Can I use azelaic acid and retinol together?

What does each ingredient do?

Azelaic acid is used for mild to moderate acne, reduces inflammation, and can help fade dark marks left after acne. Retinol helps prevent clogged pores and is also used for acne. That gives the two ingredients different jobs: azelaic acid can target inflammation and lingering pigment, while retinol can help keep pores from clogging.23

Who might this routine suit?

Azelaic acid is used for mild to moderate acne and can also help with brown marks that remain after breakouts. Retinol may suit someone treating acne or looking to improve fine lines. Azelaic acid can be an option for acne prone skin, including skin where acne leaves dark marks, but people with very sensitive skin or eczema may find it irritating. Retinol can also irritate skin, and people who are prone to allergies or have sensitive skin may want to consider other ingredients. Neither ingredient earns an automatic place in a routine just because the other one is there.23

Check the directions for your exact product

Azelaic acid is sold in different strengths and forms. DermNet describes a 20 percent cream that starts once daily and can be increased to twice daily if tolerated. A United States label for 15 percent gel directs twice daily use for papules and pustules of rosacea. Azelaic acid comes as a cream, lotion, gel or foam, so the ingredient name is not a uniform. Retinol products are sold over the counter in creams, gels, lotions, ointments and serums, which is an unusually large wardrobe for one ingredient. Follow the directions for the product you actually have; do not transfer the twice daily schedule from a prescription gel to a different cream or cosmetic serum.2345

How do I start using both?

1. 1Check each label for its strength, form, amount and frequency. If azelaic acid was prescribed, use it as directed and ask the prescriber before changing its schedule to fit retinol.
2. 2Introduce one product first, then add the other after you know how your skin responds. This makes it easier to identify which step is irritating if redness or discomfort starts.
3. 3For retinol, Cleveland Clinic advises patch testing first, then using a gentle cleanser, patting the skin dry and applying a thin layer about the size of a pea. Avoid the mouth, nose and eyes, and finish with a moisturizer that will not clog pores.
4. 4Start retinol every other day for the first couple of weeks, following the package or clinician's directions. If your skin tolerates it, build up gradually rather than applying extra to hurry the result.
5. 5Use azelaic acid on the schedule stated for its own product. For example, DermNet describes starting its 20 percent cream once daily and increasing to twice daily if tolerated; the 15 percent gel label directs morning and evening use. Those are different products, not a choose your own adventure menu.

Can I use them on the same day?

A simple way to keep applications separate is azelaic acid in the morning and retinol at bedtime, provided that schedule matches both product directions. While starting, avoid adding both in the same application. If you use prescription azelaic acid that directs morning and evening use, do not quietly skip a dose to make room for retinol; ask the prescriber how to add it. The American Academy of Dermatology notes that acne plans sometimes include more than one topical medicine, but your products' labels and any prescribed schedule still matter.13

How long before I see a change?

Azelaic acid improvement for acne often takes about four weeks to show, with further improvement possible over months. For the 15 percent gel labeled for rosacea, reassess if there is no improvement after 12 weeks of therapy. Retinol starts acting in skin cells quickly, but visible changes usually take several weeks; acne can look worse at first, and breakouts may continue during the first couple of months. For acne treatment generally, the American Academy of Dermatology says it can take at least six to eight weeks to see fewer breakouts. Give each product time on its own schedule rather than judging the pair after a few nights.1234

What should I stop for?

Azelaic acid can cause burning, stinging, itching, dryness or redness, often during the first weeks. Retinol can cause dry or irritated skin, itching, burning, redness and peeling. If irritation is severe or persistent, stop azelaic acid and seek medical advice. If retinol irritates your skin, the American Academy of Dermatology says a dermatologist may guide changes such as using less, applying it less often, or using moisturizer first. Do not increase the amount of either product to try to speed things up.34

Do I need sunscreen?

Yes, while using retinol. Retinol makes skin more sensitive to sunlight, so use sunscreen and limit sun exposure; the American Academy of Dermatology recommends broad spectrum sunscreen with SPF 30 or higher and water resistance. DermNet says azelaic acid does not cause photosensitivity, but that does not cancel the sun guidance for retinol. If you use both, keep sun protection in the routine rather than assuming one ingredient's properties cover the other.123

What if I am pregnant?

The American Academy of Dermatology says azelaic acid is thought to be safe during pregnancy. It recommends stopping adapalene and tretinoin during pregnancy; those are named retinoid medicines, not the same product as cosmetic retinol. Do not treat that distinction as automatic clearance for retinol: check with your obstetrician or dermatologist before using a topical acne treatment while pregnant. The guidance on acne treatment in pregnancy is limited, so the exact product matters.6

When should I get medical help?

Stop azelaic acid and get medical help immediately for signs of a serious allergic reaction, such as swelling of the face, lips, tongue or eyes, hives, or difficulty swallowing or breathing. Contact a clinician if severe irritation persists, if your skin color changes while using azelaic acid, or if asthma worsens during its use. Keep the product away from your eyes and mouth; if it gets in your eyes, rinse with plenty of water and seek advice if irritation continues.45