Topical Nicotinamide improves outcome in discoid lupus erythematosus

A new study published in the Journal of Cosmetics Dermatology suggests that topical Nicotinamide can be utilized as an adjuvant to various treatment regimens for discoid lupus erythematosus (DLE), with good aesthetic outcomes and low adverse effects. 

Cutaneous lupus erythematosus refers to a category of autoimmune connective tissue illnesses that affect the skin. Discoid lupus erythematosus is the most frequent kind of cutaneous lupus erythematosus. Most DLE patients react to smoking cessation, stringent photoprotection, and topical corticosteroid or calcineurin inhibitor therapy. Antimalarial medications are the first-line systemic therapy. Early treatment of DLE may result in complete eradication of skin lesions, but failure to treat leads to persistent scarring, hair loss, and disfiguring pigmentary changes, especially in those with dark skin. Aside from that, long-term topical steroid therapy is associated with adverse effects. 

Current DLE remedies are difficult and ineffective, as well as prohibitively costly, off-label, or seldom available (like antimalarials due to COVID-19 outbreaks). Nicotinamide, commonly known as niacinamide, is a water-soluble vitamin B3 form (niacin). Because of its many effects, Ahmed H. Nouh and colleagues investigated nicotinamide as a treatment for lupus-associated skin lesions.

Researchers conducted a prospective randomized double-blind clinical experiment on 60 people with Discoid lupus erythematosus, utilizing topical Nicotinamide 2% and 4% formulations in the form of cream and gel on skin and scalp lesions. As a placebo control, only cream/gel base was used in the control group.

The findings demonstrated that:

Topical Nicotinamide can be utilized as an adjuvant to various treatment regimens for the treatment of DLE with good aesthetic benefits and few adverse effects. 

In terms of responsiveness, topical 4% Nicotinamide is superior than 2% preparation, although it is linked with a greater incidence of discomfort.

Topical Nicotinamide can be used as an adjuvant to various treatment regimens for DLE, with good aesthetic outcomes and low adverse effects. Topical 4% Nicotinamide is more effective than 2% formulations in terms of responsiveness, although it is linked with a greater incidence of skin irritation. More studies with long-term treatment, longer follow-up periods, and larger sample numbers are needed.

Reference: 

Nouh, A. H., Elshahid, A. R., Kadah, A. S., & Zeyada, Y. A. (2023). Topical niacinamide (Nicotinamide) treatment for discoid lupus erythematosus ( DLE ): A prospective pilot study. In Journal of Cosmetic Dermatology. Wiley. https://doi.org/10.1111/jocd.15628