Azelaic Acid 101: A Detailed Guide

Azelaic acid is a compound that’s naturally found in wheat and barley, and it’s also produced by certain fungi on the skin, says Carmen Castilla, MD, a board-certified dermatologist in New York City. “In cosmetic formulas, azelaic acid is synthetically made. It acts as an exfoliant to promote skin cell turnover and unclog pores, and has mild anti-inflammatory properties as well,” she says.

For people who have rosacea, pigmentation problems, or acne, azelaic acid may help ease symptoms and improve skin appearance.

Azelaic Acid Can Help Treat Rosacea

In addition, azelaic acid may benefit skin with rosacea as well as acne by eradicating bacteria associated with the skin conditions, says Abigail Waldman, MD, an assistant professor at Harvard Medical School and the clinical director of the Mohs and Dermatologic Surgery Center at Brigham and Women’s Hospital in Boston.

Azelaic Acid Can Help Diminish Discolorations

You’ll often find azelaic acid in brightening products for melasma, discolorations, and post-acne pigmentation — and for good reason. “Azelaic acid works as a tyrosinase inhibitor, which means it works to decrease the synthesis of melanin, the pigment in your skin,” says Dr. Waldman.

Azelaic Acid Can Help Treat Acne

When people rate their acne improvement when using various topicals, research has found that azelaic acid may be less effective than benzoyl peroxide but as effective in clearing acne as tretinoin (Retin-A). That said, in dermatology practice, azelaic acid isn’t the first-line therapy for acne unless you are pregnant, says Waldman. During that time, there are very few anti-acne options, which makes azelaic acid a great choice for helping to keep skin clear.

You’ll find azelaic acid as an ingredient across a range of topical products. Here’s what to keep in mind when you’re shopping for the right azelaic acid product for your skin concern:

• Dark spot serums: Ones that contain azelaic acid can be part of your skin-care regimen.
• Cleansers: While azelaic acid has exfoliating properties, it’s not a one-size-fits-all solution. It’s vital to cleanse with a face wash first to remove impurities.
• Anti-acne treatments: Acne can lead to blemishes. Azelaic acid pairs well with an anti-acne product to help brighten dark spots.
• Moisturizers: Dry skin isn’t the best canvas for benefiting azelaic acid. A moisturizer hydrates the skin, making it more receptive to the active ingredients of skin care products.
• Prescription medications: The most effective azelaic acid products are found in prescription-strength formulations, says Lauren Ploch, MD, a board-certified dermatologist in Augusta, Georgia. This is particularly important if you’re intending to use it to treat a skin condition like rosacea. “There are some great prescription compounds that combine azelaic acid with other anti-inflammatories like generic topical metronidazole and topical generic ivermectin. Dermatologists often refer to this as ‘triple rosacea cream’ because it contains generic versions of some of the top branded rosacea topicals, often for a fraction of the cost of one branded topical,” she explains.

Because azelaic acid is mild, you’ll want to look for a product that contains at least 10 percent azelaic acid in over-the-counter formulations, says Waldman. If 10 percent is not working, especially for acne or rosacea treatment, increase to a prescription-strength product that has 15 to 20 percent azelaic acid.

Azelaic acid is safe and suitable even for sensitive skin. But there’s still potential for irritation.

It can cause sensitivity. Although azelaic acid is suitable for sensitive skin types and is used in rosacea treatments, the ingredient is a skin exfoliant, and it can be drying and irritating. Limit potential irritation by slowly increasing use, smoothing only a pea-sized amount on skin, and not introducing azelaic acid while using other active ingredients like retinoids at the same time, recommends Castilla.

It may increase skin issues. If you have eczema, azelaic acid may exacerbate your symptoms, so Castilla recommends avoiding it in that instance.

It isn’t a cure-all. There is limited evidence of azelaic acid improving psoriasis symptoms, though more research is needed. If you have psoriasis, talk to your dermatologist before using a new topical.

Does Azelaic React With Other Ingredients?

If you have rosacea and are using a vitamin C serum, Dr. Ploch recommends using these two products on alternate days. “Skip the vitamin C altogether if redness or irritation develops,” she says.

Avoid or be cautious about using the following products simultaneously with azelaic acid.

• Retinol
• Benzoyl peroxide
• Alpha hydroxy acids
• Beta hydroxy acids
• Face scrubs and exfoliators

In addition, due to the hormonal changes that happen during pregnancy, melasma tends to worsen during this time, adds Castilla. Because you’re limited in the skin brighteners that are safe to use in pregnancy, azelaic acid can be your go-to. After pregnancy and breastfeeding, you can use stronger ingredients, such as hydroquinone or kojic acid, she says.

Most people can use azelaic acid safely, but you want to watch out for possible side effects, including redness, dryness, and irritation. If that happens, back off use and then acclimate skin by slowly ramping back up again. After consistent use, you can expect to see improvement in six to eight weeks, says Castilla. Then follow these derm-approved tips for making it a part of your regular regimen.

Where Azelaic Acid Should Fall in Your Routine

Start with a gentle cleanser, especially as you begin to use an azelaic acid product. Even though it’s generally mild, azelaic acid can still be irritating initially, says Ploch. Next, apply the azelaic acid product and follow up with sunscreen. If you’re treating hyperpigmentation, she recommends using a tinted sunscreen (look for iron oxide in the ingredients), as it protects skin from visible light, another contributor to discoloration.

At night, wash your face with a gentle cleanser, then apply the topical azelaic acid product. If you’re using another prescription-based product to treat rosacea or another condition (such as topical metronidazole or ivermectin), you’ll apply that next, followed by a moisturizer, says Castilla.

When to Use Azelaic Acid?

You can use azelaic acid once or twice a day. Prescription azelaic acid is designed to be used twice a day, Castilla points out, but how often you use it depends on what skin condition you’re treating. For instance, if you’re treating acne, you may also be using a retinoid. Though the two can be used together, some people may find this combination irritating.

If you’re using it once per day, opt for the morning, especially if you’re using a retinoid, which is best used at night. If your skin can tolerate it, use the azelaic acid both in the morning and at night with your retinoid. (Again, retinoids are best for use only at night.)

Ploch recommends using a pea-sized amount of azelaic acid on skin. That’s an appropriate amount to be effective without resulting in irritation. If you have sensitive skin, start by using azelaic acid two or three times per week, then working up to daily use.

Azelaic acid can be drying, even for oilier skin types, says Castilla. “I start patients on once-daily use. If they can tolerate it, we increase it to twice a day.”

As for the percentage of azelaic acid, you can get 10 percent over the counter, but if you feel you aren’t seeing the results you want, you can talk about a prescription azelaic acid of 15 or 20 percent.