAD’s patient guide to OTC acne ingredients doesn’t include it either. For context on how uncertain acne evidence can be generally, a 2024 Cochrane overview of topical acne treatments found no high-certainty evidence for any of the therapies it covered.
What does niacinamide do for the skin barrier?
This is where niacinamide may be most useful for people with acne. Proven treatments like adapalene and benzoyl peroxide often cause dryness and irritation, which is a common reason people quit. The 2024 split-face trial is interesting here: when a ceramide-and-niacinamide moisturizer was paired with benzoyl peroxide and adapalene, the moisturizer side had significantly greater improvement in acne lesions than a basic hydrophilic cream after 8 weeks. The authors concluded such a moisturizer can help improve acne lesions and reduce irritation alongside acne medication.
That’s a promising finding, but keep it in proportion. It was 40 people, the moisturizer combined ceramides and niacinamide (so we can’t credit niacinamide alone), and measures like water loss and hydration improved on both sides with no significant difference. As coverage of the study noted, the researchers themselves called for larger studies. For choosing a moisturizer in general, see moisturizer and sunscreen for acne.
How do you use niacinamide in an acne routine?
- Use it as an add-on. Keep a guideline-backed active, such as adapalene or benzoyl peroxide, as the core of your routine, and add niacinamide in a moisturizer or serum if you want extra soothing or oil control.
- Stick to studied strengths. The acne trials above used 4%, and the oil study used 2%. I couldn’t find good evidence that much higher strengths work better for acne.
- Watch for dryness. DermNet suggests that if twice-daily use causes excessive drying, reduce to once a day.
- Give it time. The trials ran for 4 to 8 weeks. The AAD’s general advice is to give any acne treatment six to eight weeks before judging it.
Is niacinamide safe, and what are the side effects?
Niacinamide’s big selling point is tolerability. The 2017 review reported no major adverse side effects across the studies it summarized, and the 2013 trial reported none. Some people do notice dryness or irritation, especially when layering several products, and any cosmetic can occasionally cause an allergic reaction.
I couldn’t find pregnancy-specific guidance on topical niacinamide from the major dermatology sources I checked, so if you’re pregnant or breastfeeding, run your skincare past your obstetrician or dermatologist like any other product.
What can niacinamide realistically do for acne?
If you have mild acne with redness and oiliness, niacinamide may take the edge off, and it’s unlikely to irritate. If you have persistent adult or hormonal acne, or inflamed spots that leave marks, it’s very unlikely to be enough on its own. The strongest evidence remains with topical retinoids, benzoyl peroxide and, for many adults, prescription options. Niacinamide’s best role is making those treatments easier to live with.
When to see a dermatologist: if your acne hasn’t improved after six to eight weeks of a consistent routine; if you have painful nodules or cysts, scarring or dark marks; if your acne flares around your period or along your jaw and you suspect a hormonal pattern; or if acne is affecting your mood. A dermatologist can recommend treatments with much stronger evidence than niacinamide alone.
Kelsey’s take
Niacinamide seems to have more hype than evidence: the trials comparing it to clindamycin were small, and it isn’t in the 2024 AAD recommendations. Where it makes sense to me is as a gentle supporting player that might help stronger treatments go down easier. I’d ask my dermatologist whether it’s worth adding, or whether I should focus on a retinoid or benzoyl peroxide first.
Frequently asked questions
Niacinamide is in two famous “don’t mix” rules
Both trace back to solution chemistry from the 1960s, and one has a randomised trial pointing the other way. See the evidence.
Using niacinamide with other products
Short, sourced answers on combining niacinamide with other acne ingredients and medicines:
- Benzoyl Peroxide and Niacinamide: Yes.
- Niacinamide and Azelaic Acid: Yes.
- Niacinamide and Vitamin C: Yes.
- Tretinoin and Niacinamide: Usually yes, and plausibly helpful.
Does niacinamide actually help acne?
It may help a little. Small trials found 4% nicotinamide gel worked about as well as clindamycin gel over 8 weeks, but a 2017 review concluded its effect on acne is unclear because the studies are limited. It isn’t recommended in the 2024 AAD guideline, so treat it as an add-on to proven treatments.
What percentage of niacinamide is best for acne?
The acne trials mostly used 4% nicotinamide gel, and a study on oiliness used 2% niacinamide. I couldn’t find good evidence that higher percentages work better for acne. Higher strengths may simply be more likely to irritate, so a product in the 2% to 5% range is a reasonable place to start.
Can I use niacinamide with adapalene or benzoyl peroxide?
Yes. In a 2024 split-face trial, a ceramide and niacinamide moisturizer used alongside 5% benzoyl peroxide and 0.1% adapalene improved acne lesions more than a plain cream. Many people apply niacinamide in a moisturizer after their acne treatment to help with dryness.
Is niacinamide the same as niacin?
Not quite. Niacinamide (nicotinamide) and niacin (nicotinic acid) are both forms of vitamin B3, but DermNet notes that nicotinamide does not cause the flushing or stomach upset associated with nicotinic acid. On skincare labels you’ll almost always see niacinamide, which is the form studied for acne.
How long does niacinamide take to work on acne?
The published acne trials ran for about 8 weeks, and the oil-reduction study found changes within 2 to 6 weeks. The American Academy of Dermatology recommends giving any acne treatment six to eight weeks before judging it, so plan on at least two months.
Sources
- Walocko FM, Eber AE, Keri JE, Al-Harbi MA, Nouri K. The role of nicotinamide in acne treatment. Dermatologic Therapy, 2017;30(5). pubmed.ncbi.nlm.nih.gov
- Shalita AR, et al. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. International Journal of Dermatology, 1995. pubmed.ncbi.nlm.nih.gov
- Khodaeiani E, et al. Topical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgaris. International Journal of Dermatology, 2013. pubmed.ncbi.nlm.nih.gov
- Draelos ZD, Matsubara A, Smiles K. The effect of 2% niacinamide on facial sebum production. Journal of Cosmetic and Laser Therapy, 2006;8(2):96-101. pubmed.ncbi.nlm.nih.gov
- Tanno O, et al. Nicotinamide increases biosynthesis of ceramides as well as other stratum corneum lipids to improve the epidermal permeability barrier. British Journal of Dermatology, 2000. pubmed.ncbi.nlm.nih.gov
- Tempark T, et al. Efficacy of ceramides and niacinamide-containing moisturizer versus hydrophilic cream in combination with topical anti-acne treatment in mild to moderate acne vulgaris: a split face, double-blinded, randomized controlled trial. Journal of Cosmetic Dermatology, 2024. pubmed.ncbi.nlm.nih.gov
- HCPLive. Ceramide, niacinamide-containing moisturizer with medication improves acne lesions. February 2024. hcplive.com
- DermNet. Nicotinamide. dermnetnz.org
- Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 2024;90(5):1006.e1-1006.e30. pubmed.ncbi.nlm.nih.gov
- American Academy of Dermatology. Acne clinical guideline: guideline highlights. aad.org
- American Academy of Dermatology. Adult acne treatment dermatologists recommend. aad.org
- American Academy of Dermatology. How to treat different types of acne. aad.org
- Yuan Y, Wang Y, Xia J, et al. Topical, light-based, and complementary interventions for acne: an overview of systematic reviews. Cochrane Database of Systematic Reviews, 2024 (plain language summary). cochrane.org
- NHS Scotland Right Decisions. Dermatology pathways: Acne (adapted from NICE NG198). rightdecisions.scot.nhs.uk
