Does azelaic acid fade dark spots?

Which dark spots can azelaic acid help?

Azelaic acid is used for postinflammatory hyperpigmentation, meaning dark marks left after inflammation, and for melasma, which causes dark patches. Azelaic acid also treats acne, making it a useful option when breakouts and leftover marks are both concerns. People with darker skin who develop pigmentation after acne can particularly benefit from this approach.1234

What strength should you choose?

Azelaic acid products are not interchangeable: concentration and the cream or gel carrying the ingredient both affect performance. Clinical improvements have been reported with 15% to 20% formulations, and 20% cream has shown effectiveness for melasma. That does not make the highest percentage the automatic choice. Choose the formulation and application schedule with your prescriber when using a prescription treatment, and follow the directions for your exact product.1

How do you make treatment more effective?

• Address the trigger. If acne keeps producing new marks, treating the acne is part of treating the pigmentation.
• Use gentle skincare. Irritation can trigger additional dark spots, particularly in darker skin tones.
• Protect exposed skin before going outside. Choose tinted sunscreen containing iron oxide, with SPF 30 or higher, broad spectrum protection and water resistance.
• Reapply sunscreen every two hours outdoors and after swimming or sweating. A wide brimmed hat adds protection.

Tinted sunscreen with iron oxide helps protect against visible light, which can contribute to dark spots. Check the sunscreen's protection rather than relying on its name, because a product name has room for ambition but not much instruction.2

How long does fading take?

Think gradual fading, not an overnight change. Once the cause has stopped, a spot a few shades darker than your usual skin tone generally fades naturally within 6 to 12 months; deeper pigment can take years. Treatment can speed fading, but those natural fading times are not a timetable for azelaic acid. Slate blue, gray or very dark brown discoloration can indicate deeper pigment.2

What if your skin is sensitive?

Skincare does not need a complicated mix of acids, despite the amount of shelf space available for the argument. Avoid overdoing exfoliation or adding several acids just to chase faster fading.3

Azelaic acid can cause local irritation, even though it is generally well tolerated. Stop using a skincare product that burns or stings. Irritation is especially unhelpful when treating pigmentation because irritated skin can develop new dark marks.12

When should you get help?

If discoloration appeared after starting medication, speak to the prescribing doctor rather than stopping it yourself. Medicines can cause pigmentation through several mechanisms, including pigment production and accumulation of the medicine in skin. Azelaic acid might help persistent medication related pigmentation, but addressing the cause matters, and some discoloration is prolonged or permanent.25

See a dermatologist if your dark spot treatment is not delivering the results you want. If acne is still producing deep, painful spots or scars, see a GP rather than concentrating only on fading the marks. Acne can leave both color changes and changes in skin texture, which are different problems.26