- Azelaic acid is a topical medication with side effects that include tingling, stinging, itching, dryness and irritation
- The most commonly reported adverse effects are mild and usually last for several days
- Your dermatologist may recommend octadecenedioic acid, antibiotics, retinoids or other alternative skin care products if you experience any side effects
Considered a safe topical treatment, azelaic acid is typically prescribed for a number of skin conditions. Azelaic acid side effects are usually mild, and many patients report these effects resolve after the first few days of treatment.
What Is Azelaic Acid?
Azelaic acid, a dicarboxylic acid compound, is derived from a type of yeast that is normally present on healthy skin. It is also a natural component of barley, rye and wheat; however a synthetic version is used in skin care products. It is valued for its anti-inflammatory, antibacterial and antikeratinizing effects.
Skin care uses
Azelaic acid is a topical medication that acts as a gentle exfoliant and can treat rosacea, melasma, acne and hyperpigmentation.
In addition to exfoliation, this acid helps to even tone and smooth skin. It reduces the production of melanin and inhibits the overproduction of keratin (a protein in skin, hair and nails) that can cause acne breakouts. Azelaic acid has strong antibacterial, antioxidative and anti-inflammatory properties to reduce irritation, redness and inflammation.
Azelaic acid is available over the counter (OTC) in concentrations of 10–15% and in prescription strengths of 15–20%. The most commonly prescribed brands are Finacea, Azelex and Skinoren.
This acid is available in gel, cream and foam formulations. Gel and cream formulations are usually recommended for use on the face and the neck; foam is best for larger areas of skin such as the back or chest.
Both OTC and prescription strength azelaic acid treatments are effective against the papules, pimples and pustules that accompany acne. Both have similar efficacy – there is no conclusive evidence to indicate that one is more effective than the other.
How to Use Azelaic Acid Safely
Your dermatologist will take your condition, severity and skin type into consideration, and will either recommend an OTC or prescription treatment. To use azelaic acid safely, follow all provided instructions carefully.
Your dermatologist will instruct you to apply the medication once or twice daily. If you have sensitive skin, you may be advised to use it every other day.
It’s simple to incorporate azelaic acid into your skin care routine. First, wash your face with a gentle cleansing lotion; apply a thin layer of azelaic acid gel or cream to your skin; follow with a gentle moisturizer that’s suitable for your skin type.
It could take 4–6 weeks of treatment before you see any results. Your dermatologist may recommend up to 3 months of treatment.
Before you begin using azelaic acid, patch-test a small area of your skin to determine if you are sensitive to the product. Azelaic acid tends to cause a mild tingling sensation when first applied, but that should dissipate after a few minutes.
Only apply azelaic acid as directed; overuse could irritate your skin or worsen symptoms.
Side Effects of Topical Azelaic Acid
People who have never used azelaic acid before are particularly prone to experiencing mild side effects. Foam formulations of azelaic acid have been found to produce fewer adverse effects than cream and gel formulas.
The most common side effects of azelaic acid include:
- Skin sensitivity
Other, more serious side effects include:
- Flaking of skin
- Severe burning
- Severe redness
A number of rare side effects have been reported by patients including:
- Changes in skin color
- Difficulty swallowing or breathing
- Eye pain
- Joint swelling
- Large, significant hives on the body
- Red eyes
- Swollen eyes
- Tachycardia (rapid heartbeat)
- Tightness in the chest
- Tight, stiff or painful feeling in the joints
- Vision blurring
- Watery eyes
People with asthma should use azelaic acid with caution, as it has been shown to cause worsening of asthma symptoms in some individuals.
Can azelaic acid be used during pregnancy?
Azelaic acid is considered to be safe for pregnant and breastfeeding women. Still, it’s always recommended to consult a health care professional before using this or any medication if you’re pregnant, nursing or may become pregnant.
Azelaic Acid Side Effects for Different Skin Types
Azelaic acid is potentially problematic for some skin types, but overall, it’s considered safe and effective for most people.
If you have skin that is prone to acne breakouts, starting an azelaic acid treatment may make your acne appear worse before it improves. This is the medication effectively opening up the blocked pores and bringing the dead skin cells, oils and other impurities to the skin’s surface. This is commonly referred to as purging.
Talk to your dermatologist if your acne symptoms worsen over an extended period of time or if skin is still not improving. They may recommend you use the treatment less often or prescribe another medication.
Azelaic acid can cause skin sensitivity and irritation in some people. For those with particularly sensitive skin, it could cause severe irritation or even an allergic reaction.
With this in mind, people with sensitive skin, eczema or mild to moderate rosacea should apply the medication every other day or even every third day. Using smaller amounts of azelaic acid could also lessen the risk of side effects and their severity.
If you have dark skin, using azelaic acid could cause a condition called postinflammatory hypopigmentation. When dark skin becomes inflamed, melanin production sometimes decreases, causing the skin to lighten.
Because azelaic acid is a mild treatment, it’s safe to combine it with a number of topical products, including alpha hydroxy acids, vitamin C and retinoids. Overall, it’s safe to use with most skin care products, with two exceptions.
It is best to avoid using any toners or cleansers that have an alcohol base, as well as products meant for deep cleansing or exfoliation. These can increase skin irritation.
Benzoyl peroxide and azelaic acid can be used safely and effectively together. Benzoyl peroxide kills acne-causing bacteria and dries up pimples and blackheads, encouraging them to peel away from the skin’s surface. Azelaic acid can help fight bacteria and reduce redness associated with acne.
Azelaic acid can also be applied after a mild salicylic acid cleanser. Salicylic acid is a gentle exfoliant, and when combined with azelaic acid, the two ingredients can help even skin tone.
If azelaic acid isn’t right for you, there are OTC products and prescription drugs available that may be more appropriate for your skin type and condition.
- Octadecenedioic acid has antibacterial properties and is a bleaching agent that treats hyperpigmentation and acne
- Oral antibiotics such as tetracycline and doxycycline can effectively treat acne and rosacea
- Oral and topical retinoids can provide similar results to azelaic acid, however results may take longer to occur
- Zinc and niacinamide target lesions and inflammation caused by rosacea
- Alpha hydroxy acids (AHA) and beta hydroxy acids (BHA) act as mild exfoliants and skin rejuvenators
Azelaic acid is a topical medication that can effectively treat skin conditions such as acne, rosacea, melasma and hyperpigmentation. It is known for its anti-inflammatory, antibacterial and antikeratinizing qualities.
Azelaic acid side effects are usually mild and temporary, and include sensitivity, tingling, dryness, stinging and burning of the skin. Generally, azelaic acid is considered to be a safe medication.
Sometimes, patients who use this medication experience moderate to severe side effects such as itching, flaking, crusting, swelling, pain, hives, rash or blistering. If you experience ongoing or severe side effects, discontinue use and see your health care provider immediately for medical attention.
If this medication is not right for you, there are other solutions available that produce comparable results. These include topical AHAs and BHAs to exfoliate and smooth skin; oral antibiotics such as tetracycline and doxycycline to kill acne-causing bacteria.
It’s important to apply azelaic acid according to your doctor’s instructions. Overuse could cause skin irritation and worsening symptoms.
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