Vitamin B3 (nicotinamide) role in preventing skin cancer

Nicotinamide (Vitamin B3) has been shown by Professor Diona Damian's research group (The University of Sydney) to have a role in the prevention of non-melanoma skin cancer and the common pre-cancerous skin lesions, actinic keratoses. Their landmark study (ONTRAC) published in the New England Journal of Medicine late last year demonstrated a 23% reduction in new non-melanoma skin cancers in high-risk patients taking nicotinamide when compared with the placebo group. There was no significant difference in side-effects in the nicotinamide group versus the placebo group.

The exciting aspect of this research is that the treatment potentially offers an inexpensive and safe way to reduce non-melanoma skin cancer which is extremely common in New Zealand. Nicotinamide appears to work by enhancing DNA repair in sun-damaged skin, and by reducing the immunosuppression in the skin causing by UV light.

Do sunscreens prevent you getting necessary vitamin D?

No. Only a small amount of vitamin D is received directly from diet. The majority of our bodies vitamin D comes from conversion in our skin due to sunlight exposure. We know vitamin D is critical for healthy bones but it may have other major health benefits in many areas of our body.

So, if we protect ourselves against skin cancer with sunscreen - are we risking getting low on vitamin D? Fortunately, a number of studies demonstrate that sunscreen, in normal use, does not cause vitamin D deficiency. There are a number of explanations for this. Firstly, sunscreen is only a screen, not a total block. Some UV still gets through to the skin. Secondly, the data tells us, we only need a very small amount of UV to generate vitamin D. Depending on your skin type, exposing just 10% of your skin to 3-7 mins of sun in the New Zealand summer is enough to provide adequate vitamin D without sunburn. In fact, after a certain point of exposure, vitamin D begins to get degraded by further UV exposure. Finally, when sunscreen is applied in real-world situations, it not applied as thickly, as completely, or as frequently as it should be to provide maximum protection.

Sources: Research Review Educational Series. An update on sunscreen IV. 2015 and Sunscreen Myths Busted. 
Medscape. Jul 19, 2016.

Do sunscreens actually prevent skin cancer and pre-cancerous skin lesions?

Yes. The most regarded randomised controlled trial on the subject is the Nambour study out of Queensland, Australia. The study followed 1600+ people from 1992 to 2006. The reduction of squamous cell carcinoma (the second most common type of skin cancer) in the group that applied daily sunscreen was profound. Invasive melanomas were substantially reduced in the sunscreen group while the thinnest melanomas (melanoma in-situ) showed a trend towards reducing. No clear reduction in basal cell carcinoma was seen in this study. A possible explanation of this finding is that the time from sun exposure to basal cell carcinoma development is very long, and so it is very difficult to capture this effect in a study spanning even 5-8 years. This study and three other randomised controlled trials confirm that the regular use of sunscreen reduces actinic keratoses (precancerous skin lesions that may progress to squamous cell carcinoma with time). Source: Research Review Educational Series. An update on sunscreen IV. 2015

New UV index app

A new mobile app called uv2Day has been released that gives real-time updates on the current UV index specific to your location around New Zealand. Data is supplied by NIWA. You can download it for free from the Apple App Store, or Google Play.

Dermal microneedling compared with laser for acne scarring: same effect, less side-effects

A long-awaited randomised clinical trial comparing the effect of fractional erbium laser with microneedling for the treatment of acne scarring, was published in the February 2016 issue of the Dermatologic Surgery journal.

46 patients with facial acne scars were randomised to receive either laser or microneedling for three, monthly sessions. Two blinded dermatologists assessed the results at two and six months after treatment. Both groups showed significant improvement, and there was no statistically significant difference between the results of both therapies. The redness after each session was longer in the laser group, and 13.6% of subjects experienced post-inflammatory hyperpigmentation. No post-inflammatory hyperpigmentation was observed in the microneedling group.

The study concluded both treatments are comparable and effective in the treatment of acne scarring. Microneedling however was better tolerated, with fewer side-effects, and a shorter down-time.

Men, two ways to reduce your chances of premature greying

A cross-sectional study of more than 6000 men published in the Journal of the American Academy of Dermatology journal identified three risk-factors associated with premature hair greying:

1. Family history of premature greying (especially on father's side)
2. Obesity
3. Smoking (more than a 5 packet-year history)

You can't change your family, but quitting smoking, and maintaining a healthy body weight can reduce the chance of turning grey early. Do it in 2016.

A superior application technique for sunscreen

A recent article published in the Photodermatology, Photoimmunology & Photomedicine medical journal describes a new technique of applying sunscreen which dramatically improves the coverage compared with how most people apply sunscreen. One known issue is the quantity of sunscreen we routinely apply is insufficient. This article suggests appropriate quantities for each body area measured in teaspoons. The second issue is the application technique which will spread the sunscreen evenly minimising the chance of gaps. The principle is to apply evenly spaced spots of sunscreen to the area, then rub them in a circular motion appropriate to the area of the body. UV analysis with photographs were used to compare the new method with the standard method. The new method was superior in the following parameters: evenness of spread, amount applied, and body surface area covered.

The article is available free at:

You don't need to read all the detail but the table at the top of the third page is most important, as it explains the technique in pictures.