Can I use azelaic acid and niacinamide together?

What each ingredient can do

Topical azelaic acid is used for mild to moderate rosacea, and it can reduce inflammation and help fade dark marks left after acne. It is also listed for reducing redness, including for sensitive skin. Azelaic acid gets dramatic billing from the word acid, but it is not a hydroxy acid.345

Niacinamide, also called nicotinamide, is vitamin B3, so one ingredient has acquired an alias without changing its job title. A review reports that topical niacinamide can support the skin barrier and inhibit pigmentation, while noting that convincing evidence for specific molecular targets is lacking.2

A clinical acne trial paired 5 percent niacinamide with benzoyl peroxide, not azelaic acid.6

How to use them together

Use each cosmetic product according to its own label; there is no fixed order established for this pair. For prescription azelaic acid, follow the prescribed time and frequency, and do not use it more often than directed. Do not use other acne products on the same area unless your care team tells you to use them together. Consistency matters for facial acids, but your routine does not need a timetable worthy of air traffic control.15

If you are using azelaic acid for rosacea, keep the rest of your skin care gentle: use a gentle cleanser, moisturize regularly, and avoid exfoliants and alcohol based topical products. Azelaic acid is listed as especially good for sensitive skin, but irritation, redness, or dryness can still occur with a medicated cream.135

When should you be careful?

Before using prescription azelaic acid, tell your care team if you are pregnant, trying to get pregnant, or breastfeeding, or if you have asthma or another breathing condition, a skin infection, or a history of allergic reaction.1

What reactions should you watch for?

Azelaic acid cream can cause mild irritation, redness, dryness, or a change in skin colour. Contact your care team promptly for hives, swelling, or treated skin that burns, itches, crusts, or peels. Do not stop a prescribed course early unless your care team tells you to.1

How long does it take to see a difference?

If you are using the ingredients for acne, most treatments take at least 4 to 6 weeks to start making a noticeable difference. A prescribed azelaic acid cream can also take time to show benefit, so use it for the full course as directed unless your care team tells you otherwise.14

When should you see a doctor?

For acne, see a GP if self treatment is not helping, if spots are numerous, deep, painful, or scarring, or if acne is affecting your mental health.7