- Azelaic acid side effects include tingling, stinging, itching, dry skin and irritation.
- The most commonly reported adverse effects of azelaic acid are mild and usually only last for a few days.
- If you experience azelaic acid side effects, your dermatologist may recommend octadecenedioic acid, antibiotics, retinoids or other alternative skin care products.
Azelaic acid is generally considered to be a safe topical treatment for a number of skin conditions. Its most common side effects are mild, and many patients report that the mild side effects go away after the first few days of treatment.
What is Azelaic Acid?
Azelaic acid, a dicarboxylic acid compound, is derived from the type of yeast that lives on healthy skin. It is also derived from barley, rye and wheat. It’s an anti-inflammatory, antibacterial and anti-keratinizing substance.
Skin care uses
Aside from exfoliation, azelaic acid helps to even out the skin tone and smooth skin. It reduces the production of melanin and inhibits the overproduction of keratin, a protein in skin, hair and nails, which can cause acne breakouts. Azelaic acid’s antibacterial, anti-inflammatory properties help to reduce irritation, redness of the skin and inflammation.
Azelaic acid comes in both prescription and over-the-counter formulations including gels, creams, and foams. Prescription azelaic acid is normally found in concentrations of 15 to 20%. The most commonly-prescribed brands include Finacea (15%), Azelex (20%) and Skinoren (20%).
Gel and cream formulations are usually recommended for use on the face and the neck. Azelaic acid foam is used on larger areas of skin such as the back or the chest.
Both prescription and over-the-counter azelaic acid treatments are considered effective against conditions like papules, pimples and pustules caused by acne. There is not currently conclusive evidence that indicates that prescription azelaic acid is more effective than over-the-counter.
Azelaic acid’s effectiveness is not necessarily based on its concentration. For example, a gel formula containing 15% azelaic acid might be more effective for some people then a cream that contains 20% azelaic acid.
How to Use Azelaic Acid Safely
To use azelaic acid safely, first, consult your dermatologist, who will take your condition and your skin type into consideration. Your dermatologist will recommend either an over the counter or prescription as like acid treatment that’s appropriate for your unique condition.
Over-the-counter formulations usually contain 10 to 15% azelaic acid. If your dermatologist recommends a prescription, the treatment will contain 15% or more.
Use topical azelaic acid as recommended by your dermatologist–usually once or twice a day. If you have sensitive skin, your dermatologist may recommend that you only apply it topically every other day.
It’s simple to incorporate azelaic acid into your skin care routine. First, wash your face with a gentle cleansing lotion or mild soap. Next, apply a thin layer of azelaic acid gel or cream to your skin. Then, follow up with a gentle moisturizer that’s suitable for your skin type.
Avoid using toners or cleansers with an alcohol base. Additionally, avoid using skin care products meant for deep cleansing. Peeling or abrasive agents could irritate your skin, so it’s best to skip those if you’re using azelaic acid.
It could take four to six weeks of treatment to see the results of azelaic acid. Your dermatologist may recommend up to three months of treatment.
Before you begin using azelaic acid, patch test a small area of your skin. You’ll be able to determine whether you are sensitive to the product. Azelaic acid tends to cause a mild tingling sensation when you first apply it, but that should go away after a few minutes.
Only apply azelaic acid as directed. Using it too often could irritate your skin or make your symptoms worse.
Side Effects of Topical Azelaic Acid
People who have never used azelaic acid before are particularly prone to experiencing mild side effects at the application site. The most common, possible side effects of azelaic acid include:
- Skin sensitivity
Other, more serious side effects include:
- Flaking of skin
- Severe redness
- Severe burning
A number of rare side effects have been reported by patients who used azelaic acid. The incidence of these possible side effects isn’t known:
- Watery eyes
- Eye pan
- Red eyes
- Vision blurring
- Changes in skin color
- Tachycardia (rapid heartbeat)
- Tight, stiff, or painful feeling in the joints
- Joint swelling
- Swollen eyes
- Large, significant hives on the body
- Tight feeling in the chest
- Difficulty swallowing or breathing
People with asthma should use azelaic acid with caution. Azelaic acid has been shown to cause worsening of asthma symptoms in some individuals.
Foam formulations of azelaic acid have been found to produce fewer adverse effects then cream and gel formulas.
Can azelaic acid be used during pregnancy?
Azelaic acid is considered to be safe for pregnant and breast-feeding women. There is currently no significant scientific evidence that azelaic acid could harm a fetus or pass into a mother’s breast milk. Still, it’s best to consult a healthcare professional before using azelaic acid if you’re pregnant, nursing or may become pregnant.
Azelaic Acid Side Effects for Different Skin Types
Azelaic acid is potentially problematic for certain skin types, but overall, it’s considered safe and effective for most people.
Acne prone skin
If you have skin prone to acne breakouts, starting an azelaic acid treatment may make your acne worse before it gets better. That’s because the azelaic acid treats blocked pores, opening them up and bringing impurities to the skin’s surface. This is often referred to as purging.
Talk to your dermatologist if your acne symptoms become worse after using azelaic acid. They may recommend you use the treatment less often. You may also need to change medications.
Azelaic acid causes skin sensitivity and irritation in some people. For individuals who have particularly sensitive skin, it could cause severe irritation or even an allergic reaction.
If you experience irritation after using azelaic acid for the first time, it should go away after a few days. Because azelaic acid can irritate the skin, people with sensitive skin, eczema, or mild to moderate rosacea may only need to apply medication every other day–or possibly even every 3 days. It’s also possible that using smaller amounts of azelaic acid could make a difference in the side effects experienced.
If you have dark skin, using azelaic acid could cause a condition called post inflammatory 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. Alpha hydroxy acids, vitamin C and retinoids may be safely combined with azelaic acid with few side effects. Overall, it’s safe to use azelaic acid with most skin care products.
Benzoyl peroxide and azelaic acid may be used together safely. Benzoyl peroxide kills acne-causing bacteria and dries up comedones, helping them to shrink and eventually peel away from the skin’s surface. Azelaic acid can help fight bacteria and reduce redness associated with acne.
Azelaic acid may also be used after a mild salicylic acid cleanser. Salicylic acid is a gentle exfoliant. When combined with azelaic acid, the two ingredients can help to even the skin tone.
If azelaic acid isn’t right for you, there are alternative options like skin care products and prescription drugs that may be more appropriate for your skin type and medical condition.
- Octadecenedioic acid, a bleaching agent that treats hyperpigmentation and acne; it also has antibacterial properties
- Oral antibiotics like tetracycline and doxycyline, which treat acne and rosacea
- Oral and topical retinoids, which may provide similar results to azelaic acid; results take longer to appear
- Zinc and nicotinamide, which treat lesions and inflammation caused by rosacea
- Alpha hydroxy acids (AHA) and beta hydroxy acids (BHA), which act as mild exfoliants and skin rejuvenators
Azelaic acid side effects are usually mild and temporary, such as sensitivity, tingling, dryness, stinging and burning of the skin. Generally, azelaic acid is considered to be a safe medication.
It’s important to apply azelaic acid only as per your doctor’s instructions. Overuse could cause skin irritation.
Sometimes, patients who use azelaic acid 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 healthcare provider for medical help immediately.
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