NAD+ is marketed for skin as an anti-aging molecule, on the idea that skin cells run short of it with age and that topping it up restores them. The first half of that idea has human data behind it.
The second half is where the claims outrun the studies. Every skin result reviewed here comes from a form of vitamin B3 that the body converts into NAD+, and this page keeps the two apart.
Does skin lose NAD+ with age?
A 2012 study measured NAD+ in pelvic skin removed during unrelated surgery, from 49 people aged from newborn to 77 [1]. NAD+ fell with age in both sexes: the correlation was r = −0.706 in men and r = −0.537 in women.
In men, the activity of PARP, a DNA-repair enzyme that consumes NAD+, rose with age and tracked lower NAD+. The authors proposed that repair work driven by accumulated DNA damage uses NAD+ up faster.
That is a correlation in tissue from surgery patients, and the proposed mechanism is the authors’ hypothesis. It does not show that adding NAD+ reverses anything.
Can you raise NAD+ in the skin from outside?
One trial did, with a precursor rather than NAD+ itself. It tested myristyl nicotinate, a fat-soluble niacin derivative designed to reach the skin, on sun-damaged facial skin against placebo [2].
Skin-cell NAD rose by 25% (P = 0.001). The outer skin layer thickened by about 70%, and water loss through the skin fell by about 20% on the cheeks and arms. Those are barrier measures, not wrinkle scores.
Whether NAD+ itself can cross the skin is a separate question from whether a precursor can. Whether a patch can deliver it is covered in NAD patches.
Niacinamide on the face
Niacinamide, another name for nicotinamide, has been tested directly on facial skin. A 2005 trial had 50 women with sun-damaged skin apply 5% niacinamide to one half of the face and a blank cream to the other, twice daily for 12 weeks [3].
The niacinamide side showed fewer fine lines and wrinkles, fewer dark spots, less redness and less yellowing, and better elasticity. The lead author worked for a consumer-products company, which is worth knowing when weighing a cosmetic trial.
The strongest result: skin cancer prevention
The largest trials in this set are about skin cancer, not appearance. ONTRAC randomized 386 adults who had had at least two non-melanoma skin cancers in the previous 5 years [4].
Participants took nicotinamide 500 mg twice daily or placebo for 12 months. New non-melanoma skin cancers were 23% lower on nicotinamide (95% CI 4% to 38%). Precancerous actinic keratoses were 11% to 20% lower at each 3-month check.
−23%
New non-melanoma skin cancers on oral nicotinamide vs placebo, 12 months (n = 386)
Chen 2015
1.0
Rate ratio in transplant recipients: no effect (n = 158)
Allen 2023
−14%
Skin cancer risk in a matched VA cohort on nicotinamide (observational)
Breglio 2025
The benefit did not last after stopping. In the 6 months after the pills ended, there was no evidence of benefit [4].
A second trial, ONTRANS, tested the same dose in 158 organ-transplant recipients, whose immune-suppressing drugs raise skin cancer risk [5]. After 12 months there were 207 new skin cancers on nicotinamide and 210 on placebo (rate ratio 1.0). The trial stopped early for slow recruitment.
A 2025 study of US veterans matched 12,287 people prescribed nicotinamide to 21,479 who were not [6]. Skin cancer risk was 14% lower overall and 54% lower when nicotinamide was started after a first skin cancer. As a health-record study, it shows an association, not proof.
A small signal in a rare disease
One crossover trial gave nicotinamide riboside, another NAD+ precursor, to 9 people with Werner syndrome, a rare inherited disease of early aging [7]. Only 3 had skin ulcers.
In those 3, ulcers shrank during the supplement phase and grew during the placebo phase. That is 12 ulcers in 3 people with an unusual condition, which makes it a lead for further study rather than a general skin benefit.
| Study | Compound tested | Route | Skin result |
|---|---|---|---|
| 2007 trial | Myristyl nicotinate (niacin derivative) | On the skin | Skin NAD up 25%; stronger barrier |
| 2005 split-face trial | Niacinamide 5% | On the skin | Fewer lines, spots and redness |
| ONTRAC, 2015 | Nicotinamide 500 mg twice daily | By mouth | 23% fewer new skin cancers |
| ONTRANS, 2023 | Nicotinamide 500 mg twice daily | By mouth | No effect in transplant recipients |
| Werner syndrome, 2025 | Nicotinamide riboside | By mouth | Smaller ulcers in 3 patients |
| Any study here | NAD+ itself | Injection, IV or cream | Not tested for skin |
What this means for your skin
The case for NAD+ and skin rests on a real decline with age and on precursor studies that worked for specific endpoints. Oral nicotinamide in people with past skin cancers is the best-supported of them.
For other skin claims tested in people, see GHK-Cu benefits and glutathione for skin. For energy claims made for NAD+, see peptides for energy, and to compare NAD+ formats, the NAD+ injection or nasal spray rankings.