What is Azelaic Acid: Uses, Dosage, Side Effects and More

Azelaic acid is a gentle yet effective topical medication that helps treat acne, rosacea, and certain skin discoloration issues. This naturally occurring acid works by reducing inflammation, killing acne-causing bacteria, and helping your skin shed dead cells more effectively. Many people find it particularly helpful because it tends to be less irritating than some other acne treatments while still delivering solid results.

What is Azelaic Acid?

Azelaic acid is a dicarboxylic acid that occurs naturally in grains like wheat, rye, and barley. The topical form used in skincare is typically synthesized in laboratories to ensure purity and consistency. It comes in two main strengths: 15% gel (available by prescription) and 20% cream (also prescription-only), though some over-the-counter products contain lower concentrations.

This medication belongs to a class of treatments that work on multiple skin concerns simultaneously. Unlike some harsh acne treatments that can leave your skin red and peeling, azelaic acid tends to be well-tolerated by most people, including those with sensitive skin.

What is Azelaic Acid Used For?

Azelaic acid treats several common skin conditions that can affect your confidence and comfort. Your dermatologist might recommend it for acne vulgaris, rosacea, or post-inflammatory hyperpigmentation (those dark spots left behind after acne heals).

For acne treatment, it works particularly well on both inflammatory acne (red, swollen pimples) and non-inflammatory acne (blackheads and whiteheads). Many people see improvements in their skin texture and tone within a few weeks of consistent use.

When it comes to rosacea, azelaic acid can help reduce the redness, bumps, and irritation that characterize this condition. It's especially helpful for people who experience rosacea flare-ups triggered by other topical treatments.

How Does Azelaic Acid Work?

Azelaic acid works through multiple mechanisms to improve your skin's appearance and health. It gently exfoliates the top layer of skin, helping to unclog pores and prevent new breakouts from forming. This process also helps fade dark spots and evening out your skin tone over time.

The medication has antibacterial properties that specifically target Propionibacterium acnes, the bacteria responsible for inflammatory acne. At the same time, it reduces inflammation in your skin, which helps calm existing breakouts and prevents new ones from becoming as red or swollen.

Compared to stronger treatments like tretinoin or benzoyl peroxide, azelaic acid is considered a moderate-strength option. It's effective enough to produce noticeable results but gentle enough for long-term use without causing significant irritation for most people.

How Should I Take Azelaic Acid?

Apply azelaic acid to clean, dry skin twice daily, typically in the morning and evening. Start by washing your face with a gentle cleanser and patting it completely dry before application. You don't need to take it with food since it's applied topically, but timing with your skincare routine matters.

Use a thin layer and gently massage it into the affected areas until it's fully absorbed. If you're using other skincare products, apply azelaic acid after cleansing but before moisturizer and sunscreen. Many people find it helpful to start with once-daily application for the first week to let their skin adjust.

You can apply azelaic acid to slightly damp skin if you experience dryness, but avoid using it immediately after harsh scrubs or other exfoliating treatments. Always follow up with a moisturizer, especially during the first few weeks of use when your skin is adapting to the treatment.

How Long Should I Take Azelaic Acid For?

Most people start seeing improvements in their skin within 4 to 8 weeks of consistent daily use. However, it can take up to 12 weeks to see the full benefits, particularly for stubborn acne or significant discoloration. Your dermatologist will help you determine the right timeline based on your specific skin concerns.

Unlike some acne treatments that you use for short periods, azelaic acid is safe for long-term use. Many people continue using it as a maintenance treatment even after their initial concerns improve. This ongoing use helps prevent new breakouts and maintains the improvements you've achieved.

If you're treating post-inflammatory hyperpigmentation, you might need to use azelaic acid for several months to see significant fading. Dark spots can be stubborn, and consistent daily application gives you the best chance of seeing results.

What Are the Side Effects of Azelaic Acid?

The most common side effects of azelaic acid are generally mild and tend to improve as your skin adjusts to the treatment. You might experience some initial irritation, including redness, stinging, or a burning sensation when you first start using it.

Here are the side effects you might encounter, starting with the most common ones:

• Mild burning or stinging sensation upon application (usually subsides within a few minutes)
• Temporary redness or irritation at the application site
• Dryness or peeling, particularly during the first few weeks
• Itching or tingling sensation
• Temporary lightening of skin color at the application site

These effects typically decrease significantly after the first few weeks of use. However, some people may experience more persistent irritation that requires adjusting the frequency of application or switching to a different treatment.

Rare but more serious side effects can include severe allergic reactions, though these are uncommon. If you experience widespread rash, difficulty breathing, or swelling of your face, lips, tongue, or throat, seek immediate medical attention.

Who Should Not Take Azelaic Acid?

Azelaic acid is generally well-tolerated, but certain people should avoid it or use it with extra caution. If you have a known allergy to azelaic acid or any ingredients in the formulation, you should not use this medication.

People with very sensitive skin conditions like severe eczema or dermatitis should discuss alternatives with their dermatologist. While azelaic acid is gentler than many acne treatments, it can still cause irritation in people with compromised skin barriers.

If you're pregnant or breastfeeding, azelaic acid is generally considered safe, but you should always consult with your healthcare provider before starting any new skincare treatment. The medication has been studied in pregnant women and appears to have minimal systemic absorption.

Children under 12 years old should not use azelaic acid unless specifically recommended by a pediatric dermatologist. The safety and effectiveness in this age group haven't been fully established.

Azelaic Acid Brand Names

Azelaic acid is available under several brand names, depending on the concentration and formulation. The most common prescription brands include Azelex (15% gel), Finacea (15% gel), and Finevin (20% cream).

Some over-the-counter products contain lower concentrations of azelaic acid, typically around 10%. These include products from brands like Paula's Choice, The Ordinary, and Naturium. While these lower-concentration products can be helpful, they may not be as effective as prescription-strength formulations for severe acne or rosacea.

Your dermatologist will help you choose the right brand and concentration based on your skin type, the severity of your condition, and how your skin typically responds to topical treatments.

Azelaic Acid Alternatives

If azelaic acid doesn't work well for you or causes too much irritation, several alternatives can address similar skin concerns. Salicylic acid is another gentle option that helps with acne by exfoliating inside your pores and reducing inflammation.

For more stubborn acne, your dermatologist might recommend tretinoin or adapalene, which are retinoids that work by increasing cell turnover. These tend to be more potent than azelaic acid but can also cause more initial irritation.

Benzoyl peroxide is another common acne treatment that kills bacteria and helps prevent new breakouts. It's often combined with other treatments for better results. For rosacea specifically, metronidazole gel is a popular alternative that many people find effective.

Niacinamide is a gentler option that can help with both acne and redness. It's particularly good for people with sensitive skin who can't tolerate stronger treatments.

Is Azelaic Acid Better Than Salicylic Acid?

Azelaic acid and salicylic acid work differently and each has its own strengths. Azelaic acid tends to be better for people dealing with both acne and rosacea, or those who want to address post-inflammatory hyperpigmentation along with breakouts.

Salicylic acid excels at getting deep into pores and dissolving the buildup that causes blackheads and whiteheads. It's particularly effective for people with oily skin and comedonal acne (lots of blackheads and whiteheads rather than inflamed pimples).

If you have sensitive skin, azelaic acid might be the better choice since it's generally less irritating than salicylic acid. However, salicylic acid is more readily available over-the-counter and tends to be less expensive.

Many dermatologists recommend trying one for several weeks to see how your skin responds before making a decision. Some people even use both, alternating between them or using them at different times of day.