From the Guidelines
If you've developed a facial rash after using niacinamide, you should discontinue use immediately and consult with a dermatologist. While niacinamide (vitamin B3) is generally well-tolerated and used for improving skin texture and reducing inflammation, some people can experience adverse reactions, such as irritant contact dermatitis, which can be characterized by erythema and vesiculation in the acute phase, and dryness, lichenification, and fissuring in the chronic phase 1.
Possible Causes of the Rash
- The rash could be due to subjective irritancy, which is an idiosyncratic stinging and smarting reaction that occurs within minutes of contact, usually on the face, in the absence of visible changes, and is often caused by cosmetic or sunscreen constituents 1.
- It could also be due to acute irritant contact dermatitis, which is often the result of a single overwhelming exposure or a few brief exposures to strong irritants or caustic agents 1.
Recommended Course of Action
- Apply a gentle, fragrance-free moisturizer to soothe the affected area and avoid other active skincare ingredients until your skin heals.
- Take an antihistamine like Benadryl (diphenhydramine) 25-50mg every 6 hours if the rash is itchy or uncomfortable.
- A 1% hydrocortisone cream applied twice daily for up to 7 days may help reduce inflammation, but don't use it longer without medical advice.
Prevention of Future Reactions
- These reactions typically occur because your skin is either sensitive to niacinamide itself or to preservatives in the product formulation.
- Some people react to higher concentrations (above 5%), so if you try niacinamide again in the future, consider a lower-concentration product and patch test it first on a small area of skin.
- Consider using clinical assessment tools such as the Dermatology Life Quality Index to assess the impact of the rash on your quality of life, and to monitor the response to treatment 1.
From the Research
Niacinamide and Rash on the Face
- Niacinamide is a well-tolerated and safe substance often used in cosmetics, with various effects including antipruritic, antimicrobial, vasoactive, photo-protective, sebostatic and lightening effects depending on its concentration 2.
- However, there is a possibility of contact dermatitis or allergic reactions to niacinamide, although it is not commonly reported 3, 4.
- Topical nicotinamide has been used in the treatment of various skin conditions, including acne vulgaris, melasma, atopic dermatitis, and rosacea, with few reported side effects 5, 6.
- It is essential to note that while niacinamide is generally considered safe, excessive exposure may lead to potential side effects, and individuals with sensitive skin should patch test before using products containing niacinamide 5.
Potential Causes of Rash
- Allergic contact dermatitis can occur due to various allergens in skin products, including medications and cosmetics 3, 4.
- The ingredients in excipients of these products, such as formaldehyde releasers, non-formaldehyde releasers, fragrance mixes, and Myroxylon pereirae (Balsam of Peru), can also cause contact allergy 3.
- Strategies to avoid these allergens in commercial skin care products, including the use of online tools such as SkinSAFE and the Contact Allergen Management Program, can help minimize the risk of contact dermatitis 3.
Management of Rash
- Clinical suspicion for relevant allergens combined with the interpretation of patch tests are important in the diagnosis and treatment of patients with contact dermatitis 4.
- Alternative oral treatments, such as nicotinamide, have been investigated for the treatment of inflammatory skin disorders, with a potentially ideal long-term oral therapy profile due to its exceptional safety profile at pharmacologic doses 6.