TNF and acne: This has been used to demonstrate the efficacy of topical nicotinamide in the treatment of inflammatory acne vulgaris.66 Experimental evidence confirms that nicotinamide and some derivatives selectively inhibit proinflammatory cytokines, including TNF-α, IL-1β, IL-6, IL-12, prostaglandin E2, and nitric oxide (NO), thereby modulating the immune response.67,68