Azelaic acid gained its popularity for effectiveness in treating a variety of skin concerns. This skincare ingredient is a naturally occurring dicarboxylic acid found in grains like barley, wheat, and rye.
In skincare, it is valued for its antibacterial, anti-inflammatory, and antioxidant properties, making it effective in treating various skin conditions, like acne, rosacea, hyperpigmentation, and perioral dermatitis.
Azelaic acid works by inhibiting the growth of bacteria on the skin, reducing redness, and normalizing the production of keratin, which helps prevent clogged pores. Its ability to brighten skin and reduce pigmentation also makes it popular in treatments for uneven skin tone and post-acne marks.
How does azelaic acid help Rosacea?
It is wonderful that studies show that azelaic acid can help reduce skin inflammation caused by UV rays. This might explain why it’s effective for skin conditions like rosacea, which can flare up with sun exposure.
Furthermore, Azelaic acid do its job by blocking certain pathways in skin cells that trigger inflammation and activating others that helps to control it. This process reduces redness and irritation, makes it useful for sensitive skin issues.
Additionally, Azelaic acid is considered as one of the first-line topical treatment option for people with papulopustular rosacea in United Kingdom.
How does azelaic acid work for acne?
Azelaic acid treats acne through multiple mechanisms, making it a highly effective anti-acne treatment. It has notable benefits for both types of acne – inflammatory (red, swollen pimples) and non-inflammatory (blackheads and whiteheads) forms. Here’s how it works:
- It takes Antibacterial Action. Azelaic acid has antimicrobial properties that target Propionibacterium acnes (P. acnes), the bacteria associated with acne. By reducing the number of bacteria on the skin, it helps decrease breakouts risks.
- It shows Anti-Inflammatory Effects. Azelaic acid reduces inflammation, helping to calm redness and swelling, which can lead to quicker healing and less visible irritation.
- It does Keratin Regulation. Azelaic acid helps to normalize keratinization, the process by which dead skin cells are shed. It prevents dead skin cells from clogging pores, which can help prevent the formation of new acne lesions.
- It helps to reduce Hyperpigmentation. Azelaic acid is effective in treating post-inflammatory hyperpigmentation by slowing down melanin production in skin cells, which helps fade dark spots left behind by acne and helps to deal with acne scars.
Various researches indicates that azelaic acid can be effective as a maintenance treatment for acne, helping to extend the time between flare-ups and offering results similar to treating with adapalene cream. As a result, more people are turning to Azelaic acid as a reliable option for treating and maintaining clear skin.
Also, it is amazing that Azelaic acid has been shown to effectively improve both post-inflammatory erythema (PIE) and post-inflammatory hyperpigmentation (PIH).
In a study assessing the efficacy and safety of 15% Azelaic acid gel (AZA) for treating acne-induced PIE and PIH, 72 patients with mild to moderate acne were divided into two groups: a group which used Azelaic acid and a control group. The second group applied the 15% AZA gel twice daily for 12 weeks, while the control group used a non-medicated gel. Researchers evaluated the post-acne hyperpigmentation index, melanin levels, hemoglobin levels, and any adverse reactions.
Results indicated that the Azelaic acid group showed significantly lower post-acne hyperpigmentation scores, reduced melanin in affected areas, and lower hemoglobin levels, along with fewer adverse reactions compared to the control group.
Azelaic acid for hyperpigmentation and melasma
It is known, that the combination of tretinoin and hydroquinone cream is a highly effective treatment for hyperpigmentation, melasma, and dark spots from acne, eczema, and psoriasis. This powerful duo works by exfoliating and renewing skin cells (tretinoin) and reducing melanin production (hydroquinone), helping to fade discoloration and create a more even skin tone.
Melasma causes dark patches on the face, often in areas like the cheeks, forehead, and jaw. Although hydroquinone (HQ) is a common treatment, it can lead to permanent skin darkening if used too long.
Azelaic acid, typically in 15–25% concentrations, is a safer alternative and has been shown to work as effectively as HQ without severe side effects. In studies, 20% Azelaic acid cream provided similar melasma improvement as 4% HQ, with results in pigmentation reduction and lesion size being comparable.
For pregnant women, AZA is especially useful since it is considered safe. In one study, 15% Azelaic acid gel significantly lightened melasma in over 90% of cases, improving both skin tone and quality of life.
Can Azelaic acid can be applied to Perioral dermatitis treatment?
Azelaic acid is often recommended as a treatment option for perioral dermatitis due to its anti-inflammatory and antibacterial properties.
Perioral dermatitis, which presents as red, inflamed bumps around the mouth and nose, can be tricky to treat because many common skincare ingredients, especially topical steroids, can actually worsen the condition.
Azelaic acid is a promising treatment for perioral dermatitis due to its multifaceted approach to managing inflammation, bacteria, and skin cell turnover. Its gentle nature makes it suitable for sensitive skin, providing relief without the risks associated with more aggressive treatments.
If you are considering azelaic acid for perioral dermatitis, consulting with a dermatologist can help you create a tailored treatment plan for optimal results.
How to use Azelaic acid?
Azelaic acid comes in gel, foam or cream and the instructions are the same for all:
- Clean the Area. Wash the area thoroughly with warm water and a gentle cleanser or soap. Pat dry.
- Wash Your Hands. Before applying the medication wash your hands.
- Apply the Medication. Use a small amount of azelaic acid and rub it in gently. Let it dry. Once dry you can apply cosmetics if you want. No need to cover or bandage the area.
It is important to mention, that Azelaic acid is commonly available in concentrations of 15% and 20%, which provide therapeutic effects and are highly-tolerated by most skin types.
Before involving this ingredient into your beauty skincare routine, please consult with a dermatologist or a cosmetologist.
Azelaic acid usage tips
- Start Slowly. As involving any other new ingredient into your skin care routine, the same with Azelaic acid, be careful. Begin with a lower concentration, applying once daily to minimize any potential irritation, and gradually increase as your skin tolerates it.
- Avoid Other Irritants and Harsh ingredients. When using azelaic acid, avoid rough cleansers, scrubs, other acids or topical steroids, as they may worsen the condition. Prioritize gentle, non-irritating skincare products to support healing.
- Remember: Consistency is Key. Topical treatments often take time to show results, so be patient and consistent with your application. It may take several weeks to notice significant improvement, so it’s important to stick with the regimen while monitoring your skin’s response.
Azelaic acid purge
When new ingredients is involved in daily routine there is a risk in breakouts or skin irritation. Sadly, some people experience when they first start using azelaic acid in their skincare routine. This occurs because azelaic acid accelerates cell turnover, helping to unclog pores and bring underlying impurities to the surface more quickly.
How long does azelaic acid purge last?
While users may notice more pimples or blemishes during this phase, which typically lasts about 4 to 6 weeks, it is generally a sign that the product is working.
It’s important to distinguish purging from regular breakouts, as purging usually brings existing acne to the surface rather than causing new irritation. To achieve the best results, consistency is key, and users should continue applying azelaic acid despite initial flare-ups. However, if purging lasts longer than expected or severe reactions occur, consulting a dermatologist is advisable.
Azelaic acid is an effective and versatile treatment for various skin issues, including acne, rosacea, hyperpigmentation, and perioral dermatitis. Its anti-inflammatory and antibacterial properties make it gentle on sensitive skin while helping to reduce redness and dark spots.
Unlike harsher treatments, azelaic acid has a lower risk of irritation and side effects. With regular use, it can improve skin texture and promote a clearer, more even complexion. For the best results, consulting a dermatologist can help you integrate azelaic acid into your skincare routine effectively.
References:
King S, Campbell J, Rowe R, Daly M-L, Moncrieff G, Maybury C. A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging. J Cosmet Dermatol. 2023; 22: 2650-2662. doi:10.1111/jocd.15923
Hampton, P.J., Berth-Jones, J., Duarte Williamson, C.E., Hay, R., Leslie, T.A., Porter, I., Rauz, S., Seukeran, D., Winn, R.T., Hashme, M., Exton, L.S., Mohd Mustapa, M.F., Manounah, L. and (2021), British Association of Dermatologists guidelines for the management of people with rosacea 2021*. Br J Dermatol, 185: 725-735. https://doi.org/10.1111/bjd.20485
Feng, X., Shang, J., Gu, Z., Gong, J., Chen, Y., & Liu, Y. (2024). Azelaic Acid: Mechanisms of Action and Clinical Applications. Clinical, Cosmetic and Investigational Dermatology, 17, 2359–2371. https://doi.org/10.2147/CCID.S485237
