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30 August, 2016

How to improve your chances of finding a cooperative doctor, and what to ask your doctor when you think you have rosacea.

by Rob
July 14, 2010

Dear Patients:
You have it very hard, much harder than most people understand.  Having sat for 16 years listening to the stories, seeing the tiredness in your eyes, hearing you try to describe the indescribable, I have come to understand that I too can’t understand what your lives are like.  How do you answer the question, “how do you feel?” when you’ve forgotten what “normal” feels like?  How do you deal with all of the people who think you are exaggerating your pain, your emotions, your fatigue?  How do you decide when to believe them or when to trust your own body?  How do you cope with living a life that won’t let you forget about your frailty, your limits, your mortality? I can’t imagine. But I do bring something to the table that you may not know.  I do have information that you can’t really understand because of your unique perspective, your battered world.  There is something that you need to understand that, while it won’t undo your pain, make your fatigue go away, or lift your emotions, it will help you.  It’s information without which you bring yourself more pain than you need suffer; it’s a truth that is a key to getting the help you need much easier than you have in the past. It may not seem important, but trust me, it is.

You scare doctors. No, I am not talking about the fear of disease, pain, or death.  I am not talking about doctors being afraid of the limits of their knowledge.  I am talking about your understanding of a fact that everyone else seems to miss, a fact that many doctors hide from: we are normal, fallible people who happen to doctor for a job.  We are not special.  In fact, many of us are very insecure, wanting to feel the affirmation of people who get better, hearing the praise of those we help.  We want to cure disease, to save lives, to be the helping hand, the right person in the right place at the right time. But chronic unsolvable disease stands square in our way.  You don’t get better, and it makes many of us frustrated, and it makes some of us mad at you.  We don’t want to face things we can’t fix because it shows our limits.  We want the miraculous, and you deny us that chance. And since this is the perspective you have when you see doctors, your view of them is quite different.  You see us getting frustrated.  You see us when we feel like giving up.  When we take care of you, we have to leave behind the illusion of control, of power over disease.  We get angry, feel insecure, and want to move on to a patient who we can fix, save, or impress.  You are the rock that proves how easily the ship can be sunk.  So your view of doctors is quite different.

Then there is the fact that you also possess something that is usually our domain: knowledge.  You know more about your disease than many of us do – most of us do.  Your MS, rheumatoid arthritis, end-stage kidney disease, Cushing’s disease, bipolar disorder, chronic pain disorder, brittle diabetes, or disabling psychiatric disorder – your defining pain -  is something most of us don’t regularly encounter.  It’s something most of us try to avoid.  So you possess deep understanding of something that many doctors don’t possess.  Even doctors who specialize in your disorder don’t share the kind of knowledge you can only get through living with a disease.  It’s like a parent’s knowledge of their child versus that of a pediatrician.  They may have breadth of knowledge, but you have depth of knowledge that no doctor can possess. So when you approach a doctor – especially one you’ve never met before – you come with a knowledge of your disease that they don’t have, and a knowledge of the doctor’s limitations that few other patients have.  You see why you scare doctors?  It’s not your fault that you do, but ignoring this fact will limit the help you can only get from them.  I know this because, just like you know your disease better than any doctor, I know what being a doctor feels like more than any patient could ever understand.  You encounter doctors intermittently (more than you wish, perhaps); I live as a doctor continuously.

So let me be so bold as to give you advice on dealing with doctors. There are some things you can do to make things easier, and others that can sabotage any hope of a good relationship:
  1. Don’t come on too strong – yes, you have to advocate for yourself, but remember that doctors are used to being in control.  All of the other patients come into the room with immediate respect, but your understanding has torn down the doctor-god illusion.  That’s a good thing in the long-run, but few doctors want to be greeted with that reality from the start.  Your goal with any doctor is to build a partnership of trust that goes both ways, and coming on too strong at the start can hurt your chances of ever having that.

  2. Show respect – I say this one carefully, because there are certainly some doctors who don’t treat patients with respect – especially ones like you with chronic disease.  These doctors should be avoided.  But most of us are not like that; we really want to help people and try to treat them well.  But we have worked very hard to earn our position; it was not bestowed by fiat or family tree.  Just as you want to be listened to, so do we.
  1. Keep your eggs in only a few baskets – find a good primary care doctor and a couple of specialists you trust.  Don’t expect a new doctor to figure things out quickly.  It takes me years of repeated visits to really understand many of my chronic disease patients.  The best care happens when a doctor understands the patient and the patient understands the doctor.  This can only happen over time.  Heck, I struggle even seeing the chronically sick patients for other doctors in my practice.  There is something very powerful in having understanding built over time.

  2. Use the ER only when absolutely needed – Emergency room physicians will always struggle with you.  Just expect that.  Their job is to decide if you need to be hospitalized, if you need emergency treatment, or if you can go home.  They might not fix your pain, and certainly won’t try to fully understand you.  That’s not their job.  They went into their specialty to fix problems quickly and move on, not manage chronic disease.  The same goes for any doctor you see for a short time: they will try to get done with you as quickly as possible.

  3. Don’t avoid doctors – one of the most frustrating things for me is when a complicated patient comes in after a long absence with a huge list of problems they want me to address.  I can’t work that way, and I don’t think many doctors can.  Each visit should address only a few problems at a time, otherwise things get confused and more mistakes are made.  It’s OK to keep a list of your own problems so things don’t get left out – I actually like getting those lists, as long as people don’t expect me to handle all of the problems.  It helps me to prioritize with them.

  4. Don’t put up with the jerks – unless you have no choice (in the ER, for example), you should keep looking until you find the right doctor(s) for you.  Some docs are not cut out for chronic disease, while some of us like the long-term relationship.  Don’t feel you have to put up with docs who don’t listen or minimize your problems.  At the minimum, you should be able to find a doctor who doesn’t totally suck.

  5. Forgive us – Sometimes I forget about important things in my patients’ lives.  Sometimes I don’t know you’ve had surgery or that your sister comes to see me as well.  Sometimes I avoid people because I don’t want to admit my limitations.  Be patient with me – I usually know when I’ve messed up, and if you know me well I don’t mind being reminded.  Well, maybe I mind it a little.
You know better than anyone that we docs are just people – with all the stupidity, inconsistency, and fallibility that goes with that – who happen to doctor for a living.  I hope this helps, and I really hope you get the help you need.  It does suck that you have your problem; I just hope this perhaps decreases that suckishness a little bit. Sincerely, Dr. Rob

Post Script: This post has generated a huge amount of conversation and interest (as witnessed by the large number of comments!). I very much appreciate the dialogue it has spawned both here and across the web. I’ve subsequently written follow-up posts explaining my thoughts in more detail – largely in response to the comments here.  One of them discusses in more detail my own experiences as a doctor and the second talks of the importance of  knowing and being known. Reading these will give you a better picture of my thought process and perspective on this.
Dr. Rob" 





How to get your GP or dermatologist to prescribe you rosacea-related anti-flushing medication? 

Start by reading this blog post I wrote about the types of anti-flushing medication that exist and may be helpful for your rosacea burning and flushing. How did I get my doctor to help me? I took a recommendation letter from the dermatologist I am seeing, prof. Chu, to my GP and discussed with her if I could try the anti-flushing medication that he had suggest to me (clonidine, propranolol and mirtazapine combo) for a month and then evaluate with her. She was weary about some of these meds, as some lower the blood pressure and are not specifically designed for rosacea. But we managed to discuss honestly and openly how difficult it can be to suppress this terrible flushing. How there is nothing out there officially for it; how mostly all rosacea treatment options are aimed at subtype 2 with p&p's and skin outbreaks, and nothing to help with the flushing. She understood that the burning and flushing interfered severely with my everyday life and general well being. And also that it is a progressive problem; the more you flush over time, the more you will weaken the blood vessels in your face and the more red and flushed you can become in the long run. So it needs to be treated! I then asked her to let me try it for a given time, we agreed on a month initially, to see for ourselves if these medication types did anything for my flushing at all. Then we would reevaluate and also check my blood pressure.

During that month I went from 24/7 flushing and cold packs dragging with me wherever I went, to about 60% improvement and when she saw me again when I returned, as agreed, it was immediately clear to her that I had to continue with this medication. I had by then visited her doctor's office four years with ever worsening flushing problems. She never knew what to do about it, but was now open to the suggestions of Professor Chu. I think it helped that he wrote a recommendation letter and prescriptions for these meds, including the recommended dose. Although I also realise that this can annoy some proud GP's out there perhaps. Over time, I have had tests to check my kidney and liver function and some other things. After 4 years they were all in excellent shape, so she felt fine with continuing to prescribe it to me (for almost 7 years by now). I am still dealing with rosacea, redness and flushing. Don't get me wrong. My skin gets ruddy as well and I still need to use a fan often. But there has been massive improvement. I could not stop flushing before seeing Prof. Chu and I was at my wits end after a full year of non-stop flushing and burning. I even thought of suicide to be frank. Because nobody seemed to have any way out for me and IPL made everything so much worse, and seemed my last hope squashed. But thank God I found relief after all. So back to how to approach your own doctor: I would print out some of the medical study links I posted here, or try to find some betters perhaps even yourself. I would also consider bringing some printed out testimonials from people on The Rosacea Forum for instance. Or show my website if needed (you can always use my personal contact data and I will be very happy to help out with a testimonial, written or by phone, or sending pictures). Negotiating about a trial period helped for me as well, as GP’s are careful not to put their patients at risk. So you will give them some sense of control then. They might say that these are serious drugs. But they are common drugs as well, that have been on the market for a long time and that have been safely prescribed since the 1960's in some cases. They are today widely used and their effect of ongoing inflammation and flushing is studied and documented. This is a progressive disease that has to be stopped in its track if you want to aim for remission, or at least for it to stop progressing. Even when you might not look that red to others, the burning and pain of subtype 1/ neurogenic rosacea is often not immediately visible. Explain this to your doctor. Make sure not to focus too much on how it looks, but on how it feels and how much pain it gives and how it derails normal everyday living. Flushing has a snowball effect and the only road to recovery, is to stop it in its tracks. 

SO you most likely increase your chances by bringing along some research papers to convince the doctor. If you scroll down in this post, you will find a list of research papers for each of the medication discussed. Pubmed articles are particularly handy to print out and to show, as medical specialists like to see in black and white that an off-label medication is actually effective for the symptom at hand. They are often worried to go off the beaten paths and away from the textbook treatment protocols. But it is important to explain that up until now, there is no official flushing treatment. Nothing. The only thing specifically designed to control flushing, Mirvaso gel, is a liability of a product for many users, that has made many people with rosacea flush worse or made their rosacea entirely and permanently worse even in some cases. Same for corticosteroid creams. Medication in pill form is much less risky and can actually really help control flushing. A doctor needs to compare our face flushing medically to hot flushes, for which there is in fact medication. Our rosacea flushing may not always be hormone driven, but our triggers nevertheless also widen the blood vessels of the face regularly. Causing pain, heat and worsening of the dilation of the weakened vascular network in the face. Just like with untreated varicose veins. We need to control the flushing in order to be able to control rosacea subtype 1 or neurogenic rosacea. I am always worried about invasive treatments like laser or IPL to be honest... If they stir up your rosacea and make it worse (which was the case for me), you are often stuck with the outcome! Whereas with medication, anything but steroids or accutane is normally a temporary thing. You try it and if you feel things are getting worse, you stop taking the medication again and no long term harm is done. So it surprises me always that dermatologists are more easily swayed to offer laser or IPL treatments than towards prescribing trialed and tested prescription medication. Good luck!





Update December 30th 2018

A fellow rosacea sufferer wrote me about his flushing, redness and burning issues. He has had laser treatments, but does not get sufficient results from them. He read this blog post and wants to try my anti flushing medication; clonidine, propranolol and perhaps also mirtazapine and an antihistamine like Xyzal. But primarily clonidine and propranolol. The problem is that he cannot find a dermatologist who is understanding of his flushing problem, and willing to let him try this meds. He asked my advice, and I think anyone in this same situation needs to offer his or her specialist or GP some research papers to convince them. Like I wrote above. He also asked about what medication to best use, or start with, to reduce facial flushing. My advise: "I would start with clonidine if I were you. No doubt about it. 0,05 mg seems a very low dose.. I take 0,150 mg every 8 hours, so 3 times a day. You could start with 0,1 mg, three times a day. This is still a reasonably low dose, but I don't think going much lower will be doing much for the flushing tbh. It is very important to take clonidine 2 to 3 times a day, I'd say 3 times, as after 8 hours it can give rebound redness and flushing. This medication needs to have a stable blood level, and if you want to stop, you slowly taper its use off. I would try this for one month, then re-evaluate. And add propranolol then. I find it the best beta-blocker personally out of them all for flushing and redness. But opinions differ on that one. Propranolol 40 mg pills can be taken as needed. You don't need to take them at specific intervals. No rebound issues. But I take 80 mg 2 times a day, together with the clonidine. When I have a bad flare, I take 80 mg 3 times a day. Again, I would try this med for a month and then re-evaluate again. I also use mirtazapine, but that one comes with more side-effects, so should ideally be left as a last resort med." - Hope this helps someone :)





I read a very good article from Brady Barrows on his RRDi website: 

Some notes from him: "I have said it before and I will continue to say it again, self-diagnosis of rosacea is not a good idea. Physicians, particularly dermatologists, are trained and educated in the art of diagnosis and should be the ones to determine a diagnosis of rosacea. There really are no substitutes. You may want to consult other health care professionals as well for rosacea, but diagnosis of rosacea is reserved for physicians . Please get a diagnosis. The problems with rosaceans and physicians have become public knowledge posted all over the internet and are listed here for your information and consideration to resolve these issues. It is important to work together with a physician in determining an accurate diagnosis and a personal treatment regimen for your skin problem. What matters need to be identified and resolved? Trusting a physician, communicating with a physician and following up with your physician’s treatment.

Trusting & Communicating with your Physician
A typical initial visit with a dermatologist begins with making an appointment usually weeks in advance, sometimes months. In the meantime, a rosacean (or one who thinks rosacea is the problem or hasn’t a clue what is going on with his/her skin) is reading as much information on rosacea on the internet or by reading this book or other books, asking everyone, trying whatever non prescription , over the counter, products and methods one thinks might work or is suggested by well meaning friends. This sufferer reads about rosacea and has determined that it must be rosacea or it may be possible that the sufferer has no idea what skin condition is the problem. Finally the day arrives to visit the dermatologist. One must wait in the waiting room for what seems like an eternity with other patients who obviously have their own skin issues. You are ushered into an exam room where a nurse or other assistant takes a brief history and may take some vital signs and records everything and your chief complaint. You wait some more. Finally, after what seems like another eternity, the physician enters the room and spends maybe 10 minutes with you, explains to you that you have rosacea, gives you some samples to try, hands you a prescription and tells you to make a follow-up appointment. The physician rushes off to the next exam room. You are left stunned. If this is the first time you have ever heard of rosacea, you are a bit more stunned than those who have read this book. You may no doubt relate to this initial first visit with a physician. Rosaceans who experience this are a bit upset at the lack of patience, empathy and compassion for rosacea patients. It is not to say that all physicians are like this, but this experience of an initial visit is typical. Complaints of the lack of physician empathy for rosacea is common among the various rosacea support groups and forums. There may be several reasons why this happens, but first and foremost is to understand the physician’s point of view. Rosaceans tend to be self-centered, and that is understandable, since after all, we are the ones suffering with rosacea. Rosacea is a very confusing and debilitating disease. It changes your life forever.

Rosaceans come to a physician for comfort, help and treatment and want some compassion, understanding and communication. But wait a minute. Think about it. Remember, we are coming to a physician for help. We need to make it possible for the physician to listen to us, but at the same time we need to keep our minds open to what the physician may tell us. Knowing the physician’s point of view will help you establish better communication, trust and hopefully better treatment. Follow up visits will be better and you will look forward to the visit rather than dreading it. Becoming a physician is not an easy task. The medical schools make physicians go through some hoops and hurdles that many just simply would not even attempt. Generally speaking, physicians are very dedicated, hard workers and usually have higher IQs than the general public. It would be a mistake to think otherwise, since if this is not true, then we are certainly at a loss. I like to think that physicians who have attained to being a licensed medical doctor are more knowledgeable than me on rosacea. This entitles them to some respect, whether you agree with a physician or not. You can disagree with respect. The two initials behind their name, M.D., gives them the title doctor. It would be wise to recognize, honor and respect their office of appointment as a practitioner of medicine. Rosaceans who treat their docs with disrespect will not get very far with physician treatment. It is important for rosaceans to give their doctor the honor they deserve that goes with the title and this alone will improve communication better than all the other tips on how to win friends and influence doctors. With the advent of lawyers, physicians have to cover themselves with malpractice insurance that affects patient care since one of the chief concerns of a physician is whether or not it is possible to keep practicing medicine in such a litigious world. You may not think this is important to your care but this affects physician care of a patient. It would be good to understand that it isn’t easy to care for patients when a patient could turn on a physician and bite him. Physicians may be very careful when approaching a new patient who may be a rattlesnake. Because of the nature of rosacea and psychology (see Chapter 6, Psychology and Rosacea) rosaceans tend to be frustrated, upset, angry, confused, disappointed, depressed, and possibly aggressive. While the physician should be aware of the psychology factor in rosacea, a rosacean needs to understand what the point of view of the physician is on this subject. While one physician understands the psychological factors in rosacea, another physician may dismiss these factors as minimal, which explains the physician’s behavior.

Physicians are usually very busy, with a huge patient load with other patients who are suffering horrible skin conditions, which, by the way may be worse than your rosacea [or whatever skin condition you may suffer]. A physician may prefer to refer a patient with psychological rosacea issues to an expert dealing with such problems, like a psychiatrist or a psychologist. Find out how his point of view is on this matter if you are feeling upset at a physician’s bed side manner. Besides, the physician has treated rosacea before and for the first visit, this is what is done. Now if you have been to other physicians before, this takes on a whole list of other reasons why it is so important to understand the physician’s point of view on the initial visit. Did you explain to the physician that you have been to another (or possibly other physicians ) for this problem? The physician has a right to know what you have done before coming to him, doesn’t he? The only way to understand what the physician’s point of view (POV) is to ask. For example, you might ask him, ‘Doc, are you really busy today to answer my questions?’ Or how about, ‘Doc, I see that you are in a rush and need to tend to other matters, but could you answer just a few of my questions or would it be better to make an appointment later to help me understand some matters that are important to me?’ If the physician has the time you might want to point out how you are feeling about your rosacea, i.e., the frustration, anger or depression that accompanies rosacea. You might be surprised at what the doctor’s point of view is if you respect his and take into account that a physician has a right to his own point of view. The physician may have more empathy with your point of view if you have empathy for the physician’s POV. When making an appointment with a physician for an initial visit and you want questions answered, it would be good to explain to the one whom you make the appointment with that answers to your questions are important and want sufficient time for the physician to answer your questions. This might go a long way to help the doctor understand your needs. If you present yourself as knowledgeable on the subject of rosacea this can present some problems. After all, the physician has gone to medical school specializing in dermatology and you begin spouting out some rosacea knowledge to the physician, what do you think the physician’s point of view is of you telling him about rosacea? Remember, you came to him for advice, treatment and help? Rosaceans should want to build a good relationship with the physician and presenting yourself as more knowledgeable about rosacea than the physician tends to destroy the relationship considering that you are paying him for his advice, diagnosis, analysis, prescription and treatment.

If you preface a comment about your knowledge of rosacea with, ‘You probably know more about this than I do, but could you answer my question about [whatever]?’ will go a lot further to establishing a good relationship with your physician than belittling a physician or coming across that you know more than the physician about rosacea, which may not be true at all. After all, consider what the physician must know to differentiate rosacea from other skin conditions. The list of rosacea mimics and other skin conditions and diseases that requires a differential diagnosis from rosacea taxes most physicians. To conclude that a physician doesn’t know as much as he should about rosacea is a bit judgmental, wouldn’t you agree? A physician’s job can be at times quite demanding and overwhelming. With the patient load and who knows what else is happening in a physician’s life, if we come across like know-it-alls about rosacea, do you really expect a physician to go along with such disrespect? Maybe a physician prefers to dismiss such a patient quickly and move on to one who appreciates his services more? “Dermatologists need to ask their patients about their use of all medications including herbs, vitamins and supplements, according to Dr. Wu. “I suggest taking an extra five or 10 minutes to find out what your patients are using on their skin in addition to what you’re prescribing for them.” Rosaceans should build bridges with their physicians, not tear them down. Usually when a rosacean. visits a physician it is because everything else simply doesn’t work. It is the last resort, sort of like when one visits the dentist. So, instead of concentrating on what you think the physician should do, try to listen to his suggestions. The physician may be right. During the initial visit you should explain to the physician what other treatments you may be doing for your rosacea, i.e., natural treatments, over the counter products, herbal remedies, vitamins , supplements, diet, whatever. It is very important to explain to your physician if you have visited any other physician for rosacea before visiting him. The physician has a right to know what you have done for your rosacea before seeing him. “Due to the fact that many patients fail to inform their physicians about their use of herbal ingredients, dermatologists should be aware of what patients may be using and be able to advise them about the efficacy of these ingredients or the potential for adverse effects.” This is especially true when you consider the synergistic effect of multiple treatments for rosacea. You physician deserves to know what you are currently doing to control your rosacea, even if it hasn’t been working. He may advise you to stop all other treatment and follow his treatment regimen or may explain that what you are doing is just fine and to continue it. But the physician needs to know.

Follow up Visits
Basically, whatever the physician suggests you do, usually a follow up visit is made. That is why the physician asks you to set up an appointment before you leave the office. This is done to follow up whether the treatment suggested is working. Why? Because not all treatments work for every rosacean. You have to be the judge whether to continue a treatment suggested if it is making your rosacea worse. There are some treatments for rosacea that initially make matters worse before it gets better. You should ask your physician whether or not the treatment he is suggesting will make it worse before it gets better so you will know what to expect. However, if it continues to get worse, you will have to be the judge as to when to stop the treatment and report back to the physician at the follow up visit what exactly happened. The follow up visit may include new treatment to follow. This is not unusual for a rosacean to receive several treatment regimens before finding one that controls your rosacea." - Thanks Brady, great info. 

Finding a Physician
Finding a physician who is knowledgeable with rosacea and has a record of happy rosacea patients is the dream of all rosaceans who use physicians to treat their rosacea. Many of the forums and rosacea support groups offer suggestions or recommendations of physicians they have used and some report whom not to use. Word of mouth has always been the best source of whether a physician is recommended. Please also ask around on facebook rosacea health groups and on forums. There are some very good specialists out there. My own is a professor in dermatology and specialized in acne and rosacea. His name is Prof. Tony Chu and he works in Hammersmith Hospital in London and sees both NHS patients and private (international) patients. 










Posted by at 3 comments:

12 August, 2016

Niacinamide as a rosacea treatment




Niacinamide as a rosacea treatment

Some time ago, two friends with active rosacea wrote me about niacinamide, and about how taking it in tablet form seemed to curb some of their rosacea symptoms. One wrote me: 

"The Basis product has really kicked in. Last few weeks I have had far less flushing. More stable skin. There is nothing else I'm taking to attribute this to. I will mail u a bottle of these pills of NR. Nicomide Riboside. The product is Basis by Elyssium." The other wrote: "I just saw a post that you are going to try oral niacinamide. I do hope it helps you. It continues to hold my face together, and in my case, along with topical niacinamide gel and oral vitamin C. I have been taking this for about 5 weeks and it has SIGNIFICANTLY, calmed my face. PLUS, seeing my newly returned volcanic flushing has virtually disappeared, I  wonder if it has been helpful for any hormonally induced flushing too."


So what is niacinamide?

Niacinamide, also known as nicotinamide (nicotinic acid is very different from the nicotine that's used in tobacco, and plays an important part in our health), is the water-soluble, active form of vitamin B3. It is not the same as vitamin B3's other principle form, niacin (but an amide of it; niacin on the other hand can actually induce flushing for some). It has been tried and used in the field of dermatology so far, but it is still studied in that respect. Small amounts of nicotinamide are naturally present in foods like yeast, lean meats, fish, nuts and legumes. It is also often added to cereals and other foods. Oral nicotinamide is available as 20-30 mg in many variations of multivitamine pills or on its own as inexpensive 500-mg tablets. It has also been incorportated in many topical agents including sunscreens and cosmetic agents.


 You can use niacinamide both topically, in a cream, or orally for your skin. It has been reported to:

*Have anti-inflammatory properties
*Effectively treat acne by its anti-inflammatory action and reducing sebum.
*Improve skin barrier function by decreasing the amount of water that gets lost through the epidermis (the outer skin layer). The result is increased skin hydration.
*Improve the complexion, by improving the pigmentation, blotchiness and redness of ageing skin; it is used in a number of cosmetical products.
*Reduce actinic keratoses and possibly reduce the risk of skin cancer.


How does niacinamide work?

Niacinamide acts as:
*a creator of cellular energy
*a modulator of inflammatory cytokines
*an inhibitor of the nuclear enzyme poly(adenosine diphosphate-ribose [ADP]) polymerase [PARP], which plays a significant role in DNA repair, maintenance of genomic stability, and cellular response to injury including inflammation and apoptosis (cell death). - Niacinamide and tetracycline together have been shown to treat a condition called bullous pemphigoid. They can work so well together, that they're mentioned as a useful alternative to systemic steroids in the treatment of bullous pemphigoid, and also of dermatitis herpetiformis. It is less toxic and safer than dapsone and/or prednisone.


 Niacinamide has also been shown to be effective in clearing acne. It is available in topical cream, gel and oral forms (e.g. trade name Nicomide). In a controlled clinical trial, 4% nicotinamide gel was found to be as effective as the topical antibiotic 1% clindamycin gel in the treatment of acne vulgaris in 76 patients with moderate acne. The study concluded that the anti-inflammatory properties of nicotinamide may have played a part in this success. The main downside of antibiotics is that it can cause resistant microorganisms. If further research confirms that niacinamide is at least as effective as topical antibiotics, it may become a more mainstream treatment option for not only acne sufferers but also rosacea patients, as unlike antibiotics, it does not gives rise to microbial resistance.


 Niacinamide also reduces facial sebum production. Sebum protects dry skin, but when you have oily skin, it can cause a shining skin and clogging of the pores, resulting in comedones (skin colored small bumps, sometimes with blackheads or whiteheads) and inflammatory acne lesions. Results of a well-controlled clinical trial in Caucasian and Japanese women have shown that application of 2% niacinamide moisturizer to the face for 4-6 weeks reduces sebum production with significant differences in facial shine and oiliness.


Niacinamide for rosacea
In at least two studies, moisturizers with added niacinamide have been shown to improve skin barrier function in rosacea patients, making the skin less prone to reactions to irritants including cleansers and cosmetics. In another small scale study, treatment with 1-methylnicotinamide (metabolite of niacinamide with known anti-inflammatory effects) resulted in improvement in 26 out of the 34 treated patients. Niacinamide strengthens the barrier function of the skin, by stimulating the production of keratine -a protein- and ceramides -the fat molecules which help to keep the skin well functioning and firm-. As a result, the epidermis will be better at remaining hydrated, and be less prone to dryness and redness. See this  article for more on this. In this well documented research, Draelos and colleagues researched in 2005 what the effects are of a mix of 2% niacinamide in Olay Total Effects 7 visible Anti-Aging Vitamin Complex Fragrance Free cream on rosacea skin. They took a group of 50 women, of which a dermatologist confirmed that they had advanced subtype 1 or 2 rosacea, characterized by persistent redness (erythema), broke blood vessels (telangiectases), and inflammatory lesions. 79,2% of these rosacea patients saw an improvement in their skin after 2 weeks, and reported less dryness and redness of the skin. After 4 weeks 95,7% of the patients reported improvement of their symptoms. Only the broken blood vessels remained the same and didn't improve (note: for broken blood vessels, only lasers or sometimes IPL can help). Dr. Torok, a clinical professor of dermatology at Northeastern Ohio Universities Colleges of Medicine and Pharmacy, states that niacinamide can be an effective treatment for the inflammation related to rosacea. "It has been shown to increase biosynthesis of ceramides and other stratum corneum lipids to improve the epidermal permeability barrier, and niacinamide has also demonstrated in studies a broad array of improvements in the appearance of aging facial skin." She used a topical niacinamide formulation, CeraVe Facial Moisturizing Lotion PM (Coria). It is formulated with niacinamide, ceramides and physiologic lipids. "I have incorporated CeraVe PM for the last two months for most of my acne and rosacea patients as an add-on treatment with other topical and oral prescription products," Dr. Torok says. This product reduces the irritation and inflammation of topical retinoids and benzoyl peroxide products, according to her. "The advantage of this therapy is that patients readily will use it, as it is not an antibiotic, nor a prescription that will give them side effects. They are very receptive to this 'natural' treatment," she says.  -  The cause of rosacea is still unknown, but research indicates that some cases of rosacea might be worsened by factors that trigger an auto immune response in the body, and the release of cathelicidin antimicrobial peptides.




The researchers also made a comment about how rosacea patients often have dry and hyper reactive skin, with a top layer of the epidermis that isn't functioning as it should: 
The facial skin of patients with rosacea is often hyperirritable compared with that of healthy patients. A variety of exogenous insults can trigger a flare-up of symptoms such as erythema, stinging, or burning. Skin care products are commonly identified as offending agents. Additionally, patients with rosacea often experience dry facial skin that can exacerbate subjective symptoms. Application of moisturizers or emollients helps to ameliorate this dryness. The susceptibility to hyperirritability, exogenous insults, and subjective symptoms that are associated with rosacea are reminiscent of the symptomatology reported for sensitive skin. A deficient stratum corneum barrier contributes to sensitive skin, and skin sensitivity and reactivity are reportedly decreased by treatments that improve stratum corneum barrier function. Although there is no reported link between rosacea and a deficient stratum corneum barrier, the similar response pattern elicited by certain personal care products in patients with rosacea and sensitive skin suggests that individuals with rosacea also may benefit from an improved facial stratum corneum barrier. This study was conducted to assess the effect of a niacinamide-containing facial moisturizing product that improves barrier function in healthy skin on the stratum corneum barrier function of subjects with rosacea and to determine whether they may derive a clinical benefit from using this moisturizer

In other words: people with rosacea often have very reactive and easily irritated skin. Outside triggers can set it off easily, making it red, stinging and burning. Often rosacea skin is also dry, making symptoms worse, because dry skin (with not great barrier function) in itself -even without rosacea- is prone to these symptoms. It is suggested that it could help rosacea skin, if this barrier function is repaired, for instance by good moisturizers, but also with the use of niacinamide, which repairs skin barrier function as well (as described above).

Niacinamide also has anti-ageing properties. Nicotinamide has part in the creation of nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), which are co-enzymes that play a key role in the metabolism of glucose, cellular energy production, and synthesis of lipids. The levels of NADH / NADPH (the reduced forms of NAD and NADP) decrease with age, and topical nicotinamide appears to reverse this decline. In multiple clinical studies, topical nicotinamide improved fine lines and wrinkles, hyperpigmented spots, red blotchiness, and skin sallowness (yellowing) as well as elasticity. One study showed nicotinamide to increase the skin's production of ceramides, which are natural emollients and skin protectants, and improving skin hydration.


 Anticancer effects of nicotinamide. Ultraviolet radiation (UVR) can lead to cancer, as it directly damages skin DNA and effects on the immune system. Nicotinamide has been shown to improve the repair of direct and oxidative DNA damage in human skin. It can also prevent UV-induced immune suppression. In a randomised controlled clinical trial in 50 patients, 1% nicotinamide gel applied twice daily to the head, forearms and hands for 6 months reduced the mean number of precancerous actinic keratoses by 28%. Another study has shown that oral nicotinamide also reduces the numbers of actinic keratoses compared to placebo. A reduction in skin cancers has also been observed in high-risk sun-damaged patients treated with nicotinamide. Nicotinamide does not work as a sunscreen (and does not prevent sunburn). It does not have antioxidant properties, but it may affect cell energy metabolism and cell death.


Adverse effects of oral nicotinamide 
Oral nicotinamide is generally well tolerated in doses under 3 g/day. It does not cause flushing or gastrointestinal upset, unlike nicotinic acid (niacine, B3 vitamin). It has been reported to increase sweating and raise blood sugar. Very high doses of nicotinamide may lead to nausea.

Niacinamide gel is marketed as an over-the-counter treatment for acne in Canada, Australia, NZ, UK, USA and Ireland. You can also purchase niacinamide powder and add it to a moisturizer of your own choice (it's a stable, soluble and safe product to use). The efficiency of niacinamide has been shown at a concentration of 2 - 5%. Sometimes the concentration in cosmetic products is only 0,5% or more. It's best to keep an eye on this. If using the cream two times a day is making your skin too dry, you can reduce it to once daily, or every other day. Nicotinamide is well tolerated and often can be used by those who cannot tolerate topical retinoids or fruit acids. Nicotinamide is not recommended for acne in pregnant and nursing women. As a side note it could be mentioned, that niacinamide has so far limited and small scale research behind it, and that some of them are sponsored by cosmetical companies. There are also niacinamide serums available, all with different inactive ingredients, so best check their full ingredient list to see if your skin will tolerate the serum likely or not. Some examples;


NiaSerum 12% Topical Niacinamide Serum 
Ingredients:
12% Niacinamide USP, water, glycerol BP (glycerin)
This product has the highest concentration of niacinamide of all the serums mentioned below, and also by far the least ingredients. My favourite!




Advanced Skin Care Niacinamide & Bearberry Face Serum, Cream, 5% Vitamin B3 Cream 
Ingredients:
Ingredients: Niacinamide Vitamin b3,Wrinkle blur, Hyaluronic Acid,Bearberry Extract,Emu oil,Sea kelp, sepiplus 400,Leucidal Liquid.




Gia Naturals B3 Serum Niacinamide 5%.
Ingredients:
Organic Aloe Leaf Juice, Glycerin, Vitamin B3, Emulsifying Wax, Avocado Fruit Oil, Hyaluronic Acid, Vitamin E, Sunflower Seed Oil, Organic Neem Seed Oil, Organic Rosemary Leaf Extract, Organic Sunflower Seed Oil, Xanthan Gum, Phenoxyethanol, Tetrasodium Glutamate Diacetate. - The makers of this product claim that it is sulfate, paraben, and EDTA free. Cruelty free. Natural, pure and organic ingredients.  Be aware that this product contains Hyaluronic Acid, which can be irritating to very hypersensitive, intolerant skin types.

Miracle Renew B3 Serum with 5% Niacinamide 
Ingredients:
5% Niacinamide (Vitamin B3), Neem (Melia Azadirachta) Seed Oil, carthamus tinctorius (safflower) seed oil, oenothera biennis (evening primrose*) oil, prunus armeniaca (apricot kernel) oil, argania spinosa (argan*) nut oil, orbignya oleifera (babassu) oil, prunus dulcis (sweet almond*) oil, simmondsia chinensis (jojoba* ) oil, karanja oil, jasminum (jasmine) oil, rosa canina (rose hip seed*) extract, arnica Montana (arnica) extract, calendula officinalis (calendula) extract, centella asiatica (gotu kola) extract, glycyrrhiza glabra (licorice root) extract, symphytum officinale (comfrey root) extract, lonicera caprifolium (honeysuckle) flower extract*Organic. - This serum contains a couple of natural oils, which is not tolerated by everyone's rosacea skin. The makers claim that this product is 100% Natural, GMO-free, NO-Parabens.

Eva Naturals Niacinamide Vitamin B3 5% Serum
Ingredients:
Aloe Barbadensis (Organic Aloe) Leaf Juice, Glycerin, Niacinamide (Vitamin B3), Emulsifying Wax NF, Persea Gratissima (Avocado) Oil, Phenoxyethanol, Tocopherol (Vitamin E), Azadirachta Indica (Organic Neem) Seed Oil, Rosmarinus Officinalis (Rosemary) Leaf Extract, Sodium Hyaluronate (Hyaluronic acid), Xanthan Gum, Tetrasodium EDTA, (May contain sodium bicarbonate and/or citric acid as pH adjusters). -  Be aware that this product contains Hyaluronic Acid, which can be irritating to very hypersensitive, intolerant skin types. This serum contains a couple of natural oils, which is not tolerated by everyone's rosacea skin. The makers of this product claim that their niacinamide serum provides powerful strength to the skin's protective barrier, defending it from external factors that can cause breakouts, irritation and aging concerns. Be aware that this product contains Hyaluronic Acid, which can be irritating to very hypersensitive, intolerant skin types.

Insta natural Niacinamide Serum 
Ingredients:
Aloe Barbadensis Leaf Juice, Niacinamide, Glycerin*, Olea Europaea (Olive) Fruit Oil, Ceteareth-6 Olivate*, Potassium Cetyl Phosphate, Sodium Hydroxypropyl Starch Phosphate*, Magnesium Aluminum Silicate*, Dicaprylyl Ether*, Persea Gratissima (Avocado) Oil, Hesperidin, Rosmarinus Officinalis (Rosemary) Leaf Extract, Centella Asiatica Extract, Hibiscus Rosa-Sinensis Flower Extract, Limnanthes Alba Seed Oil, Sodium Hyaluronate, Melia Azadirachta Seed Oil, Lavandula Angustifolia Oil, Tocopherol* (Vitamin E), Xanthan Gum*, Pentylene Glycol*, Caprylyl Glycol, Ethylhexylglycerin.

Skinlex 10% Niacinamide Serum
Ingredients: Water, Niacinamide (B3), N-Acetyl Glucosamine, Panthenol (B5), Salix Nigra (Willow) Bark Extract, Butylene Glycol, Glycyrrhiza Glabra (Licorice) Root Extract, Sodium Hyaluronate, Glycerin, Allantoin, Xanthan Gum, Ethylhexylglycerin, Phenoxyethanol



Elixir Triple Action NIACTIL 4%
Ingredients: Aqua, Butylene Glycol, Diethylexyl Carbonate, Niacinamide, Glycerin, Squalane, Ammonium Acryloyldmethylaurate/VP Copolymer, Salicylic Acid, Sodium Gluconate, Phenoxyethanol.

If you want to take niacinamide orally instead, 250mg three times daily is a good start for rosacea treatment.






One of the friends wrote me in more detail about her use of niacinamide, and was OK me with using this info here


"I take the following niacinamide. I  purchase it from this site, iherb. I purchase most of my supplements from there as it is cheap. It is best to start out with a lower dose than the capsule. I split mine and  took 125mg then waited to see if I had adverse reactions. I developed a headache and a pressure feeling in my face. It wasn't overly pleasant, but I did not flush badly. In fact, I didn't seem to flush at all. Niacinamide is a phosphodiesterase inhibitor, which means, it tends to keep blood vessels open, but it does not dilate them abnormally. At first I feared this meant it would cause flushing, but apparently, it doesn't. After a few days, the headache wore off and I increased my dose to 125mg, twice daily. By that time I was receiving benefits, but no side effects, barring upset gut. There could be several reasons for this, and one of them is it inhibits fungal growth. This has been shown in studies. You may recall, a poster on the forum raved about a topical gel which pushed his seb derm into remission. That is partly due to the fact niacinamide inhibits the release of fatty acids, which fuel fungal growth. Niacinamide is anti-inflammatory too. After a few days, increased my dose again to 4 times daily. Then I changed and took a full capsule, three times daily. I space them out at 7 hours. Now that is just what I do. Other people find ONE capsule twice daily is sufficient and of course, the more someone takes the  more risks of  negative side effects. Niacinamide has very low toxicity risks, unlike niacin, BUT anything in therapeutic doses can act like a double edged sword. There is a longevity forum where many people are taking Elysium Basis, and they are reporting all sorts of health benefits, including improvement of rosacea. That poster, Bryan has since joined our forum. Elysium Basis contains a slightly different form of niacinamide plus Pterostilbene, which among other things, has antimicrobial effects, although no one on the forum seems interested in that fact. A poster on our forum has pushed his type two rosacea into remission, and some of his other health issues are receding. There is debate in the science world as to how niacinamide affects a certain gene called Sirtuins. Some people think niacinamide adds to aging and resveratrol slows it, but another body of scientists think it is the opposite and it is niacinamide which slows aging. I do think the Elysium Basis product has benefits, as it addresses gut flora too, but I have a feeling that would be short term. It would get rid of a lot of bugs, but I have to wonder longer term what might happen if good guys weren't replaced? Still if it were available for international shipping I would probably try it. The downside is, it is very expensive. If I were you, I'd opt for the plain niacinamide to see how you react, and go from there. If it didn't help you could try one of the other forms, but if it is going to help you, I think in the right dose you would see some indication. And remember, you have a severe case of flushing and LOTS of abnormal vasculature and LOTS of inflammation. You are not going to see immediate results. PLUS it is just a tool and you still need to  assist your body in other ways. Oh, I forgot, niacinamide, MIGHT, transiently increase superficial redness, for about 20 minutes, after which the face calms down and goes paler, as it does increase circulation, but it does not cause flushing through release of nitric oxide (a bad thing). I find my topical gel  does this as well and more markedly, but pretty quickly my face calms down and over time, the  reddening effect has lessened A LOT. I guess you can only try the NR, and see what happens. It might suit you and that would be wonderful. If not, you can always try plain niacinamide which has other benefits that NR doesn't. Oh and also keep in mind that oral niacinamide in very large doses alters neurotransmitters and seeing you are already taking antidepressants, you'd be better off starting at a low dose. You might experience digestive upset initially. I had to start at 100mg, or less and work my way up to 250mg, which I take three times per day, spaced at around 7 hours apart. Same for the topical gel. By the way, niacinamide is also antimicrobial, in particular for yeast. This is one reason it his helpful topically for seb derm patients.
Some scientists which friend has talked to, take a particular interest in inflam-mation and hormones and some are big fans of niacinamide.
"Basically, it has helps stressed cells function better. Our faces are VERY stressed. You have noted in the past that when you gobble lots of carbs your face calms and this confuses you, given the fact it is pretty well known, a lowish carb diet if favorable to rosacea. The problem is when you gobble carbs, PARTICULARLY STARCH, you suffer the consequences, hours, or days later, as starch feeds abnormal bowel flora. Carbs do help relieve cellular stress, but so does Niacinamide and it is also anti inflammatory and a bunch of other things. There is  a downside, at high doses, in theory it MIGHT prevent the body from fighting an infection, but on the other hand, in very high doses, it has been shown to fight infection and viruses. So, the jury is still out on that. Meanwhile there are numerous studies and  reports by physicians/patients, that moderate dosing improves mitochondrial stress and I believe that is how it is helping me. It also helps wound repair and  improves skin barrier function. My face looks much better and calmer now, barring the damaged areas with visible capillaries. I have been able to apply my niacinamide gel in full strength 4%, and I have seen further improvements. It isn't perfect and I start to worsen if I miss a dose of oral niacinamide, but compared to how I was previously, so far I am pleased and intend to continue. I have been running my latest experiment for about 5 weeks now and so far, I am very impressed. I feel almost certain it will help you too. Honestly, I really feel this will benefit you and the results should present quickly."



Reviews from people on The Rosacea Forum for topical niacinamide cream

Snuffleupagus wrote on May 7th 2008; "Anyone try niacinamide topically? It's supposed to be anti-inflammatory and good for redness. My derm prescribed me a cream of 4% metro. and 2% niacinamide mixed together. I hope it works!!! Antibiotics are not doing the trick yet. I get small pustules everywhere. I also tested a few spots of my face with 10% mandelic acid. No bad reaction (although I've read it could cause major dryness - I'lll limit use to a thin layer and not 2x a day). I'll have to wait and see if it does something."

Big Red replied on May 11th 2008: "I tried it, I didn't have great results. It was better than doing nothing, but what I am using now is working better for me."

J-Mill replied on May 13th 2008: "Niacinamide has tested well as an anti-inflammatory for skin with good ability to correct barrier disruption. Are you sure it isn't 2% metro + 4% niacinamide you were given?"

Snuffleupagus replied; "Yep that's it! My bad, I reversed the numbers. So far, no huge change on it. It's been about a week. P and p's still keep raging on."

Owenblinky wrote on December 27th 2015: "niacinamide is the most effective in topical form for treating the skin, according to my research. Unfortunately there very little products that contain 5% or more (the amount needed to see results), and the ones that do have it contain other ingredients which I don't know if I want on my skin. I would like to make my own niacinamide ointment but I am scared because if niacinamide isn't kept at a neutral PH it will badly burn your skin. I was terrible in chemistry lab in highschool, no way I trust myself not to screw it up"

TinyDancer replied on December 27th 2015: "I am using 4% prescribed by my naturopath. It's in versa base lotion. I tried the gel. But, the lotion was better. They also have a clarifying lotion. The ingredients are mostly ok. But, they do use propylene glycol. I saw serums at 5% with glycerin and hyaluronic acid on amazon."

Tom Busby replied on December 27th 2015: "Niacinamide is water soluble. Therefore niacinamide powder can be easily added to any typical commercial lotion. The base lotion must be pH 5 to 7, which again, is nearly every commercial cosmetic lotion or shower gel. For finer aesthetics, I prefer to add it at 150F so it's less waxy feeling. Proportions from 2% to 5% are equally effective in my opinion. All research is done at 5% for reasons that are never explained. Buy niacinamide powder from lotioncrafters or many other sources -- it's very inexpensive."

Sans0002 wrote on April 18th 2012: "Hey Everyone, I post from time to time on here mostly because I try to stay away from getting addicted to the site . But about a month ago I ordered this Niacinamide Cream. The ingredients are the following: Niacinamide (4%), Purified water, Glycerol (Vegetable glycerine), Cetostearyl alcohol, Caprylic triglycerides (derived from Coconut Oil), Coconut oil, Cetomacrogol, Phenoxyethanol, Hydroxy benzoates, Grapefruit seed extract (natural preservative). My skin has been sort of 'addicted' to La Roche Posay Toleriane for probably 5-6 years where anytime I'd ever try to switch moisturizer 'd either breakout, skin would be really red or really dry and always have to go back. I've finally broke the cycle after 1 month. The most surprising thing is that it didn't break me out and is helping some of what I think are just acne breakouts. Nothing for blackheads good or bad but still. Also honestly it's the only moisturizer that I've tried in years that I now put on during the day since it doesn't turn my skin red and actually calms it and makes it more pale. I'm going to continue to use it now and will report any changes if anything takes a turn for the worst. What I currently use is Spectro gel to cleanse and then this day and night followed by a 0.5% salicylic acid cream on my nose for black heads every three days."

Laska wrote on October 28th 2013: "Hi gang, been a long time since I was on here but I've had crazy crazy success eliminating my rosacea. I suffered subtype 2 rosacea with bad flushing along with seb derm. Rosacea is such a cruel skin disease, as you all know it strips away your personality and becomes an obsession. I'm in Australia and found a place that make niacinamide 4% cream. It has eliminated all of my seb derm and rosacea, it tightens pores and supposedly is a powerful anti aging cream as well. I've had the cream for a week and after 3 days my partner demanded to let her use it too lol. I'll try and post a pic tomorrow. I still have some broken blood vessels on my nose but I can live with that. It tingles slightly when you first put it on but is a very thin cream and soaks in and dries very quickly. If you do some research you'll see it has some amazing benefits like evening out skintone and pigmentation. I've read about some other ppl trying it on here but don't know how well it worked for them as we're all different. I read its more effective than antibiotics and being natural the bacteria can't build resistance to it. It's only been a week so hopefully it continues to keep the beast at bay. It forms a barrier on the face so triggers are less effective. Oh did i mention its cheap. Btw I didn't suffer from the permanent redness just the ugly raised patches that crack lol. laska"

Starlite replied: "This is interesting. I've been taking 1,000 mg of niacinamide daily for over a year for depression and a side benefit I had not expected was a reversing of my gray hair. I didn't notice it but my family mentioned how it was changing back to my old color. Just thought I'd throw that in there."

Laska updated on October 31st 2013:  "hi gang, well its been 10 days since I've used niacinamide cream for rosacea/seb derm and I've yet to have a breakout of any sort. The weather in Perth is starting to warm up and its great to wake up with a fresh and non oily face. I don't suffer the redness , it clear up the spots real quick though. I suffer flushing when under pressure but haven't since using this cream, it must create a barrier of some sort. I have no scientific proof but since using it I feel as though I'm flushing but I don't get the redness, I cant explain it."

Johnabetts replied: "Niacinamide powder for cosmetic applications is obtainable in the small quantities in the UK from Aromantic In the US you can get it easily from here. It is not expensive."

Sammilynn replied: "I got tired of the gritty from the vit. B powder so yesterday I dissolved warm distilled water and let it strain through a coffee filter then put it in a small spray bottle. This worked great for me and seems to do something to the SD on my face/scalp/body. This is how I have been using the Xylitol/rose water topical for several months. I'm not mixing with creams because I have to be careful not to use oils that encourage and feed some types of yeasts. It has a tighting/drying effect on my skin with water only so others may want to try to mix it in with their creams/lotions but not me. I noticed some sores/lesions I have and sprayed last night are healing faster than the usual. I have had an extensive vit/mineral deficiency test and it's for sure I'm low on all the B's anyway so I'm sure that it helps healing too. Just the last few days I have read ton's of positive info or science studies showing the positive effect of vit. B3 as a topical for many things. Google niacinamide or Niacin vit B3 topical for skin and you can read the good reports. Also, I have on hand several lbrands/ bottles of different types niacinamide/ Niacin/ B3. For my spray I just used some from every bottle. They all worked on my skin similar when I tried them out over the last few weeks, but did figure out yesterday for some reason that the Now brand non-flushing Niacin (powder/clear capsules) worked the best. All of these where inexpensive and can be picked up at the local drug store. Hope this helps someone."

Mystica replied: "Here is a study using the topical application of NADH for treatment of two cases. One, rosacea and the other, dermatitis. The results are very encouraging. NADH is the reduced form of nicotinamide adenine dinucleotide." http://www.nadh-apotheke.eu/NADH-Studien/Topical%20application%20of%20NADH%20for%20the%20treatment%20of%20rosacea.pdf

And updated on August 1 2015: "I decided to try this gel again back in February 2015. Reason being, since the ZZ cream formula/base was changed it has never suited my skin, nor worked as well. Due to my previous reaction to the niacinamide gel, I decided to take it slowly and mix it with the ZZ 'cream'. This worked quite well, but I was still stuck in the cycle of drying the skin, followed by exfoliation, followed by increased sensitivity until my skin had dried out again. This drying process was paramount in bringing down my completely inflamed face with constant and easy flushing to a far more controlled state. When the surface is dry it acts like a brace (in me) and at least dampens superficial flushing allowing the pathways responsible for flushing to downregulate. But I had reached the point where no further benefits were to be seen, so I wanted to try something different. I began to use the niacinamide gel full strength on my skin and whilst I did have a similar reaction to my previous test, it wasn't quite so bad and once it had faded over 20 minutes or so, my face actually looked calmer. I was encourage to continue. Over the next week these initial reactions became less marked and only lasted about 10 minutes. It is here that this experiment as a sole trial of one new tool became ruined, because I also added in oral niacinamide. The two together work very well for me. Sometimes it is necessary to utilize more than one tool to control a situation. The 'one tool at a time' approach to test for reactions does have limitations when it comes to health. The body is complex and nutrients work in tandem with each other. Such as vitamin D needs to be accompanied by vitamin A and K2, and so on. (As an example). For me, I feel the gel base is just as important as the niacinamide. I could never tolerate creams. The gel provides a dewy barrier. It goes on dewy, dries, then feels a bit tight, but after 20 minutes or so, it relaxes and has a dewy, pliable feel. I like it. It suits me. My skin barrier is much improved now. I am not cured by any means and I can still flush badly if I don't control my regime/environment, but compared to previous times, these severe episodes are less and on a day to day basis my disease/condition is far more controlled. Of course it has to be taken into consideration that I also follow the GAPS diet, and take several other supplements. I should also mention, I was diagnosed with Hashimoto's disease in May and given the fact Birdie also seems to benefit from niacinamide more than most here, it could be that oral niacinamide is particulalry helpful in this condition."

And: "I decided to test patch a couple of areas with the same gel that Laska has, but WITHOUT the Lipoic acid. The best and controlled areas of my face were not adversely affected. But the areas which are highly vascularized became extremely angry looking soon after applying the gel. I think one reason is, the gel is drying and while it slides nicely on to the skin, as it rapidly dries, it leaves the skin tight and uncomfortable. This contributed to a very angry look. Every visible capillary became even more prominent. However the test areas on my forehead and chin didn't react one way or the other. I could be reacting to the base, rather than the niacinamide. Or perhaps it is a bit of both with 4% being too high a dose? The gel base is not suitable for me, however and usually my skin does well in a drier state. After an hour, my face calmed down and at one point I didn't think it looked too bad, but over the 5 days or so, it has definitely become irritated. My feeling is, those with very sensitive rosacea skins probably won't do well with this gel. I can see those with seb derm benefiting. I can see those with very oily skins possibly benefiting. I did a google for other products containing a 4% niacinamide gel, and found two for sale in the UK. Freedom Gel and Nicam. Reviews by acne patients were mixed, but there is definitely a large number of people with sensitive skin who simply can't use this stuff. But as I said, it could be the gel. Niacinimide does seem to increase cellular turnover and together, it could just be too much."

Lucaasalberto wrote on March 7th 2014: "I've been using niacinamide for a couple of years now between OTC products, compounded and DIY. For the last year I used at least 5% niacinamide and unfortunately saw only mild improvement in redness, texture and skin barrier/sensitivity. So I decided to try NIA24 mineral sunscreen, that has a different derivative of vitamin b3 (myristyl nicotinate, as opposed to niacinamide). I'm using myristyl nicotinate at night as well, and this seems to be working better for me than niacinamide. Niacinamide seems like a great option for those with rosacea, considering its non-irritating profile, as well as its ability to improve skin barrier and modulate inflammatory cytokines. It's worth a try, and an increasing dose as well as skin type appropriate base will enhance outcome. I don't know a lot of products that state the amount of niacinamide, but you can estimate that Olay products like Total Effects 7-In-1 Anti-aging Moisturizer and Pro-X Deep Wrinkle Treatment have around 4% niacinamide and something like Olay Regenerist Regenerating Serum has around 2-3%. Hope others give it a try!"

Tom Busby wrote on April 7th 2014:  "Here's a good site. This blog points out that there's no known downside to using more than 2% but most people use 2% and get results. For me, Niacinamide is a one of three topical additives that I consider were a "breakthrough" for me, in terms of healing-power. (The other two "breakthroughs" were MCT oil and climbazole.) I have seb derm induced by malassezia."

AnastasiaBeaverhausen wrote on November 16th 2006: "My derm gave me a bottle of niacinamide and wants me to take 3 tablets/day for a total of 1500mg. He said it's safer than being on antibiotics for 3 months (like some derms prescribe). He said it should combat the inflammation and any rosacea pimples."



SkincareKev wrote on July 4th 2009: "Anyone get irritation from the niacinamide in Metrogel 1%? I can't tell if it is the active ingredient in Metrogel or the niacinamide. I have read conflicting information on niacinamide. Some says it soothes skin and others say it causes flushing. What are your experiences?"

Mutant Frog replied on July 4th 2009: "My personal experience is that it made my rosacea worse (big time, deep red flushing and irritation feeling) but made dermatitis better (under my lips, around my nose).
Go figure."

Snuffleupagus replied: "really? hmm i have a cream that has niacinamide in it and I don't really notice anything. I mean right now I haven't noticed any more bonuses from using it for over a year, but when i first started noticing it my derm noticed an improvement in my permanent redness."

Kaye wrote on November 13th 2012: "I use Nia24 products (with niacinamide, SN) with fabulous results- I don’t even have to use medication on my rosecea spots when I use it. However, the Nia24 moisturizer is very expensive. I’m looking for another moisturizer that works as well but costs less."

Johnabetts replied: "Nia 24 products contain myristyl nicotinate as the active vitamin B3 component. It may be this that gives their products their special properties and an improvement over niacinamide. According to beautypedia however there is not much advantage in the Nia 24 range over more conventional niacinamide formulations. One if the difficulties with topical niacinamide is the low bioavailability. Perhaps the myristyl nicotinate overcomes this to some extent. I know that P&G are researching to improve topical niacinamide biovailability and it is a subject of some work that I am doing myself."

Robbi768 replied: "Topically applied niacinamide has been shown to increase ceramide and free fatty acid levels in skin, prevent skin from losing water content, and stimulate microcirculation in the dermis. It also has a growing reputation for being able to treat an uneven skin tone and to mitigate acne and the red marks it leaves behind (known as post-inflammatory hyperpigmentation). I use the Citrus Clear Pore & Blackhead Mask because it has these excellent ingredients for wrinkles and breakouts. Apply the Citrus Clear mask, let dry in about 10 minutes, rinse and off you go. I do it once per week, and I see results right after the first use."



More reviews from people on The Rosacea Forum for niacinamide oral pills

hg24 wrote on February 21st 2016: "My derm recently put me on niacinamide 500 mg 2x day. I don't have p+ps. Used to a few yrs ago. That cleared then I became flusher (subtype 1 rosacea). The doc originally prescribed Nicomide - a prescription supplement with niacinamide, zinc, copper, folic acid. My insurance wouldn't cover it and it was $375 with a coupon. I notice that the cream NicAzel Forte is niacinamide (in the form of Azerizin - a blend of nicotinamide, azelaic acid, quercetin and curcumin). Plus zinc/copper, folic acid and pyridoxine. I'm also taking quercetin - my idea not my derm's. Been taking it for a couple months or more. I've read posts here on this forum, on the acne forum and elsewhere niacinamide where people have said niacinamide helped their breakouts (rosacea or acne related). Niacinamide topically has helped people, too. The doc has me taking niacinamide because of flushing on my chest, neck and ears - which I think she thinks is nerves/anxiety related. But when I flush on my face, I flush elsewhere, too. I feel a benefit from the niacinamide - but my flushing isn't gone. It has seemed to help my evening ear flushing. But I may try adding in the pyridoxine, zinc/copper and folic acid and see if that helps. Anyway, for those without access to Nicomide or NicAzel - you might try over the counter niacinamide 500 mg 2x day. Some people take 1500 for anxiety."

Woogie wrote on April 30th 2015: "I want to try the basis by Elysium despite the arguments that have gone on in threads but I was wondering if I could have more information on the Naicinamide and the other supplement another user was taking with it: what dosage do you take and what brand? could I please have links to figure out costs etc. I am in the UK so hopefully I can order them."

Johnabetts replied on April 30th 2015: "The important thing to note with the Basis product is that is is not marketed as a therapy for rosacea. The product is marketed as a food supplement (to overcome potential problems with the regulatory authorities. There is not mention of rosacea, or any other illness or ailment, in the marketing information on Basis."

Woogie wrote on April 30th 2015: "True but after a few others had success I have a glimmer of hope, I suppose that's the bad thing about being desperate to find anything that soothes it! I'm hopeful but after trying so much I'm also thinking it probably won't do anything, the niacinamide seems more likely to do something though with a few Rosacea people confirming they are having results. I'm looking for advice on both especially where's best to buy niacinamide and how, with anything? What dosage etc before I buy as I have no idea what it is!  Thanks for your reply!"

PaulB replied: "Greetings, The basis product's active ingredients are N/R 250mg per dose and pterostilbene 50mg per dose. There are other companies you can get these two supplements from as I don't think basis ships outside the US anyway and I think the other sources are less expensive. It seems it helps some people and does not help others so you might like it or you might find you are wasting your money. The N/R will possibly become cheaper in the future as more people use it. The fact basis is sold out shows me there is a real market. They make no claims about rosacea and it is not what this was intended for. I did not have rosacea in mind when I started taking it. I can't speak to niacamide at all from personal experience. Paul"

Brian_S replied on May 1st 2015: "I'd say if you are Responsive to Niacinamide for or your rosacea, then you might want to explore Nicotinamide Riboside as a more bioactive form. Niacinamide (Nam) is cheap, I buy the "Now Niacinamide 500 Mg" capsules at about $6 dollars a bottle thru Amazon and take 2000mg once per day. Google Niacinamide Rosacea. This has already been a documented treatment for Rosacea for a very long time and is a known anti-inflammatory. There is a product by the name of Nicomide intended for skin conditions based on Nicotinamide (Nam). On the other hand Nicotinamide Riboside (NR) didn't become publicly available until 2013 where frankly I stumbled into this for joint issues and by chance noticed a change in my "Bumpy Rosacea." Scientists in the laboratory have shown (NR) to be more potent than Nicotinamide but it is so new there has been no comparison to demonstrate its effectiveness against Rosacea. What you are reading are reports from the first human guinea pigs and we've only reported we noticed a change in our skin condition since taking it but we are not making a comparison to anything else. David Sinclair Phd published this article in December of 2013 about his experimental use of nicotinamide mononucleotide (NMN) a NAD precursor similar to Nicotinamide Riboside (NR). The Price of (NR) went from about 17 dollar a bottle to 47 almost overnight as an anti-aging agent. The difference is (NMN) is most potent as an injection without digestive breakdown where as (NR) can be taken orally and is also absorbed thru the mucus membranes. Plus only the very wealthy could afford nicotinamide mononucleotide (NMN) anyway, its a non-starter for most of us. I do supplement it with some (Nam) because it is cheap and I noticed it cleared my skin up to a higher degree. Some have reported less flushing with their Rosacea but this hasn't been my experience. It may have diminished but what I've noticed is with less skin irritation, inflammation and itching. I'm not as apt to touch my skin during my flushing episodes and this has helped me greatly. At least for me I think my condition has its roots in a autoimmune disorder which also aggravates my skin and arthritis, so reducing inflammation is paramount to me. If you have this type of Rosacea I think much of what we experience as a group is self exacerbated do to the itching we get during our flushing episodes and for me reducing my inflammation has had an unintended benefit where I'm not constantly touching my skin anymore. This is a vicious cycle that can be broken if you share a similar condition. I take 1000mg's of (NR) in the morning and 2000mg's of (NAM) in the evening. I've reported that I've seen the affects for my skin at 250mg of (NR) but my skin wasn't why I started this regime so I pushed my dose higher for my joint problems. I should note I have not tried (NAM) alone. I buy my (NR) on discount and will not pay retail. If cheap Niacinamide (Nam) works for you then Nicotinamide Riboside (NR) will likely work better. Hope that helps you make a decision but what ever you decide give it a month or 2 to see results."

Birdie replied on May 1st 2015:  "Thanks Bryan. This makes it even more clear of the distinction between NR and nicotinamide. I believe you are accurate that if a person reacts favorably to the nicotinamide, the NR will likely work even better. The cycle of inflammation is hard to break; but so far I'm finding the NR plus the Nicotinamide work very well in tandem together. This is new territory so I'm getting my liver enzymes checked again next week. I would rather eventually simply take the NR. Last, from the readings I've done, it appears that people like us with autoimmune issues and inflammation react favorably to the anti- inflammatory affects of the NR and nicotinamide, thus relieving skin symptoms as well as other symptoms. It may be a good starting point for people to try the much more known product nicotinamide, see how they react, then decide about trying the NR. How long have you been boosting in the evening with NAM at 2000 mg? To be clear for anyone unfamiliar with this supplement: that's a lot! Thanks."

Paperbag replied on May 1st 2015: "Niacinamide is the non flushing version of Niacin. Look at the pictures of nicotinamide and niacin (nicotinic acid). You will see the only difference. Niacin has an OH group hanging off the end, Niacinamide has an NH2 group hanging off the end. An NH2 group is an amine. In organic chemistry, when you attach an amine where an acid (OH) group used to be, you get an Amide. Hence the name, Nicotinic Amide or Nicotinamide for short. It is the process of converting nicotinic acid (niacin) to nicotinamide that causes flushing. So if you take nicotinamide, you bypass the step that causes flushing. My experience-- I recently jumped on the nicotinamide bandwagon too. I ordered the Now Foods cheap $6/bottle nicotinamide from Amazon. They are 500mg pills. I took one pill a day, for 2 days, and I honestly believe it prevented breakouts. I usually get 1-3 big red swollen spots on my face every single day, and I have not the past 2 days. However....I have had pretty bad, how shall I say, "digestive drama". Also, my urine is orange. So, I stopped taking the nicotinamide, and have ordered a lower dose 100mg nicotinamide pill from Amazon. I am still waiting for those to arrive. Hopefully they won't cause so much indigestion."

Brian_S replied on May 2nd 2015: "Hi Guys. First off, this stuff is expensive and I only buy it from discount offers and stock-up until the next one. I think the (NR) is superior at raising NAD levels and it gives us the secondary affects of Nicotinamide through the NAD salvage cycle. I think its all about breaking the cycle of inflammation and as I alluded the less I itch the less I touch. Both Nicotinamide (Nam) and Niagen Nicotinamide Riboside (NR) do not produce flushing like their cousin Niacin (Na) which could be maddening. I buy the "Now brand Niacinamide 500 Mg" capsules at about 6 dollars a bottle thru Amazon. I'd start here and wait for the next discount offer on Nicotinamide Riboside unless your willing to pay retail right now. As far as the dose I'd look to the prescription medication Nicomide at 750mg of Nicotinamide per pill. and I think the dose is one or 2 per day and Birdie can comment. So that is a range of 750mg - 1500mg of (Nam) for a reference. If your taking the Nicotinamide Riboside (NR) it can be taken at a much lower dose. I reported beneficial affects for my skin after a month at 250mg. The affects do not come overnight and take time to accumulate. I believe the non-flushing B3 solutions are best for inflammatory skin conditions. I'll note that I would avoid straight Niacin (Na) because it induces flushing and long term at higher doses it can cause liver issues. I would adhere to the same Contraindications/Precautions as Nicomide  for the Nicotinamide (Nam) and the (NR). The methods of action for the NAD boosters are only recently becoming understood and it would take pages to cover it. Both (Nam) and (NR) are NAD precursors. Nicotinamide adenine dinucleotide (NAD) is the energy currency used in our cellular metabolism, there are some 400 biological reactions dependent on having an adequate supply and this drops with age. Much of this understanding has come from the study of Sirtuin's and how they interrelate with our epigenome which turns on and off sections of DNA code."

Johnabetts, This is true, it is not marketed for Rosacea. The prudent thing to do is wait until a doctor recommends it but don't hold your breath because I've documented what Nicotinamide Riboside projects are in the wings and Rosacea doesn't rank as a life threatening disease so it might take awhile. Its only been available to the public since 2013 and before that in very expensive lab quantities. We put together a thread here http://www.longecity.org/forum/topic...s-and-updates/ pointing to where researchers are investigating and their findings have been nothing short of phenomenal in animal models. Human clinical trials are just beginning so for these will just have to wait."

Sportsfan81 wrote on April 2nd 2015: "Hi everyone, today I began taking Basis which has been taken by another member with some unexpected Rosacea benefits. I am going to take it in upon waking each morning and serving size is two pills. Currently I am taking other medications to help control my flushing and I will continue them as I do not want to risk any major flare ups. My goal is to figure out if this product has any effect on my rosacea either baseline redness or flushing. I am subtype 1 and can have some pretty nasty flushes. I do not think major changes happen overnight so I am not going to update this every hour but rather weekly to give it time to see any benefits. If it works awesome if not I'm not too worried as I have spent much more on alternatives that never pan out. I have attached some pics of how my flushing has been, lately it has been better with medication but I still get my usual nose flushes post workout and around 4-5pm everyday. Day 1: I took the serving size of 2 pills in the am which had no immediate effect. I took note throughout the day and I would say no difference in baseline redness or susceptibility to flush. I did not have any flushing throughout the day until I was finished working out and was sitting around 6pm. I had my normal nose flush which was pretty intense as usual. Overall it's day 1 and I am not expecting to see any results for at least a week. I will continue to update my progress as the month goes on"

Sportsfan81 updated on April 4th 2015: "So it has been 4 days since I started and unfortunately I have not seen any benefits from taking the Basis product. I have tried to stay as routine as possible and I still have flushing under normal triggers and baseline redness has not changed. I am going to see this through as it has not caused any negative side effects either. It's disappointing as previous user saw a 80% improvement after 4 days. Maybe it's just gonna take more time but I will continue to update."

hg24 replied: "Thanks for the update! It seems to have helped PaulB and Bryan_S with their bumps and associated inflammation. What we don't know is if it will help flushing and associated symptoms like burning and swelling. It's still early days. We're rooting for you. I ordered it today. My feeling is -If it doesn't curb my flushing, anything that helps the body run a little better and curb inflammation a bit isn't a waste of time. May not be the rosacea answer, but still good to have tried."

Sportsfan81 updated on April 4th 2015: "I agree it hasn't caused any negative side effects so it's worth a shot. It's a safer try then Mirvaso lol. About a week into this and no changes good or bad. I take it first thing in the morning before breakfast and honestly have not noticed any difference. I will continue to take on set schedule and hope to see something in a week or so. Has any other users had a different experience thus far? I am taking the recommended dosage 2 pills per day. I'm guessing that's probably 250 mg."

Wiry replied: "I haven't noticed any positive or negative effect either. Based on the posts from the other two members, they are in the early stages of actually treating rosacea. At that stage, you can get real improvement by doing a lot of things. They are also trying to be healthier, which can coincide with improvements in rosacea. I am not convinced that people who are healthy and have already been treating their rosacea properly will see any improvement. I am also not convinced this is a "good general pill". For the money and the time spent researching this stuff, I think you are going to be far healthier if you redirect that towards good diet (veggies, berries, etc.) and exercise. I do think this is worth a shot, but if members are not seeing any benefit, my opinion is that we should not encourage this direction."

PaulB replied: "FYI I noticed an improvement starting after day 4 and it was 80% better around day 17 - 20. The first thing I noticed was my skin on my face was much smoother and felt better to the touch. It was like baby soft, oily/moist but not in a bad way. Fingers crossed for you."

Johnabetts replied: "How did this product (Basis, Elysium) come to be regarded a a rosacea therapy? The product is marketed as an anti-aging food supplement and I am unable to find any references in the makers literature that points to it being a treatment for any disease whatsoever."

 Sportsfan81 updated on April 27th 2015: "As I conclude my month trial of the Basis product I saw no changes in my condition after following the recommended dosage. I had normal flare ups and issues as well as good days just like any other month. I changed nothing and tried to keep my dosage times the same. I know many are still looking into other similar products but I am done with this route as I saw no improvement."

Birdie replied: "After going on line and reading reviews of different/ similar products I concluded that a majority of people who do not see/ feel any difference did bit give the product a long enough trial period. One month to change things on a cellular level is a very short amount of time. It's not cheap, and this falls into the equation. But if you can trial it for a minimum of 3-4 months, I think you have a more accurate conclusion as to whether this may help or not. Boosting the dose also seems to help people if you are comfortable with that. Best, birdie"

Wiry replied: "Personally, I would wait for the cost to come down. This a new "hot" supplement...just like many before it. Prices will come down in time and you will feel like a fool spending all that money just to get ahead of the curve by short amount of time. Besides that, I find it hard to believe you are going to respond in a nonlinear fashion (i.e. no improvement for the first month then significant improvement at 3 months). It is more likely you would see gradual improvement. If you see none after a month, I can't see a reasonable case to continue. Paul said he saw improvement at 10 days."

Mistica wrote on March 8th 2015: "I'd like to suggest supplement with the following to improve your ability to handle oxidative stress.
*Selenium
*zinc/copper (with a ratio of 10 to 15:1) Jarrows makes one.
* magnesium
(Personally I find Trace Mineral ConcenTRACE drops more helpful, as you can take smaller doses in one hit and avoid potential for flushing).
You could also try eating 15 gm of liver a couple of times per week for the vitamin A and copper. Recently, I have been supplementing with oral niacinamide, with the idea of improving mitochondrial respiration/reducing oxidative stress. It was advised by Prof Ayers and Prof Jaminet who have been trying to help me for years. Prof Peat, (with whom I do not have personal contact), also has some ideas about this method and you can read about these here. Oral niacinamide is new to my regime, and so far I have taken too much and too little and then arrived at what appears to be an appropriate dose... for me. I must say, so far, it looks promising. For me, around 125mg, taken 3 to 4 times per day is helping. Too much will cause vasodilation. Big hits cause headaches in nearly everyone and digestive disturbance. The only other person on this board that I know of, who supplements in large doses is Birdie, who also experiences benefits. In addition, in my case, I find topical niacinamide helpful, but again, it took experimentation to find the right dose and my initial attempts were a failure. **I mix my topical niacinamide with Egozite cream (for babies). Both have been shown to improve the skin barrier. In summary, you really need to reduce the oxidative stress in your face and I am just passing on what has been advised to me. Niacinamide is known to be anti-inflammatory, it can reduce hyperpigmentation and protect DNA, so it seems like it might be worth trying in your case, even if it might cause some transient superficial redness in the short term. A note about polyphenols, resveratrol, etc, .. all these things lower glucose and whilst in general avoiding a diet high in carbs in recommended for us, when the body has suffered a significant trauma, it needs a good supply of glucose to assist in repair. I don't know what your diet is like, but if you avoid starches (grains, potatoes etc), like many of us do, including me, you might try adding dextrose to food, or even orange juice if you can tolerate it.



A friend wrote me: "Niacinamide is my favourite thing in the universe and topical zinc oxide. I am so pale, I've never seen it this light since Rosacea started! I take both Internal niacinamide and topical. I use about 3 teaspoons of moisturizer to one capsule of powder. It would sting at first, but then it would calm after like 5-10 minutes, but nowadays there's no stinging at all."

Another friend said: "I love it too! I use 4 or 5 % topically. Some people use up to 6%. Is it bad to use it this high? My skin feels a lot better"

 I wrote Mistica: "I am very eager to try it, Birdie sent me some, I think it's from a brand called Basis. How much should I take you think? Start with 100 mg, as you mentioned and also work up to 250 mg 3 times a day? I plan on taking it slow at first bc my skin is so hyper reactive usually. Some good reports on it on the forum :)"

 Mistica replied: "The NR. Oh yes! Birdie is kind. I tried a few capsules. They made me flush badly☹ Much like NADH does☹ Alas. Yet, niacinamide, which sits in another part of the krebs cycle, suits me well. I guess you can only try the NR, and see what happens. It might suit you and that would be wonderful. If not, you can always try plain niacinamide which has other benefits that NR doesn't. I do hope it helps you. It continues to hold my face together, and in my case, along with topical niacinamide gel and oral vitamin C. Anyway, I will keep my fingers crossed for you." Basis contains a slightly different form of niacinamide plus Pterostilbene, which among other things, has antimicrobial effects, although no one on the forum seems interested in that fact. A poster on our forum, PaulB, has pushed his type two rosacea into remission. There is another product called NR, which again, is the preferred form of niacinamide (perhaps preferred. I am not convinced, but perhaps). It is cheaper than Basis, as it does not contain pterostilbene. I believe you can purchase the latter separately, so it would be possible to combine the two if desired. If I were you, I'd opt for the plain niacinamide to see how you react, and go from there. If it didn't help you could try one of the other forms, but if it is going to help you, I think in the right dose you would see some indication."









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