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Dr. Alpana Mohta Ranka, MD, DNB, IFAAD, is a dual-board-certified dermatologist with over 90 research publications in peer-reviewed scientific journals.

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Azelaic Acid for Skin: Not Just an Ordinary Skincare Active

Updated: Nov 24, 2023

Azelaic acid can not only combat acne and unclog pores, but it also evens out the hyper-pigmentation of skin and helps lighten dark spots and make skin look brighter.


This relatively lesser-known skincare active punches way above its weight and has very few side effects.


As a dermatologist, I have prescribed azelaic acid to numerous patients and have seen its miraculous effects first-hand.


In this article, I will explain what this wonder ingredient is, what it does, and how it should be used. I will also provide my review of the available azelaic products in the markets based on the ingredients and their effectiveness.


Let's dive right in!

Properties of azelaic acid (anti-bacterial, anti-inflammatory and tyrosinase inhibtor) are mentioned against an aesthetic backdrop of an azelaic acid bottle, jewelry and a golden statue of a dog.
 

Tables of Contents

 

Why Azelaic Acid?

Although retinoids have proven to be a boon for acne-prone skin, they pose a major risk of making the skin extremely dry and prone to sunburns. Vitamin C can help in reducing the unsightly dark spots left by healing acne, but it acts very slowly, and it takes a long time, patience, and consistent usage before we can see any significant results.


Azelaic acid brings the best of both worlds, lesser side effects, and relatively quicker results.


What is Azelaic Acid?


Azelaic acid is a naturally occurring dicarboxylic acid that is derived from wheat, rye, and barley. It has several medical applications, including acne treatment, hyperpigmentation, and rosacea. As we will discuss below, in certain cases, It is vastly superior to other skincare actives.


What is Azelaic Acid Used For?

Due to azelaic acid's anti-bacterial action and its melanin-suppressing properties, it has various applications in skincare:


  • Acne Treatment: Azelaic acid fights acne by reducing the production of oil and fighting acne-forming bacteria. It is beneficial in the treatment of both inflammatory acne (papules and pustules) and non-inflammatory acne (blackheads and whiteheads). It also helps in reducing the redness and inflammation associated with acne.

  • Anti-inflammatory: Azelaic Acid also holds myriad anti-inflammatory, antioxidant, and antibacterial properties making it a holistic tool in a dermatologist's tool kit for various dermatological diseases. Apart from treating acne, hyperpigmentation, and dull skin, it is also used as a prescription drug for rosacea, keratosis pilaris, male pattern baldness, and hidradenitis suppurativa. However, before starting Azelaic Acid, you must always consult your dermatologist about how and when to use it.

  • Rosacea: The anti-bacterial and anti-inflammatory properties of azelaic acid make it an effective tool for the management of Papular Pustular Rosacea.

  • Treating dark spots or hyperpigmentation: It fades marks of hyperpigmentation caused by acne, melasma, sunburn, or any other form of skin trauma like insect bites. Azelaic acid reduces the activity of the enzyme tyrosinase. Tyrosinase is an essential enzyme for the production of melanin (the pigment that imparts color to the skin). In the case of skin hyperpigmentation and dark spots, there is an excessive accumulation of melanin. Azelaic Acid reduces the production of melanin and hyperpigmented skin cells.

  • Unclogs pores: Azelaic Acid can penetrate the sebaceous glands and unclog pores. It dissolves the excessive oily over your skin and clears your pores. It, therefore, helps prevent the formation of acne.

  • Mild exfoliant: It is also a mild skin exfoliant. Unlike alpha-hydroxy and beta-hydroxy acids, Azelaic Acid causes gentle skin exfoliation. By virtue of its keratolytic properties, it can break down the excessive epidermal keratin and remove the upper dead skin layers. Keratin is a protein found in the uppermost layer of skin, which can clog the pores when in an excessive amount.

Azelaic acid has an excellent safety profile. Unlike most other topical agents used for acne and melasma, Azelaic Acid is also safe to be used in pregnancy.


What are the Various Formulations of Azelaic Acid?

You can find azelaic acid in a 20% cream and a 10-15% gel, foam, lotion, or suspension. Even though the gel and foam have less active ingredients, they get into the skin better than the cream. This makes them work better. Patients might like the gel and foam more than the cream.

How to Use Azelaic Acid?

I will provide some general guidelines below.

This is how azelaic acid can be used depending on your skin condition.


For Rosacea:

The use of 15% Azelaic acid gel is an FDA-approved method for managing rosacea. For application, ensure your face is clean, then gently apply a thin layer of the azelaic acid gel across the affected areas on your face twice daily. This regimen can significantly contribute to improving the symptoms of rosacea over time.


For Acne:

While the FDA's approval of azelaic acid is specifically for rosacea, it has gained popularity for treating acne, particularly when other options like retinoids are contraindicated, such as during pregnancy.


For acne, you can choose between a 20% azelaic acid cream or a 15% gel/foam.


To use, cleanse your face thoroughly and allow it to dry before gently applying a thin layer of the chosen formulation to the affected areas.


Unlike harsh exfoliants such as tretinoin, azelaic acid's exfoliating effects are generally milder. Another advantage is that it doesn't bleach clothing, unlike benzoyl peroxide. While applying it twice a day is an option, individuals with sensitive skin might find it more suitable for nighttime use.


For Hyperpigmentation:

When addressing hyperpigmentation or dark spots, a targeted approach is often preferred. For this purpose, you can use a 20% azelaic acid cream.


Apply the cream specifically to the affected areas in the evening. This spot application method allows the active ingredient to work on the hyperpigmented regions overnight. The azelaic acid helps regulate melanin production and improve skin tone. It can take up to 3 months to see optimal results.

 

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How Long Does it Take for Azelaic Acid to Clear Rosacea?

You can expect significant improvement around the three-month mark of usage. Research published in JAMA Dermatology has even indicated that azelaic acid gel surpasses metronidazole gel in rosacea management.


Simply put, Azelaic Acid is an under-explored drug with versatile properties. It not only cleans your pores but also watches over the acne-causing bacteria. Azelaic Acid is available in the market in various concentrations and preparations ranging from gels, creams, foams, and lotions in 5% to 20%.


Can You Layer Azelaic Acid with Sunscreen?

Even though Azelaic acid doesn't make your skin sensitive to the sun, it does gently exfoliate the skin cells, which can result in slight sun sensitivity. Therefore, if you're using Azelaic acid during the day, always wear sunscreen with SPF 50 or higher. It usually takes around 3-4 weeks to start noticing a significant reduction in acne when using Azelaic acid.


Azelaic Acid Side Effects


Side effects of azelaic acid can include:

  • Skin Irritation: Some individuals may experience mild to moderate skin irritation, redness, itching, or burning at the application site. This is usually temporary and diminishes as the skin becomes accustomed to the treatment.

  • Dryness: Azelaic acid may cause dryness or peeling of the skin, especially when starting treatment. Proper moisturization can help alleviate this effect.

  • Tingling Sensation: A slight tingling or stinging sensation might occur upon application, mainly if the skin is sensitive.

  • Temporary Hyperpigmentation: In some cases, azelaic acid might cause temporary skin darkening (hyperpigmentation). This effect is usually reversible upon discontinuation.

  • Allergic Reactions: While rare, allergic reactions such as rash, hives, or swelling may occur. If these symptoms develop, discontinue use and consult a healthcare professional.

  • Exacerbation of Asthma: Azelaic acid can be a potential trigger for asthma symptoms in individuals with a history of asthma.


Best Azelaic Acid Products - Dermatologist Recommended

  1. My personal favorite is the Sesderma Azelac Ru Serum.


As we conclude our exploration of the impressive benefits of azelaic acid, let's turn our attention to another skincare powerhouse that offers its own unique advantages – Glycolic Acid.


While glycolic and azelaic acids should not be used together due to potential interactions, it's important to understand the potential of each individually.


In this context, let's delve into the remarkable properties of Glycolic Acid and

discover how glycolic acid can enhance your skincare routine and unveil a complexion that exudes vibrance and vitality.


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