Can I use azelaic acid while using tretinoin?

Should azelaic acid and tretinoin be used at different times of day?

Morning azelaic acid and bedtime tretinoin is a practical schedule to discuss with your prescriber, not a mandatory separation rule. Tretinoin is used at bedtime; prescription azelaic acid is usually used morning and evening. If your prescription includes evening azelaic acid too, ask how to fit both medicines into that routine rather than silently dropping a dose or inventing a layering order.23

How to use the combination

1. 1Confirm the azelaic acid product and frequency with your prescriber. Azelaic acid cream can start once daily and increase if tolerated, but follow your own prescription rather than changing the schedule yourself.
2. 2Wash with a mild cleanser and dry gently. Before tretinoin, let your skin dry as directed.
3. 3Apply a thin layer to the affected area at the agreed time. Keep azelaic acid away from eyes and mouth; keep tretinoin away from eyes, mouth, ears and the corners of your nose.
4. 4Wash your hands afterwards. Makeup can go on once azelaic acid has dried.
5. 5Ask about moisturizer for tretinoin dryness. Wear sunscreen and protective clothing, and avoid unnecessary or prolonged sun exposure.

What does azelaic acid add?

Azelaic acid treats mild to moderate acne, including blocked pores and inflamed spots. It can also help persistent brown marks left after acne, a useful job description without the usual skincare poetry. Those marks are pigmentation changes, not the shallow holes of acne scars. This makes azelaic acid particularly relevant when acne leaves brown marks, including on darker skin tones.45

Azelaic acid probably produces a similar acne treatment response to tretinoin when compared as separate treatments, so a longer ingredient list is not automatically a promotion. Whether adding azelaic acid improves your existing tretinoin routine remains uncertain. Azelaic acid cream is used for acne; gel and foam are also used for rosacea, which causes facial redness, flushing and pimples. Keep the treatment goal and formulation clear.67

How long before you see improvement?

Azelaic acid cream usually starts improving acne after about four weeks, with maximum results after six months of continuous use. Tretinoin can initially worsen acne during the first 7 to 10 days; spots should improve after 2 to 3 weeks, although improvement sometimes takes more than six weeks. These are individual treatment timelines, not a separate timetable for the combination.24

Who should be careful?

Very sensitive skin or eczema can make azelaic acid irritating. Do not apply tretinoin to eczema or sunburn. Discuss pregnancy, pregnancy plans or breastfeeding with your prescriber, and call if you become pregnant during treatment. Tell your clinician about asthma before azelaic acid and report worsening asthma or unexpected skin lightening.234

Both medicines can cause dryness, burning and stinging; report symptoms that are severe or persist. Stop azelaic acid and seek medical advice for severe redness, scaling, itching or burning. Stop it and get immediate medical help for hives, rash, facial or throat swelling, or difficulty breathing or swallowing. With tretinoin, call your doctor immediately for itching, rash, hives or treatment area pain. Seek acne care for deep, painful spots, scarring or acne that is not improving.2345