Azelaic Acid: What It Is, Benefits, Uses, Side Effects, and More

• Azelaic acid is a gentle exfoliant effective at treating acne, rosacea, hyperpigmentation and melasma
• It possesses anti-bacterial, anti-inflammatory and anti-keratinizing properties
• It touts exfoliating and antioxidant benefits that smooths skin and evens out skin tone.
• Some side effects may include irritation, dry skin, tingling, itching and stinging, and usually only lasts within the first few days

What is Azelaic Acid?

Azelaic acid is a dicaboxylic acid compound that is naturally produced from yeast that lives on healthy skin, but can also be derived from wheat, rye and barley.

This particular acid is used in skincare products to battle skincare issues such as mild to moderate acne vulgaris, rosacea and hyperpigmentation. Considered a multi-tasker, it can also be used in hair products and commonly formulated with minoxidil (Rogaine) to help treat baldness.

What does azelaic acid do to skin?

Azelaic acid is able to minimize dark spots by reducing melanin production. (Melanin is a natural pigment responsible for producing color in the skin). It is also anti-keratinizing, meaning that it inhibits keratin (a protein found in skin, nail and hair) growth and prevents the buildup of dead skin cells that can trigger breakouts. It is also anti-bacterial and anti-inflammatory, which helps reduce inflammation, irritation and redness caused by blemishes or rosacea.

Azelaic acid vs AHAs and BHAs

While azelaic acid isn’t as common as other chemical-based acids such as alpha hydroxy acids (AHAs), which include glycolic acid and lactic acid, and beta hydroxy acids (BHAs), such as salicylic acid, they do share some similar traits.

All of these acids are considered exfoliants and remove dead skin cells, makeup and excess sebum in the skin’s top layer. This exfoliation encourages cell turnover which aids in a smoother complexion and more even skin tone.

Azaleic acid is milder than AHAs and BHAs, with fewer side effects and complications. It also may have the upper hand since in addition to exfoliation, it touts antibacterial and anti-inflammatory benefits (salicylic only has anti-inflammatory), that minimizes the bacteria that causes pimples, and its resulting inflammation and irritation.

Azelaic acid can also be layered with retinol, unlike AHAs and BHAs, where the combination can dramatically increase irritation and dryness.

Azelaic Acid Benefits and Skin Care Uses

Azelaic acid is a skincare multi-tasker that possesses the ability to handle a variety of skin issues.

First, it touts anti-keratinizing capabilities, which means it reduces the production of keratin — the protein that produces sebum which can clog pores, create a buildup of dead skin cells and cause pimples.

It’s an antioxidant that helps battle chronological aging by neutralizing the free radicals that create cellular damage and lead to wrinkles, fine lines and skin sagging.

It is anti-inflammatory and helps minimize redness and inflammation caused by acne or rosacea.

It has antibacterial properties that curbs the growth of acne-producing bacteria (Propionibacterium acnes), as well as the bacteria that causes rosacea.

It inhibits the production of tyrosinase, the enzyme that promotes pigmentation, resulting in dark spots or melasma. When tyrosinase is reduced, so is melanin synthesis and this stops the discoloured cells from populating and creating dark patches.

Azelaic acid also has exfoliating capabilities that help remove dead skin cells, unclog pores, and helps make way for new cells to emerge for a more even skin tone.

Acne treatment

Azelaic acid has proven to be an effective acne treatment thanks to its triple-threat combination of anti-keratinizing, anti-inflammatory and anti-bacterial properties.

One of the causes of acne is increased sebum production. By reducing the production of keratin within the hair follicle (the pore), this lessons sebum generation, which can clog pores and form a pimple.

Since azelaic acid contains anti-bacterial properties, it can eradicate the free fatty acid content found on the skin’s lipid layer, making it bacteria intolerant, therefore preventing pimple flare-ups.

Azelaic acid’s anti-inflammatory nature is an added bonus as it reduces redness, inflammation and skin sensitivity.

Azelaic acid has been proven to be just as effective as some oral antibiotics and topical benzoyl peroxide, and with less side effects, some of which can include skin sensitivity, dryness and irritation.

Rosacea

Rosacea is a skin condition where areas of the face — primarily the chin, cheeks and forehead — turn red from dilated capillaries with some bumps and swelling occurring.

Azelaic acid’s anti-inflammatory properties has been shown to successfully reduce the pustules and papules caused by rosacea, and is approved by the U.S. Food & Drug Administration (FDA) as a formal, topical treatment for rosacea.

Hyperpigmentation

Azelaic acid can help reduce post-inflammatory hyperpigmentation — dark, discolouration of the skin that can show up as brown or black marks or freckles. These marks are usually triggered by acne, aging and prolonged sun exposure.

By limiting tyrosine (the enzyme that promotes pigmentation) and free radical production — another hyperpigmentation-trigger, it reduces the pigmentation that causes dark spots and melasma.

Prescribed as an alternative to hydroquinone (a spot-lightening agent) azelaic acid’s side effects have a lower degree of irritation and dryness, which makes it more suitable for those with dry, sensitive or eczema-prone skin.

Azelaic acid can help lessen hyperpigmentation, but those with darker complexions could experiencing hypopigmentation or abnormal discolouring of the skin. If this occurs, stop using azelaic acid immediately and consult your dermatologist.

Melasma

Similar to hyperpigmentation, melasma is a condition caused by an overproduction of melanin but is initiated by hormonal fluctuations like pregnancy. It can also be exacerbated by sun and heat exposure, and mainly appears in blotchy patterns along the nose, forehead, chin and upper lip.

Azelaic acid is frequently combined with retinoids and is considered a milder alternative to hydroquinone to manage hard-to-treat melasma. And since it can make skin sun-sensitive, it’s best to layer a sunscreen of SPF 30, or higher overtop.

Azelaic Acid Products

Azelaic acid comes in a variety of formulations, ranging from foams to creams and gels. They can be found over the counter (OTC) or by prescription. The most common brands are Azelex (20%) Skinoren (20%) and Finacea (15%), and are only available with a prescription.

Foams are generally prescribed for use on larger areas like the chest, while gels and creams are recommended to use on the face and neck.

Prescription vs OTC azelaic acid topicals

Choosing between an OTC or prescription should be determined with guidance from a dermatologist who will take into consideration your skin type and tolerance levels. Usually, a doctor-prescribed treatment will have 15 percent azelaic acid or more.

OTC options are generally available in 10 to 15 percent concentrations. While there aren’t conclusive evidence that prove that prescription is more effective than OTC versions, both are still considered an effective acne treatment.

In some cases, a higher concentration doesn’t mean better results. For example, a 15 percent gel formula can have a better delivery system than a cream with a higher concentration, and therefore, can be more effective.

How to Use Azelaic Acid

Before introducing any new ingredient into your skincare regimen, start with a patch-test. Usually, azelaic acid will have a slight tingle when first applied to the skin. If there is no irritation after a few hours, apply the product up to twice a day — morning and evening.

For those with sensitive skin, apply it once every other day. If there is no discomfort, slowly increase to once a day. If you are using a prescription-based product apply it according to the directions.

After washing with a mild cleanser, apply a thin layer of azelaic acid. Follow with a moisturizer suited to your skin type. Since azelaic acid can cause skin sensitivity, it’s best to wear a sunscreen with a minimum of 30 SPF and reapply regularly.

Avoid alcohol-based cleansers or toners, or anything that is labeled ‘deep-cleaning’. It’s also best to skip the use of abrasive or peeling agents as this could cause additional irritation to the skin.

Azelaic acid results are slow but effective so try to stick with your skincare routine for up to three months (some people could see results within 4-6 weeks).

If azelaic acid gets into the eyes, rinse immediately. If your eyes start to experience any irritation, call your doctor.

Who should avoid using azelaic acid?

Avoid azelaic acid if you are allergic to propylene glycol (type of alcohol used in personal care products) or azelaic acid.

While there is no significant evidence that azelaic acid (OTC or prescription) can pass through breast milk or harm to a nursing baby, you should consult your doctor before use, and if you are pregnant or thinking of getting pregnant.

For those with asthma or prone to cold sores, speak with your doctor before using azelaic acid.

Azelaic Acid Safety and Side Effects

Azelaic acid is considered to have mild side effects, but could still cause skin irritation, especially for first-time users. This includes skin sensitivity, dryness, tingling, burning or stinging, redness, or peeling of the skin, and usually at the site of application. If there is irritation, it should subside after a few days of use.

For those with sensitive, rosacea or eczema-prone skin, begin by using azelaic acid, say, every 2-3 days instead.

Out of the three types of formulas: cream, gel or foam, it was found that the foam (at 15% azelaic acid) produced less side effects than those who used a gel (also at 15%) or cream (at 20%).

More serious side effects can include blistering or flaking of skin, swelling, hives and itching, tightness of joints, fever or difficulty breathing.

Azelaic acid could also cause post-inflammatory hypopigmentation in those with darker skin tones. Darker skin produces more melanin, but it can also have the opposite effect. If the skin becomes inflamed, it can cause a severe decrease in melanin production and the skin lightens in shade. If you experience this or any of the less-common side effects, stop using the product and contact your doctor immediately.

Interactions

Due to its mild nature azelaic acid can be combined with many other topical products, such as retinoids, vitamin C and alpha hydroxy acids, and with minimal side effects.

In some cases, skin can become sensitive with azelaic acid use, so it’s recommended to stop the use of alcohol-based cleansers or toners, and abrasive or peeling agents.

Azelaic Acid Alternatives

Few ingredients have such multi-tasking abilities as azelaic acid.

One ingredient that could be considered an alternative is octadecenedioic acid — also a dicaboxylic acid compound that can deliver similar skin benefits, but in lower concentrations. While it is considered more of a bleaching agent, it also has anti-bacterial properties, can reduce hyperpigmentation, and help treat acne.

The only caveat is that not much research has been done on this ingredient and it needs further study before it can be deemed equal to azelaic acid.

Other possible alternatives lack azelaic acid’s triple-threat results. For example, there are oral antibiotics such as tetracycline (it also touts anti-inflammatory and anti-microbial properties), that can help with acne and rosacea, but not hyperpigmentation.

Hydroquinone, a known skin-lightener, is able to treat hyperpigmentation and melasma, but would have to be combined with other ingredients in order to manage rosacea or acne.

A combination of oral (isotretinoin) and topical retinoids may also have similar results as azelaic acid but can have longer wait times before seeing any improvement.

The antioxidant nicotinamide and zinc have also been used to help reduce and regulate inflammatory lesions caused by rosacea, but don’t have the same anti-acne effects.

Takeaway

Azelaic acid is a multi-functioning compound that is highly effective in treating acne, rosacea, dull skin and hyperpigmentation and melasma, thanks to its antioxidant, anti-inflammatory, anti-keratinizing and antibacterial capabilities.

While it may not be as popular as its AHA and BHA exfoliating counterparts, or other well-known treatments such as retinoids (tretinoin), hydroquinone and oral antibiotics, azelaic acid shows similar results with less side effects, allowing it to be tolerated by more people.