NR supplementation blunts Th1 and Th17 immune responsiveness in healthy volunteers and in psoriasis...This study has expanded our understanding of NAD+ boosting in the adaptive immune system with the focus on NR blunting Th17 immune activity...The finding from this study that NR blunts Th1 and Th17 immune responsiveness in an ex vivo study supports that the utilization of NAD+ boosting could potentially be employed as a supplemental therapy in this disease. The concept is now being explored in vivo, where mild to moderate psoriasis patients are being investigated in a placebo-controlled study...

Increasing the level of NAD+ in psoriatic lesions could be considered as a therapeutic option. We have already shown that the topical composition of NAD+ can effectively be used for treatment of psoriasis, with effects comparable to conventional therapy with anthralin. More recent research has confirmed that the augmentation of NAD+ can result in amelioration of psoriasis-like dermatitis . This effect is linked to elevated Sirt1 activity, which is an NAD+-dependent process.

A rare mutation that disorganizes keratin filaments, and causes skin blistering and liver injury, can be treated with parthenolide, which has the effect of upregulating SIRT2. Giving mice NMN had a protective effect similar effect to parthenolide.

Oral nicotinamide (NAM) supplementation has been shown to decrease the incidence of keratinocyte carcinoma (KC) in high-risk skin cancer patients. NAM is a nicotinamide adenine dinucleotide (NAD+) intermediate and thus directly leads to increased NAD+. This increase in NAD+ is believed to be responsible for NAM’s impact on keratinocyte carcinoma risk. NAD+ has protective cellular effects and is a necessary cofactor for DNA repair, helping to prevent potentially oncogenic mutations. Nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN) are NAD+ intermediates like NAM...

Addressing aging at the cellular level is now critically important. Many surgical procedures rely on the healing and regenerative capacity of the skin which is known to decline with age, leading to disappointing results or negative postsurgery outcomes. Improving health and resilience at the cellular level with NAD+ restoration could be harnessed as a way to ensure consistent results and recovery irrespective of patient age. It should also be noted that the efficacy of many nonsurgical aesthetic procedures such as microneedling and laser technologies ultimately rely on the activation of cellular stress pathways to trigger the clearance of damaged cells and stimulate the production of new collagen. Many of these pathways require adequate NAD+ levels for optimal function, meaning NAD+ restoration before treatment could be a strategy to ensure the underlying cells are in an optimal condition to respond to the treatment.

The future of NAM as a photoprotective agent is promising, with this paper highlighting its positive safety profile and showing evidence supporting its utility in those patients at high risk for the development of non-melanoma skin cancer.

In this phase 3, double-blind, randomized, controlled trial, we randomly assigned, in a 1:1 ratio, 386 participants who had had at least two nonmelanoma skin cancers in the previous 5 years to receive 500 mg of nicotinamide twice daily or placebo for 12 months. Participants were evaluated by dermatologists at 3-month intervals for 18 months...Oral nicotinamide was safe and effective in reducing the rates of new nonmelanoma skin cancers and actinic keratoses in high-risk patients

A recent large study evaluating nicotinamide for the treatment of acne or rosacea has confirmed the potential benefits of oral nicotinamide as an alternative approach to managing inflammatory lesions associated with acne vulgaris and acne rosacea. This article reviews the substantial number of reports published over the past 50 years that document the clinical utility and safety of oral and topical formulations of nicotinamide for the treatment of a variety of inflammatory skin conditions.