Azelaic Acid Cream: Uses, Benefits, Side Effects and More

• Azelaic acid cream is a topical azelaic acid treatment available in prescription and over-the-counter formulations. 
• Azelaic acid cream is recommended to treat conditions like rosacea, acne, and melasma. 
• Azelaic acid cream can be easily integrated into your daily skin care routine.
• Azelaic acid cream helps to target inflammation, redness, and bacteria.

Azelaic acid cream is a topical cream that contains azelaic acid, an ingredient used to even the skin tone and treat a number of skin conditions. Azelaic acid works to combat bacteria and inflammation, so it’s commonly recommended to people with acne and rosacea. It’s a versatile ingredient and is considered a multi-tasker among skin care products. 

What Is Azelaic Acid? 

Azelaic acid is a dicarboxylic acid compound, which is a gentle, natural exfoliant. It can be made from rye, wheat, barley and yeast, but it is often created in a lab. 

Azelaic acid contains beneficial antioxidants and is considered to be a multi-tasking product. It’s often recommended or prescribed to treat hyperpigmentation, mild to moderate acne vulgaris, and rosacea. 

Azelaic acid cream

Azelaic acid cream is available as both a prescription and over-the-counter (OTC) treatment. Based on your individual condition, your dermatologist will determine whether you need an OTC or prescription azelaic acid cream. 

Over-the-counter azelaic acid cream usually comes in 10% to 15% concentration and is considered an effective treatment for mild skin concerns. 

If you have a more serious skin condition, your dermatologist will probably prescribe a 15% to 20% concentration azelaic acid cream. The brand name Azelex is a commonly-prescribed azelaic acid cream.

Azelaic acid gel

Azelaic acid gel is typically available in 10% to 15% concentrations, both OTC and prescription. Some clinical evidence shows that a 15% gel formulation is more effective than 20% azelaic acid cream. Finacea is a popular, brand name, prescription-only azelaic acid gel. 

Gels require a lower concentration of azelaic acid to be effective, and they permeate the skin more easily than creams. In fact, the results of azelaic acid gel appear to be significantly better. 

Other evidence shows that azelaic acid gels with as low as a 10% concentration are also effective treatments. 

Benefits of Azelaic Acid Creams

Azelaic acid creams come with a number of benefits that make them ideal for several different skin conditions and concerns. Azelaic acid cream can: 

• Alleviate skin sensitivity
• Address and reduce redness
• Reduce skin inflammation
• Even the skin tone by gentle exfoliating skin
• Fight harmful bacteria on the skin’s surface
• Open and unblock pores
• Reduce the appearance of pustules and papules
• Fade hyperpigmentation and skin discoloration

Azelaic Acid Cream Uses

Azelaic acid is most often used to treat acne and rosacea. Its combination of anti-inflammatory, antibacterial and exfoliating properties make it a popular option for skin care.

Acne treatment

Azelaic acid is often used to treat acne because it helps to clear pores, targets inflammation, and fights bacteria. It’s a triple-threat against the inflamed pustules and papules caused by acne. Azelaic acid also reduces redness and skin sensitivity. 

Azelaic acid fights excess keratin production, reduces the amount of oil in the skin’s surface, and helps the skin to become bacteria intolerant. This helps to prevent future acne flare-ups. 

Rosacea treatment 

Azelaic acid is routinely prescribed for people with rosacea because its anti-inflammatory properties are clinically proven to reduce symptoms associated with rosacea, including redness, papules and pustules. Its gentle exfoliating properties help to continuously resurface the skin. 

How To Use Azelaic Acid Cream

To use azelaic acid cream in your skin care routine, follow your dermatologist’s instructions. You may be instructed to apply the cream once or twice daily. Only use azelaic acid cream as prescribed, as over-using it could trigger side effects like irritation and redness.

To safely use azelaic acid in your skin care routine: 

1. Wash your face with a gentle cleanser and warm water.
2. Pat dry with a soft washcloth or towel. 
3. Apply a thin layer of azelaic acid cream to your skin.
4. Wash your hands.
5. Allow the medication to dry.
6. Apply moisturizers or makeup to your face. 

Most likely, your dermatologist will recommend that you apply azelaic acid in the morning and at night. 

Here are a few tips for using azelaic acid safely: 

• Set a reminder for yourself so you can stay on schedule. 
• Be sure to only use small amounts of azelaic acid cream on your skin. 
• If you miss an application, don’t use a double dose. Just skip the application and resume use at the next scheduled time.
• Keep azelaic acid cream away from your eyes, mouth, and the inside of your nose. 

How to use gels

Azelaic acid gels are used in much the same way as a cream. When you use azelaic acid gel in your skin care routine, apply the gel and allow it to dry before you continue the steps in your routine. 

Side Effects

It’s common for people who use azelaic acid for the first time to experience a mild, temporary tingling sensation on the skin immediately after application. This should go away within a few minutes. If it doesn’t, discontinue use and talk to your dermatologist. 

The people who are most prone to experiencing the side effects of azelaic acid are people who have never used the treatment before. Common and frequently-reported azelaic acid side effects include: 

• Dryness
• Tingling
• Burning
• Stinging
• Sensitivity

Moderate side effects, which occur less frequently, include: 

• Pain
• Swelling
• Itching
• Hives
• Rash
• Flaking
• Crusting
• Blistering
• Severe burning
• Severe redness
• Fever

Although the incidence of severe side effects isn’t known, there are a number of rare side effects which have been reported in association with azelaic acid use. These include: 

• Difficulty breathing
• Difficulty swallowing
• Chest tightness
• Large hives over significant areas of the body
• Joint swelling
• Joint pain
• Swollen eyes
• Stiffness in joints
• Rapid heartbeat (tachycardia)
• Skin color changes
• Hoarseness
• Eye pain
• Watery eyes
• Red eyes
• Blurred vision

If you have asthma, only use azelaic acid with caution and under a doctor’s care. In some adults, asthma symptoms may be worsened by azelaic acid. 

If you are pregnant or breast-feeding, ask your dermatologist before you begin or continue use.

Azelaic acid cream and gel tend to cause more side effects than foam formulations, but the reason why is unknown. 

Alternative Options

Although azelaic acid is considered to be generally safe for most skin types, it still has the potential for adverse side effects. While there are alternative options to azelaic acid, they don’t necessarily provide the exact benefits. 

Some alternatives, like alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs), may be used safely alone or in combination with azelaic acid. Unlike azelaic acid, they don’t fight bacteria, but they do exfoliate and combat inflammation. 

Other alternatives, like retinol, may also be used alone or in combination with azelaic acid. Retinol is used more often as an anti-aging skin care ingredient, as it minimizes fine lines and wrinkles. 

Alpha Hydroxy Acids

AHAs such as glycolic acid may be a strong alternative to azelaic acid. They’re most often used to rejuvenate and resurface the skin. People with hyperpigmentation, sun damage, acne scars, dry skin, fine lines and wrinkles, and even acne may be good candidates for AHAs as an alternative to azelaic acid. 

AHAs may be used as an alternative to azelaic acid, or they may be used safely in combination with azelaic acid. 

Salicylic Acid (BHA)

Salicylic acid is a BHA that is most often used to treat oily skin, acne-prone skin, acne, blackheads, and sebaceous filaments. Salicylic acid helps to clear pores and gently dry excess oil, removing it from the skin’s surface and helping blemishes to dry up. 

Salicylic acid may be used as an alternative to azelaic acid, or it may be used safely in combination with azelaic acid. 

Retinol

Unlike azelaic acid, retinol does not exfoliate the skin. Instead, it focuses more on reducing the appearance of the signs of aging. Retinol helps to minimize the look of fine lines and wrinkles by boosting the production of collagen in the skin. It also helps to plump the skin and restore a youthful appearance. 

Retinol may be used as an alternative to azelaic acid or it may be used safely in combination with it.  

Takeaway

Azelaic acid cream is an effective treatment for skin conditions like acne and rosacea. Its anti-inflammatory, antibacterial and exfoliating properties make it a great option for someone who wants to address multiple skin issues. 

Azelaic acid cream can easily be integrated into your skin care regimen. It can be safely combined with certain skin care products like retinol, AHAs and BHAs for a multi-pronged approach to skin care.

Generally considered safe, azelaic acid cream is appropriate for all skin types. Use only as recommended by your dermatologist. Seek medical advice right away and discontinue use immediately if you experience side effects.