Journal Scan / Case Study · June 25, 2020

Nicotinamide for Resistant Actinic Keratoses

Journal of the European Academy of Dermatology and Venereology: JEADV

 

TAKE-HOME MESSAGE

• The authors report a patient with actinic keratoses (AKs) refractory to treatment with photodynamic therapy, ingenol mebutate, and topical retinoids who was successfully treated with oral nicotinamide 500 mg twice daily. While on treatment, the patient did not develop any new AKs and had resolution of existing lesions. Two prior studies treating AKs in immunocompetent patients with nicotinamide 500 mg twice daily also demonstrated a lower risk of new AKs, although the results were not maintained after treatment discontinuation and were not duplicated in immunocompromised patients.

• Oral nicotinamide 500 mg twice daily is an affordable drug that may be effective in treating and/or preventing actinic keratoses, although larger randomized studies are necessary to confirm this.

– Margaret Hammond, MD

Written by

 

 

Peter A. Lio MD, FAAD

The tripartite dream of a preventive treatment for actinic keratoses that is safe, effective, and accessible continues to be elusive. However, with nicotinamide (synonymous with niacinamide), we may finally see this dream realized. The authors of this short paper do a commendable job of reporting their fairly impressive case of a patient with truly refractory AKs having failed PDT, ingenol mebutate, and topical retinoids. Notably, this patient suffered the relatively rare and unfortunate erosive pustulosis of the scalp from the retinoids, nicely demonstrating a safety/tolerability issue even in the face of treatment failure. Although it is difficult to draw too many conclusions from a single patient, his clearance over the 8 months of treatment with nicotinamide is indeed remarkable.

The authors summarize the four known trials of nicotinamide for AKs nicely, with three of the four (including the largest of the studies, which had 386 patients) showing significant improvement without any concerning safety signals. Appropriately, they conclude that "more robust data are needed," but I can say that, for less than $5 per month and with an excellent safety profile, I have been recommending this to many of my patients who are seeking ways to decrease painful cryotherapy visits and expensive skin cancer surgeries. Even if the effect size is modest, or if it turns out to only help certain subgroups, this is precisely the type of treatment that may well be worth a try as an adjunctive approach.

Abstract

Actinic keratoses (AK) present as erythematous scaly lesions usually overlying sun-damaged skin, made of an epidermal proliferation of atypical keratinocytes known as field cancerization.1 They are secondary to a prolonged and excessive ultraviolet radiation (UVR) exposition. Although most AKs will never develop into Squamous cell carcinomas (SCCs), AKs remain a concern in dermatology as most of SCCs rise from pre-existing AKs.2 As the global population is getting older,3 AKs have become a real public health issue. Along with skin protection, additional oral therapy may be an interesting option in patients at high risk of developing skin cancer. Alternate systemic therapies have been tried in the treatment of sun-damaged skin such as oral retinoid with poor tolerance and numerous side effects. We report the case of a patient, followed up over a long period of time with resistant AK, who responded dramatically to oral nicotinamide treatment within 4 months.

Journal of the European Academy of Dermatology and Venereology: JEADV

Is Nicotinamide a Sustainable Therapy for Resistant Actinic Keratoses?

J Eur Acad Dermatol Venereol 2020 Apr 20;[EPub Ahead of Print], C Paugam, B Dréno 

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.