What is niacinamide, and does it help acne?

What niacinamide is

Niacinamide, also called nicotinamide, is a form of vitamin B3. Reviews of vitamins in skin care note its use in acne, either instead of the antibiotic clindamycin or alongside other treatment, and for uneven pigmentation ^[1].

In the acne trials it was used as a gel applied to the skin, usually at a strength of 4 percent ^[2][3]. That is different from tablets: the NHS notes that a pharmacist may suggest supplements such as zinc, niacinamide and vitamin A ^[7], but the evidence on tablets is a separate question that this article does not cover.

What the trials found

In a 1995 double-blind trial, 76 people with moderate inflamed acne applied either 4% nicotinamide gel or 1% clindamycin gel twice a day for eight weeks. By the end, 82 percent of the nicotinamide group and 68 percent of the clindamycin group were rated as improved, and inflamed spots fell by 60 percent and 43 percent. The differences between the two groups were not statistically significant, so the fair reading is that the two gels did about equally well ^[2].

A 2013 trial in 80 people with moderate inflamed acne repeated the comparison and found the same: both groups improved substantially over eight weeks, with no significant difference between them. In that trial nicotinamide did better in people with oily skin and clindamycin did better in people with non-oily skin, and no one had a major side effect ^[3].

A third small trial, also published in 2013, gave 60 women with mild to moderate acne either 5% nicotinamide gel or 2% clindamycin gel for eight weeks. Acne severity fell in both groups, with no significant difference between them, and no side effects were seen ^[8]. All three trials were small, and none of them compared niacinamide with a dummy gel, which is the usual way to show that a treatment works at all.

One more trial tested a cosmetic emulsion that combined 4% nicotinamide with a phospholipid, a fat-like ingredient, applied once a day for 12 weeks against both clindamycin and a dummy emulsion, and reported it slightly better than clindamycin ^[9]. Because two ingredients were tested together, it cannot say how much of the effect came from niacinamide.

What the reviews say

A 2020 Cochrane review looked at 49 trials of six topical acne treatments whose benefit was unclear, including niacinamide. For niacinamide it found four trials, all comparing it with the antibiotics clindamycin or erythromycin, and none measured how much people themselves felt their acne had improved ^[4].

On what was measured, the review found low-quality evidence of little or no difference between niacinamide and clindamycin in how many people dropped out or had minor side effects. Across the whole review the authors judged most of the evidence low or very low in quality and called for better head-to-head trials ^[4].

The 2024 guideline from the American Academy of Dermatology does not list niacinamide among the treatments it recommends; its strong recommendations go to benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline ^[6].

What it does to oil

Niacinamide is often sold as an oil-control ingredient. In a 2006 study, 100 Japanese participants used a 2% niacinamide moisturizer or a plain one for four weeks, and the niacinamide group made less oil by weeks 2 and 4 ^[5].

In a second part of the same study, 30 white participants used it on one side of the face for six weeks. The amount of oil sitting on the skin went down, but the rate at which the skin produced oil did not ^[5]. The study measured oil, not acne, so it says nothing directly about spots.

Why the comparison with antibiotics matters

Both trials compared niacinamide with an antibiotic gel rather than with a dummy gel. The 1995 authors chose that design because antibiotics used on their own can encourage resistant bacteria, and they argued that a non-antibiotic option was worth having ^[2]. The 2024 guideline also advises keeping oral antibiotics limited and combining treatments that work in different ways ^[6].

The catch is that "as good as clindamycin gel" in a small trial is not the same as "proven". With only a few small studies and no measure of how people themselves rated the results, the honest label is thin evidence ^[2][3][4].

How to think about it

Niacinamide was well tolerated in the 2013 trial, where no one had a major side effect ^[3], so it is a reasonable thing to try if you want a gentle addition to a routine.

It is not a substitute for the treatments with the strongest evidence. If you add it, introduce it on its own and give it several weeks before judging it; the trials ran for eight weeks ^[2][3]. If your acne is deep, painful or leaving marks, talking to a pharmacist or doctor is a better next step than adding another product ^[7].

Sources

1. Elgharably N, Al Abadie M, Al Abadie M, Ball PA, Morrissey H. Vitamin B group levels and supplementations in dermatology. Dermatol Reports. 2023;15(1):9511. PubMed 37063401
2. Shalita AR, Smith JG, Parish LC, Sofman MS, Chalker DK. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol. 1995;34(6):434–437. PubMed 7657446
3. Khodaeiani E, Fouladi RF, Amirnia M, Saeidi M, Karimi ER. Topical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgaris. Int J Dermatol. 2013;52(8):999–1004. PubMed 23786503
4. Liu H, Yu H, Xia J, et al. Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne. Cochrane Database Syst Rev. 2020;5(5):CD011368. PubMed 32356369
5. Draelos ZD, Matsubara A, Smiles K. The effect of 2% niacinamide on facial sebum production. J Cosmet Laser Ther. 2006;8(2):96–101. PubMed 16766489
6. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1–1006.e30. PubMed 38300170
7. NHS. Acne. Page last reviewed September 22, 2026; accessed October 5, 2026. Read it
8. Shahmoradi Z, Iraji F, Siadat AH, Ghorbaini A. Comparison of topical 5% nicotinamid gel versus 2% clindamycin gel in the treatment of the mild-moderate acne vulgaris: a double-blinded randomized clinical trial. J Res Med Sci. 2013;18(2):115–117. PubMed 23914212
9. Morganti P, Berardesca E, Guarneri B, et al. Topical clindamycin 1% vs. linoleic acid-rich phosphatidylcholine and nicotinamide 4% in the treatment of acne: a multicentre-randomized trial. Int J Cosmet Sci. 2011;33(5):467–476. PubMed 21668835

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