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Topical niacinamide (Nicotinamide) treatment for discoid lupus erythematosus (DLE): A prospective pilot study.

  • 2023-01-22
  • Journal of cosmetic dermatology 22(5)
    • Ahmed H Nouh
    • Ahmed R Elshahid
    • Ahmed S Kadah
    • Youssef A Zeyada

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 60
Population
60 subjects diagnosed with Discoid lupus erythematosus
Methods
Prospective randomized double-blind clinical trial; topical Nicotinamide 2% and 4% preparations in form of cream and gel on skin and scalp lesions; control group using cream/gel base as placebo
Blinding
Double-blind

Background

Cutaneous lupus erythematosus is an umbrella term for a group of autoimmune connective tissue disorders affecting the skin. Discoid lupus erythematosus (DLE) is the chronic condition and most common form of cutaneous lupus erythematosus.

Aims

Current therapies of DLE are challenging and not completely satisfactory, highly expensive, off-label, or poorly available (like antimalarials due to COVID-19 outbreaks). Nicotinamide, also called niacinamide, is a water-soluble form of vitamin B3 (niacin). Its multiple effects let us think that nicotinamide could be a therapy for lupus-associated skin lesions.

Methods

We performed a prospective randomized double-blind clinical trial on 60 subjects diagnosed with Discoid lupus erythematosus using topical Nicotinamide 2% and 4% preparations in form of cream and gel on skin and scalp lesions. Control group was included using only cream/gel base as placebo control.

Results

Obtained data showed that topical Nicotinamide can be used for the treatment of DLE as adjuvant to other treatment regimens with good cosmetic results and minimal side effects. Topical 4% Nicotinamide is superior to 2% preparation in response but associated with a higher incidence of irritation.

Conclusion

Topical Nicotinamide can be used for the treatment of DLE as an adjuvant to other treatment regimens with good cosmetic results and minimal side effects. Further trials with long-term therapy, follow-up period, and bigger sample sizes are required.

Research Insights

  • Vitamin B3→Improved DLE Lesion Response

    Obtained data showed that topical Nicotinamide can be used for the treatment of DLE as adjuvant to other treatment regimens with good cosmetic results and minimal side effects. Topical 4% Nicotinamide is superior to 2% preparation in response but associated with a higher incidence of irritation.

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    Topical 2% and 4% preparations in form of cream and gel

Adverse Events Reported

  • Vitamin B3→irritation

    Topical 4% Nicotinamide is superior to 2% preparation in response but associated with a higher incidence of irritation.

    Finding
    Increased risk
  • Vitamin B3→Overall tolerability

    Obtained data showed that topical Nicotinamide can be used for the treatment of DLE as adjuvant to other treatment regimens with good cosmetic results and minimal side effects.

    Finding
    Reported
    Grade
    mild
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