10% azelaic acid: what it does and how to use it

What does azelaic acid do?

Azelaic acid helps unclog pores, kills bacteria involved in acne and helps fade lingering dark spots. It also reduces the production of keratin, a natural substance that can contribute to acne. These actions make azelaic acid relevant when you want to address both active spots and the marks they leave.12

Dark marks and scars are different concerns. Acne can leave changes in skin colour, but it can also leave shallow holes or other changes in texture. Fading a dark mark is not the same task as treating an indented scar.34

Is 10% azelaic acid effective?

Azelaic acid is a recognised acne treatment option, with a conditional clinical recommendation: it suits many patients, but the best choice depends on the person and their treatment needs. That supports considering the ingredient, not promising a particular result from every 10% product. Do not choose a formula on the assumption that its percentage guarantees clear skin or a fixed results date.15

Azelaic acid is not the only route for acne. Benzoyl peroxide and topical retinoids, medicines applied to the skin, have stronger clinical recommendations. Treatment can also combine ingredients that work in different ways. Choose treatments for a clear purpose rather than collecting every acne active; a bathroom shelf is not a clinical team.15

How do you use it?

Prescription azelaic acid is usually applied morning and evening. A 10% skincare product needs its own instructions for frequency and layering. Follow the actual directions rather than the product name; branding has not yet learned to apply a cream.2

For prescribed azelaic acid gel or cream, the general application sequence is:

1. 1Wash the affected skin with a mild cleanser and pat dry.
2. 2Apply a thin layer to the affected skin and gently massage it in.
3. 3Leave the area uncovered. Apply makeup once the medication is dry.
4. 4Wash your hands afterwards.

What should the rest of the routine look like?

For acne, wash twice daily with a gentle cleanser, remove makeup at the end of the day and choose skincare and makeup labelled noncomedogenic, meaning designed not to clog pores. Do not scrub or squeeze spots: scrubbing can worsen irritation, and squeezing can cause scars.34

Prescription azelaic acid gel and foam are also used for rosacea, which causes facial redness, flushing and bumps. Those uses are separate from choosing a 10% skincare formula. With rosacea, avoid alcoholic cleansers, abrasives, astringents and peeling agents when using prescribed azelaic acid.2

Who should be careful, and when should you stop?

Before using prescribed azelaic acid, tell your clinician about allergies, other medicines, asthma, recurring cold sores, pregnancy plans or breastfeeding. Report unexpected skin colour changes, particularly with a darker complexion. Keep azelaic acid away from your eyes and mouth.2

Azelaic acid can cause itching, burning, stinging, tingling, tenderness and dryness. Contact your clinician if symptoms are severe or persistent. Stop using it and seek immediate medical help for rash, hives, facial or throat swelling, hoarseness, or difficulty breathing or swallowing.2

When is an acne appointment better than another product?

See a doctor if self treatment is not helping, you have many spots, or spots are deep, painful or causing scars. Seek help for hot, swollen, red skin that could indicate infection, or if acne is affecting your mental health. Prescription treatments can be more effective for severe acne; increasing a skincare percentage is not a substitute for assessing those symptoms.34

Is 10% azelaic acid available over the counter?

Check the exact 10% product's label or ask a pharmacist whether you can buy it without a prescription. A pharmacist can also help you choose an acne treatment, while a doctor can offer prescription options if treatment from shops or pharmacies is not enough.34