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

• Azelaic acid cream is a topical treatment available in prescription and over-the-counter formulations 
• This is a versatile cream that can treat several skin conditions such as rosacea, acne and hyperpigmentation
• This treatment targets inflammation, redness and bacteria
• Azelaic acid cream can be easily integrated into your daily skin care routine

Azelaic acid cream boasts a number of skin-healing properties to treat a number of skin conditions. Azelaic acid targets acne-causing bacteria and inflammation, exfoliates rough skin, fades pigmentation and evens skin tone. It’s a versatile ingredient and is considered a multitasker among skin care products. 

What Is Azelaic Acid? 

Azelaic acid is a dicarboxylic acid compound found naturally in wheat, rye and barley, and is produced naturally by a specific yeast that is normally present on the skin. It is a compelling treatment for hyperpigmentation, mild-to-moderate acne vulgaris and rosacea due to its keratolytic and antibacterial qualities. It is also an antioxidant.

Azelaic acid cream

Azelaic acid cream is available as both a prescription and over-the-counter (OTC) treatment. The treatment you receive will be based on your dermatologist’s judgment. 

The OTC cream is formulated in concentrations of 10–15% and is considered an effective treatment for mild skin conditions. For more severe concerns such as moderately inflamed acne lesions, a 15–20% concentration is typically prescribed. Azelex is one commonly prescribed brand.

Azelaic acid gel

Azelaic acid gel is typically available in 10–15% concentrations, in both OTC and prescription strengths. Some clinical evidence indicates the 15% gel formulation is more effective than the 20% cream. Finacea is one example of a 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. Other evidence shows that even low concentrations of 10% are also effective treatments. 

Benefits of Azelaic Acid Cream

Azelaic acid cream provides a wide range of benefits, making it an ideal solution for several different skin conditions and concerns. Azelaic acid cream can:

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

Azelaic Acid Cream Uses

Azelaic acid is commonly used to treat acne, rosacea and hyperpigmentation. The combination of anti-inflammatory, antibacterial and exfoliating properties make it a strong choice for these skin conditions.

Acne treatment

As a keratolytic, azelaic acid cream helps clear acne blemishes by softening and breaking down debris and oil that plug skin cells. It also prevents future buildup by encouraging cell turnover and reducing the amount of oil on the skin’s surface.

It kills the bacteria associated with acne, reduces inflammation and skin sensitivity, and smooths rough skin. 

Hyperpigmentation

Dark spots on the skin can result from acne lesions, aging and sun exposure. As a remedy, this cream can help fade hyperpigmentation by inhibiting the production of tyrosinase, the enzyme required for pigmentation. As fresh cells form, dark spots fade.

Rosacea treatment 

Azelaic acid is routinely prescribed for people with rosacea primarily due to its anti-inflammatory properties. It’s been 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

Azelaic acid cream can be used by itself or safely with other products within your skin care regimen. Your dermatologist may instruct you to apply the cream once or twice daily. Use only as prescribed, as overuse can lead to unwanted side effects such as irritation and redness.

To safely use azelaic acid in your skin care routine: 

1. Wash your face with a gentle cleanser; pat dry
2. Apply a thin layer of azelaic acid cream
3. Wash your hands
4. Allow the medication to dry
5. Apply moisturizer and follow your regular skin care routine 

Following are a few tips for using this product safely: 

• Set a reminder for yourself so you can stay on schedule 
• Use sparingly 
• If you miss an application, don’t double dose; simply resume at the next scheduled time
• Keep the product away from your eyes, mouth and the inside of your nose 

How to use gels

Azelaic acid gels are used in the same way as cream. After applying the gel, allow it to dry before you continue with 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 resolve within a few minutes; if not, rinse your skin, discontinue use, and speak to your dermatologist. 

Side effects are usually limited to those using the product for the first time.  Common mild, side effects include: 

• Burning
• Dryness
• Sensitivity
• Stinging
• Tingling

Moderate side effects, which occur less often, include: 

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

Although the incidence rate of severe side effects have not been documented, there have been a number of rare side effects reported in association with azelaic acid use. These include: 

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

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

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

Alternative Options

Although azelaic acid is generally considered safe for most skin types, it still has the potential for adverse side effects. If this is the case, or you would prefer another treatment, there are several alternatives to consider.

Alpha Hydroxy Acid (AHA)

AHAs such as glycolic acid may be a strong alternative to azelaic acid. They can effectively treat dull rough skin, lighten hyperpigmentation, reduce the look of acne scars, clear blocked pores and control oily skin. AHAs can soothe inflammation and have antibacterial benefits. 

Beta Hydroxy Acid (BHA)

Salicylic acid is a BHA typically used to treat oily skin and symptoms of acne (whiteheads, blackheads and sebaceous filaments). Salicylic acid helps to clear pores and gently removes excess oil to both treat and prevent acne breakouts. This acid has anti-inflammatory and antimicrobial properties. 

Retinol

Retinol and other retinoids are a first-line treatment for acne. It can open clogged pores, smooth the look of scars and improve skin tone. As an anti-inflammatory, it can significantly reduce swelling and ease discomfort. Retinol can also help improve hyperpigmentation and acne scars.   

Retinoids are not recommended for rosacea as they can worsen redness and the appearance of spider veins. And unlike azelaic acid, retinol does not exfoliate the skin.

 Takeaway

Azelaic acid cream is an effective treatment for skin conditions such as acne, rosacea and hyperpigmentation. Its anti-inflammatory, antibacterial and exfoliating properties provide benefits to address multiple symptoms. 

Azelaic acid cream can be easily integrated into your skin care regimen. It can be safely combined with other skin care products that you normally use. Azelaic acid gel provides the same benefits but absorbs into skin more quickly. Some scientific evidence points to a 15% gel being more effective than a 20% cream. 

If you are unable to use this cream due to side effects or for any other reason, other products such as retinol, AHAs or BHAs are appropriate alternatives.

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