Can azelaic acid help red marks left after acne?

Are the marks red, dark or actually scars?

Acne can leave flat red marks, called post inflammatory erythema, or pigmented marks, called post inflammatory hyperpigmentation. Scars are a separate concern, particularly when the skin is sunken or raised. 'Post acne marks' is a broad label, which is convenient for a product name and less convenient for choosing a treatment.34

Check whether the spot is still a bump rather than a flat leftover mark. Active pimples can look red, purple or darker than the surrounding skin, and inflammation causes swelling and discoloration. Azelaic acid reduces swelling and treats acne, making it a useful option when breakouts are still happening alongside the marks.5

What improvement can you expect?

Azelaic acid has benefits for redness after acne as well as inflammation during breakouts. In 20 adult women with mild to moderate acne, using 15% azelaic acid gel twice daily for six months improved both acne severity and redness. Inflammatory signals in the skin also decreased. That makes azelaic acid a reasonable option for redness accompanying acne, but the time needed for an isolated red mark to fade remains uncertain.1

For dark marks, 20% azelaic acid cream used twice daily improved acne related pigmentation over a 12 week treatment period. Those results concern pigmentation, not a deadline for red marks. The 15% gel and 20% cream are specific treatments; choose your application schedule from your own product's instructions rather than assuming every azelaic acid formula has the same directions.26

How should you use azelaic acid?

Use these general application principles, with your product's directions taking priority.

1. 1Wash your face and pat it dry before applying the treatment.
2. 2Apply a thin layer. If you are treating ongoing acne, cover the acne prone area rather than only the visible pimples.
3. 3Follow the instructed frequency. Twice daily application, in the morning and at night, was used for the 20% cream treatment of dark marks.
4. 4Include morning sunscreen. SPF 30 sunscreen was part of the dark mark treatment routine.

Keep the routine focused on one acne product at first, because a longer shelf is not a treatment plan. Give an acne treatment 6 to 8 weeks of directed use before adding another product. For acne generally, fewer breakouts can appear after 4 to 8 weeks, with clearing around 16 weeks; these are acne treatment expectations, not red mark fading times.2

When should you be careful or get help?

Azelaic acid can cause redness, dryness, burning, scaling and peeling. Higher concentrations can bring more side effects, so sensitive skin needs particular care with strength and directions. New redness with burning or peeling can be treatment irritation rather than the original acne mark.6

See a dermatologist for deep, painful pimples, acne that leaves scars, or acne that is not improving after weeks of treatment. Avoid picking or popping pimples, which adds injury and can leave permanent scars. If you are pregnant or trying to become pregnant, discuss acne treatment with a dermatologist before starting it yourself.24

If the redness is widespread or comes with flushing rather than matching former pimples, have the cause assessed instead of assuming it is an acne mark. Rosacea needs a different treatment plan: azelaic acid treats its acne like breakouts and may reduce persistent color, while visible blood vessels can require other treatments.7