Can adapalene and azelaic acid be part of the same routine?

What does each treatment add?

Adapalene is a retinoid, a type of medicine that clears pores and helps prevent new pimples. Retinoids treat blackheads, whiteheads and some pimples, and can help lighten dark spots left after acne. Azelaic acid helps keep pores open, acts against acne bacteria, reduces inflammation and also treats those dark spots. Using more than one topical medicine can address different causes of acne. The aim is fewer breakouts and fewer new scars, not a routine that needs its own contents page.1

Whether azelaic acid or adapalene works better for acne remains uncertain. There is no clear reason to add both simply to collect another active ingredient; the choice should match the acne being treated and how well the existing treatment is tolerated.14

How do you use them in one routine?

1. 1Wash gently with a mild cleanser and pat dry. Avoid scrubbing or abrasive cleansers.
2. 2In the morning, apply a thin layer of azelaic acid to the affected skin as directed. Wash your hands afterwards. Makeup can go on once the medicine is dry.
3. 3Protect exposed skin with sunscreen offering broad spectrum protection, SPF 30 or higher and water resistance. Seek shade and wear protective clothing.
4. 4At bedtime, apply a thin film of adapalene over the entire affected area, rather than individual spots. Keep the medicine away from your eyes, nose and mouth.
5. 5Include moisturizer. If adapalene causes irritation, ask your clinician about applying moisturizer first or using the medicine less often.

Adapalene is usually used once daily at bedtime; prescription azelaic acid is usually used morning and evening. If your azelaic acid prescription specifies twice daily use, ask your pharmacist or prescriber how to fit the evening application around adapalene rather than quietly dropping a dose. The morning and bedtime split is an option to discuss, not a replacement for your prescription.23

Topical retinoids should be introduced slowly, using a low strength and low frequency alongside hydrating products. If you already have prescribed directions, agree any changes with your clinician. Keep the supporting routine simple: harsh or drying products can irritate skin used with adapalene. More products are not automatically a better treatment plan, even if the bathroom shelf has other ambitions.125

How long should you give the routine?

Acne treatment generally takes at least 6 to 8 weeks before fewer breakouts appear. Adapalene's full benefit can take 8 to 12 weeks or longer, and acne can initially worsen. Dryness and irritation are common during its first 2 to 4 weeks. Applying extra adapalene will not speed up results.12

When should you pause or get help?

Do not apply adapalene to sunburned, broken or eczema affected skin until it heals. Speak to your doctor about burning, stinging or irritation, especially when symptoms are severe or persistent. Azelaic acid can also cause dryness, itching and tenderness; report unexpected skin colour changes.23

Stop azelaic acid and get immediate medical help for facial or throat swelling, hives, or difficulty swallowing or breathing. Adapalene also requires urgent help for swelling, hives or breathing difficulty.23

Do not use adapalene during pregnancy. If you are planning pregnancy or breastfeeding, speak to your prescriber before choosing this routine. Tell your clinician about other medicines and skincare products you use.25

See a doctor if self treatment is not helping, or if spots are deep, painful or leaving scars. Persistent dark marks and acne that affects your mental health also deserve medical attention rather than another routine adjustment.56