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Another skincare buzzword making waves? NAD+. Some call it a miracle for reversing aging — but what’s hype, what’s hope, and what’s actually backed by science?

 

 

Let’s take a closer look at what NAD+ really does for your skin.

 

 

What is NAD+?

NAD+ is short for Nicotinamide Adenine Dinucleotide and is a non-protein compound acting as coenzyme in many different cells in the body. Coenzymes are necessary for the proper function of different enzymes, but not enzymes themselves – they are a third factor that needs to be present for a reaction to happen: enzyme, substrate and coenzyme.

Think of it like the key when starting the car: You need the car, you need the fuel, but even if you have these two, you’ll still need the key to start the engine and get the process running.

The processes NAD+ acts as coenzyme in mainly evolve around DNA-Repair and energy production in the cell and it is found in many different tissues in the body, it isn’t exclusive to the skin.

Like many other good things though, it declines as we age – not in all tussies equally, but still enough throughout the body to make a difference. The decline is due to an increasing imbalance between NAD+ production and consumption, as the need for repair processes increases – the older we are, the more damage there is to tend to it seems – and at the same time the Nicotinamide Phosphoribosyltransferase (NAMPT) levels – it is the enzyme responsible for recycling used up NAD+ – decline, so in short:

NAD+ gets used up quicker and at the same time isn’t recycled as efficiently as it used to.

We have known about the importance of NAD+ for a long time as there is a specific disease called Pellagra caused by NAD+ deficiency that presents with dermatitis, diarrhea, dementia and finally death if untreated and that has basically been eliminated by fortifying food with B-Vitamins. It is like Scurvy, but based on a different vitamin deficiency.

 

 

Why is NAD+ important for skin aging?

The role of NAD+ in the skin is basically the same as everywhere else in the body: it repairs DNA damage and makes sure there is enough energy present in the cells for them to do what they are supposed to do. A main source of DNA damage in the skin is for example UV exposure, which NAD+ helps repair – but no, you shouldn’t use it instead of sunscreen, I just know that someone somewhere might come to that conclusion. (More info: What is UVA and why is it important?)

So with declining levels of NAD+ in the skin cells, existing damage in the skin doesn’t get repaired as quickly as it once did and the different cells lack the energy to produce for example collagen and elastin. And we all know what that means in terms of appearance: Wrinkles start to show and skin starts to sag.

Some TikTok users call NAD+ a „miracle molecule that will reverse skin aging„—which raises three red flags for me: miracle, reverse, and social media hype…

 

 

 

NAD+ in skincare

When talking about NAD+ for skin aging, we need to distinguish two different things: topical application through skincare products and oral or intravenous supplementation. Let’s look at topical first.

When you look at the brands promoting products around NAD+ levels, they often use claims like “reduce fine lines, enhance elasticity, restore a youthful appearance”, which are vague enough to still count as skincare claims and promote their products as “regenerative” or “skincare on a cellular level”, which promotes the impression that the products work not only superficial, but on a deeper, cellular level. (More info: Can skincare cure acne? The difference between skincare and medication)

And I get where it comes from: When NAD+ levels decline, we apply NAD+ where we want it to increase – on the skin – and watch our replenished cells wake up and get going. That sounds convincing. The common problem in topical products though is: How do we get it into the cells and if it gets into the cells, will it actually have the effect we hope it has?

NAD+ is a large molecule and charged, meaning it doesn’t really penetrate the skin very well. It is also unstable, so it is likely to degrade quickly either in the product or directly after application. This is why most brands don’t use NAD+ for application, but precursors, so ingredients that are converted into NAD+ in the cells. One that you have surely heard of is a prominent Vitamin B in skincare: Niacinamide. In post on The benefits of Niacinamide in your skincare I mentioned that part of its effect is due to an increase in NAD+ in the cells.

There are newer precursors called Nicotinamide Riboside (NR) and Nicotinamide Mononucleotide (NMN) that are closer to NAD+ than Niacinamide, so could in theory trigger a higher boost of NAD+ in the cells, but both are again unstable in watery solutions and bigger than Niacinamide, so that theoretical booster effect could be counteracted by worse penetreation.

They are however what is often included in NAD+ promoting products – Niacinamide isn’t really something you can justify a higher price point with.

 

 

Is there data on the effects of topical NAD+ and its precursors?

While we have studies looking at topical application of NAD+ and its precursors, there aren’t many and they don’t really answer the questions you might have.

There is a 2024 in vitro study where NAD+ was applied to fibroblasts that showed that UV protection was increased by this topical application and that adding enzymes that inhibit the enzymes breaking down NAD+ in the cells increases that effect even further. Very interesting, but as they were working on isolated fibroblasts it doesn’t tell us if and how NAD+ would actually get into the skin.

For topical NAD-precursor application, Nicotinamide Mononucleotide (NMN) in that case, we have animal studies that show improvement in eczema lesions and increased protection of the skin against UV damage in mice, which seems to show that NMN is able to penetrate the skin with beneficial effects. At least in mice with a compromised skin barrier.

We also have a human study from 2007 where a NAD+ containing ointment was used in psoriasis patients and compared to placebo (same vehicle, but without the NAD+) on matched psoriatic lesions. Here the NAD+ ointment performed better than placebo and comparable to Anthralin, an established therapy. (More info: Everything you need to know about Psoriasis)

It was also possible to keep the NAD+ stable (fresh batches and kept refrigerated) and patients found it to be cosmetically pleasing in texture. This answers some questions regarding potential penetration (on an impaired barrier) , formulation and beneficial effects, but can’t be transferred to skin aging and cosmetic products that aren’t produced fresh and kept refrigerated.

These aren’t all studies available, but all studies have one thing in common: They are either animal studies, in vitro studies (which means studies conducted outside a living organism, typically in a lab dish) or done on a very small population with specific characteristics, meaning they offer great insights, but aren’t “proof”.

They do show that topical application is generally considered safe though, which is a good start.

But you know where we have a lot of studies? Niacinamide. Not directly on its effects on NAD+ levels in the cell, but on how it improves signs of aging in a split face trial for example – indirectly supporting the claim that NAD+ levels are important.

 

 

What about oral NAD+ or NAD+ precursors?

Straight NAD+ as supplement will have no effect at all, as it is broken down by digestion, you will have to stick to the precursors.

There are Nicotinamide Riboside (NR) and previously also Nicotinamide Mononucleotide (NMN) pills available that will, that much has been demonstrated, increase NAD+ levels in human tissue. The increase they provided wasn’t however reproducible in all tissues and all studies, with the effects varying depending on doseage and treatment duration as well as study population – male only vs mixed genders, age groups studies and overall healthy vs patients with preexisting conditions like obesity, neurodegenerative disease or cardiovascular disease, meaning there is a lot we don’t know yet.

The main one being if this increase in NAD+ levels does translate to general health or skin improvements. That remains unclear, mostly because the studies done focus on lifestyle improvement rather than skin, and things like “more energy” are quite hard to objectively measure. Some more objective indicators like systolic blood pressure or level of circulating cytokines have shown promising trends in small sample sizes.

There don’t seem to be any side effects other than costing you money, so it might be worth a try for you – I personally don’t really take supplements.

NMN, however, can no longer be sold as a dietary supplement in the US due to the FDA reclassifying it as an investigational drug (meaning it is now treated as a substance under investigation or formerly under investigation for potential therapeutic uses rather than as a general supplement), so for now only Niacin and Nicotinamide Riboside are available.

 

 

Are NAD+ and its precursors safe?

In general the topical application of both NAD+ and its precursors seems to be safe and widely tolerated, and the same seems to be true for oral supplementation.

NAD+ infusions on the other hand seem to come with discomfort with people reporting nausea, chest tightness or headaches, probably because NAD+ in high concentrations in the blood stream isn’t physiological, meaning the body isn’t used to it – the increase with oral precursors happens slower and is closer to how it usually works. i.v.s are also quite expensive and, just like anything else that punctures the skin, associated with the potential risk for infection – even though that should be small when the provider follows hygienic precautions.

 

 

Do I personally use NAD+ in my routine?

No.

Topical NAD+ isn’t something I’d invest in. I will stick to my Niacinamide in the products I alreday use, pay a fraction of the price and will most likely have the same benefit. And as I bet Niacinamide is already present in your routine as well, you can keep using whatever worked for you in the past with the good feeling that you are absolutely up to speed with this new trend.

 

TL;DR

Is NAD+ topical or via supplement a proven anti-aging ingredient for the skin? Not yet. It has some promising preliminary data that warrants further research, but if it were a drug aiming to treat a disease, it wouldn’t be ready for approval yet, but just at the start of its journey. Yes, there is a good hypothesis to why it might affect cell aging in the body in general and the skin specifically, so it isn’t all hype – but this hypothesis needs further testing. Especially as the topical application has not much data showing it actually changes something, NAD+ is large and unstable, so difficult to formulate with. While there seem to be no side effects with topical application, I personally will stick to my basic routine with Vitamin C, a retinoid and sunscreen and take advantage of the effect that Niacinamide, a stable and well studied NAD+ precursor, is already widely available in many skincare products without me having to spend the extra bucks that come with buying dedicated NAD+ or NAD+ precursor skincare formulations.

How do you feel about it? Is this something you use?

 

 

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