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Nov 04, 2021
6 min read

Azelaic acid: benefits, side effects, what does it do

Azelaic acid is a natural acid that has anti-inflammatory and antimicrobial properties. It’s available in both over-the-counter and prescription formulas, in a wide range of topical products like gels and creams. Since it can kill bacteria and quell inflammation, it’s commonly used to treat acne and rosacea. Azelaic acid causes temporary skin irritation in 5–10% of people who use it.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

If you’re new to the wide world of skincare products, dipping your toe into acids can seem, well, unappealing. But despite any painful mental images you may be conjuring about their effects, products such as azelaic acid may work wonders for your skin tone, calming redness, and evening out skin tone. Read on to learn more about azelaic acid.

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What is azelaic acid?

Azelaic acid belongs to a family of medications called dicarboxylic acids, and it’s naturally occurring. In fact, many of the foods you eat contain it. This natural acid is found in whole grains such as barley, wheat, and rye. 

Here’s the important part for your skin: Unlike those acids from chemistry class you’re probably thinking about, azelaic acid has antimicrobial and anti-inflammatory properties (Searle, 2020). 

Azelaic acid also comes in a wide range of skincare products. You can find azelaic acid gel, azelaic acid cream, and azelaic acid foam products. They also vary in concentration—the over-the-counter versions have a lower concentration, while more potent formulations are available with a prescription under brand names such as Azelex and Finacea.

What does azelaic acid do?

Azelaic acid is an effective treatment for different skin conditions because of its anti-inflammatory, antioxidant, and antimicrobial properties. 

Azelaic acid helps with inflammation by preventing skin cells from activating specific immune pathways. This decreased inflammation improves certain skin conditions like rosacea and inflammatory acne

It also has antioxidant properties. Azelaic acid prevents the formation of oxygen free radicals, which cause oxidative damage to your skin and can trigger more inflammation (Searle, 2020; Dall’Oglio, 2021). 

In addition to its effects on inflammation, azelaic acid also stops the growth of skin bacteria, like Cutibacterium acnes (C. acnes) and Staphylococcus epidermidis (S. epidermidis). Scientists have not discovered the exact mechanisms azelaic acid uses to fight these bacteria, but they suspect it may interfere with the microbe’s ability to make specific proteins (Hung, 2021). This can come in handy when treating the infectious components of acne breakouts. 

Lastly, azelaic acid also helps prevent pore clogging, making it an effective acne treatment (Searle, 2020).

Azelaic acid uses

Azelaic acid is FDA-approved to treat the following conditions (UpToDate, n.d.): 

  • Mild to moderate acne (inflammatory type) 
  • Mild to moderate rosacea, an inflammatory skin condition

Sometimes azelaic acid is used “off-label,”—meaning to treat a condition other than what it was FDA-approved to treat. Off-label uses include treating hyperpigmentation, hidradenitis suppurativa, male pattern baldness, and psoriasis (Searle, 2020).

Benefits of azelaic acid

Until recently, azelaic acid hadn’t gotten as much attention as alpha-hydroxy acids (AHAs) such as glycolic acid or lactic acid. But the benefits of this well-tolerated acid should earn it a large following. Like benzoyl peroxide, azelaic acid can kill bacteria that may cause breakouts. It also has exfoliating properties and may reduce the look of wrinkles like harsher acid treatments, just with far less irritation. But that’s just the beginning of what azelaic acid may do for your skin.

Azelaic acid for acne

Azelaic acid is no stranger to skincare regimens for acne-prone skin. Several studies have shown that it can help improve inflammatory acne, either alone or in combination with other treatments. One small study suggests that azelaic acid may also improve noninflammatory acne lesions. This effect against pimples is most likely due to azelaic acid’s anti-inflammatory and antibiotic properties (Searle, 2020; Hashim, 2018).

Once you’ve cleared your skin, you’re probably going to want to keep it clear from breakouts going forward. Azelaic acid may also be able to help prevent acne. Its antibacterial properties have been shown in vitro to fight the bacteria responsible for causing certain types of acne (Apriani, 2019). Bacteria trapped in pores or hair follicles are one cause of acne.

Clogged pores are another cause of acne. People with acne have sticky dead skin cells and increased oil (sebum) production that leads to acne development. Azelaic acid can help prevent your pores from getting clogged, thereby keeping your skin clear (Searle, 2020).

Azelaic acid for rosacea

Rosacea is a common, chronic dermatological condition that causes visible blood vessels and redness in the face. Sometimes people with rosacea may develop small, red, pus-filled bumps or pustules called acne rosacea (or papulopustular rosacea), and the severity of these symptoms can change over time (Farshchian, 2021). Several studies have shown that azelaic acid can help treat rosacea thanks to its anti-inflammatory and antioxidant properties (Searle, 2020). 

Azelaic acid for hyperpigmentation

This compound may also help with skin conditions characterized by dark spots or hyperpigmentation—azelaic acid may lighten these dark spots. This effect may be due to its anti-inflammatory and antioxidant properties. Azelaic acid may also decrease the function of pigmented cells (melanocytes) responsible for those dark spots. Several studies show that azelaic acid may be an effective treatment for post-inflammatory hyperpigmentation and melasma (Searle, 2020; Rachmin, 2020).

Azelaic acid for acne scars

Dark spots that appear from old acne scars have a similar hyperpigmentation issue as cells discussed above, so azelaic acid may act on these spots in the same way. These dark spots that appear following acne are called post-inflammatory hyperpigmentation (PIH), and people with darker skin tones are at a higher risk of developing them (Fatima, 2020). Since azelaic acid can help decrease inflammation, it may reduce PIH (Zaenglein, 2018).

Azelaic acid for wrinkles

As time goes on, your skin ages due to extrinsic factors, like sun damage, and intrinsic causes like natural aging. Oxidative stress can be a significant cause of aging signs (Shanbhag, 2019). Azelaic acid may help improve the signs of aging due to its antioxidant properties.  

How to use azelaic acid

To prep your skin for any azelaic acid, you should cleanse your skin before using these products. Some azelaic acid treatments are applied to affected areas rather than over the entire face. 

You should allow the product to dry before using lotions, moisturizers, makeup, or other skincare products to allow for maximum absorption.

How long does it take azelaic acid to work?

It takes some time to see results from azelaic acid. Many studies looking at the effectiveness of azelaic acid allowed for anywhere from 12–24 weeks of treatment, depending on the skin condition.

It’s important to note that you may not experience the same results observed in a study. Still, consistency in using the product is just as important for you as for study participants. If a product is not used as advised, any results may take longer to appear.

Azelaic acid side effects and risks

Although it’s uncommon, azelaic acid products such as cleansers, serums, and gels may initially cause skin irritation. That could mean burning, itching, peeling, skin dryness, or skin redness (UpToDate, n.d.). Your dermatologist may be able to suggest a concentration best suited to your skin type to prevent possible irritation.

Rarely, people with darker skin may notice skin lightening in the treated areas—this is called hypopigmentation (UpToDate, n.d.). 

Some people develop hyperpigmentation or acne in response to the hormonal changes of pregnancy. Azelaic acid is sometimes used during pregnancy or while breastfeeding. The FDA rates it as a Pregnancy Category B drug—meaning, animal studies did not show harm, but there is not enough human data to know for sure. You should discuss the risks and benefits with your dermatologist.  

References

  1. Apriani, E. F., et al. (2019). Formulation, characterization, and in vitro testing of azelaic acid ethosome-based cream against propionibacterium acnes for the treatment of acne. Journal of Advanced Pharmaceutical Technology & Research, 10(2): 75–80. doi: 10.4103/japtr.japtr_289_18. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/31041186
  2. Dall’Oglio, F., Tedeschi, A., Lacarrubba, F., Fabbrocini, G., Skroza, N., Chiodini, P., et al. (2021). A novel azelaic acid formulation for the topical treatment of inflammatory rosacea: A multicentre, prospective clinical trial. Journal of Cosmetic Dermatology, 20(Suppl 1), 28–31. doi: 10.1111/jocd.14098. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33934475/
  3. Farshchian, M. & Daveluy, S. (2021). Rosacea. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Retrieved on Oct 25, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK557574/
  4. Fatima, S., Braunberger, T., Mohammad, T. F., Kohli, I., & Hamzavi, I. H. (2020). The role of sunscreen in melasma and postinflammatory hyperpigmentation. Indian Journal of Dermatology, 65(1), 5–10. doi: 10.4103/ijd.IJD_295_18. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32029932/
  5. Hashim, P. W., et al. (2018). The Efficacy and Safety of Azelaic Acid 15% Foam in the Treatment of Facial Acne Vulgaris. Journal of Drugs In Dermatology, 17(6): 641–645. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29879251
  6. Hung, Wan-Hsuan et al. (2021). Preparation and evaluation of azelaic acid topical microemulsion formulation: in vitro and in vivo study. Pharmaceutics, 13(3):410. doi: 10.3390/pharmaceutics13030410. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33808836/
  7. Rachmin, I., Ostrowski, S. M., Weng, Q. Y., & Fisher, D. E. (2020). Topical treatment strategies to manipulate human skin pigmentation. Advanced Drug Delivery Reviews, 153, 65–71. doi: 10.1016/j.addr.2020.02.002. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32092380/
  8. Searle, T., Ali, F. R., & Al-Niaimi, F. (2020). The versatility of azelaic acid in dermatology. The Journal of Dermatological Treatment, 1–11. Advance online publication. doi: 10.1080/09546634.2020.1800579. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32730109/
  9. Shanbhag, S., Nayak, A., Narayan, R., & Nayak, U. Y. (2019). Anti-aging and sunscreens: paradigm shift in cosmetics. Advanced Pharmaceutical Bulletin, 9(3), 348-359. doi: 10.15171/apb.2019.042. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773941/
  10. UptoDate. (n.d.). Azelaic acid: drug information. Retrieved on Oct 25, 2021 from https://www.uptodate.com/contents/azelaic-acid-drug-information
  11. Zaenglein A. L. (2018). Acne vulgaris. The New England Journal of Medicine, 379(14), 1343–1352. doi: 10.1056/NEJMcp1702493. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32029932/