Why is azelaic acid linked to wrinkles?

Photoaging means skin aging caused by repeated sun exposure. Ultraviolet radiation disrupts the balance between making and breaking down collagen, the protein that gives skin structural support. That damage contributes to wrinkles and loss of firmness. In laboratory experiments, azelaic acid helped skin cells recover after UVB exposure. It increased a precursor of collagen and reduced an enzyme involved in collagen breakdown. It also restored activity in a cell signaling pathway involved in skin repair. The practical question is still unanswered: whether applying azelaic acid to a person's face reduces visible wrinkles, at what strength, and over what period. A promising laboratory result is not a finished wrinkle treatment, even if a product description could have it dressed for work by Monday.123

What can you realistically expect?

Azelaic acid has established uses for acne and the dark spots left after acne clears. It opens clogged pores, helps keep them open, acts on acne causing bacteria and reduces acne related inflammation. Improving dark spots can make skin tone more even. That is a different result from reducing the depth of a wrinkle. Skin tone and wrinkle depth belong in separate boxes, however tempting the marketing umbrella of 'younger looking skin' is. For acne treatment generally, allow at least 6 to 8 weeks before expecting fewer breakouts. That is an acne treatment timeline, not a countdown to smoother wrinkles. There is no established azelaic acid strength or treatment duration for wrinkle reduction.4

What should you choose if wrinkles are the main concern?

Prioritize sun protection because chronic sun exposure is a major driver of premature skin aging. Use broad spectrum sunscreen with SPF 30 or higher and water resistance, alongside shade and protective clothing. For treatment of existing sun related wrinkles, discuss topical tretinoin with a dermatologist. Tretinoin has clinical evidence for improving photoaged skin; azelaic acid's laboratory findings are not a reason to substitute it for a wrinkle treatment. If you already use azelaic acid for acne or dark spots, judge it against those goals rather than changing its dose to chase wrinkles. A prescription for acne or rosacea is not a wrinkle dosing schedule.24

Is azelaic acid the same as an exfoliating acid?

Azelaic acid is a dicarboxylic acid, not an alpha hydroxy acid such as glycolic or lactic acid. Alpha hydroxy acids shed surface skin and are used in products marketed for fine lines, surface wrinkles and texture. Their effect depends on the acid, concentration, acidity and the rest of the formula. Those products also increase sun sensitivity. If you choose an alpha hydroxy acid product, follow its directions, use sunscreen, wear protective clothing and limit sun exposure during use and for a week afterwards. Do not transfer its wrinkle claims or directions to azelaic acid simply because both names contain 'acid'.15

Does azelaic acid help with redness?

Azelaic acid is used to treat rosacea, but facial redness can include persistent redness, flushing, visible small blood vessels and inflammation. Those features do not all need the same treatment. Rosacea treatment options include azelaic acid 15% gel or 20% cream. One NHS rosacea pathway uses these once daily for 2 to 3 months, then intermittently as needed; follow your own prescription rather than treating that schedule as universal. Persistent redness also has separate treatment options, including brimonidine for temporary improvement. Seek medical review for severe rosacea or symptoms that do not respond to treatment. Dry, gritty eyes or other eye symptoms warrant assessment by an eye care professional.6

Where this answer comes from

  1. 1Frontiers | Azelaic acid alleviates UVB-induced photoaging in keratinocytes by restoring Smad-dependent TGF-β signalingfrontiersin.org
  2. 2Photoaging: Update on Pathogenesis, Prevention, and Treatmentpmc.ncbi.nlm.nih.gov
  3. 3Azelaic acid alleviates UVB-induced photoaging in keratinocytes by restoring Smad-dependent TGF-β signalingpmc.ncbi.nlm.nih.gov
  4. 4Acne: Diagnosis and treatmentaad.org
  5. 5Alpha Hydroxy Acidsfda.gov
  6. 6CfSD - rosacearightdecisions.scot.nhs.uk