Should I use azelaic acid in the morning or at night?

Does the formula change the schedule?

Azelaic acid comes as a cream, gel or foam, so the ingredient name is not a complete instruction manual, however convenient that would be. Common prescription options include Skinoren 20% cream and Finacea 15% gel. Follow the directions for the formulation you actually have.12

Skinoren 20% cream is used twice daily for acne. For sensitive skin, its starting schedule is once daily for the first week, then twice daily. Finacea 15% gel also has twice daily directions for rosacea, a condition that causes facial redness, flushing and bumps. A once daily introduction for Skinoren is not a universal schedule for every azelaic acid product.134

How should I apply azelaic acid?

1. 1Wash with a mild soap or soapless cleanser, then pat dry.
2. 2Apply a thin layer of cream or gel to affected skin and gently massage it in. For foam, shake first and apply a thin layer to the whole face.
3. 3Leave the area uncovered by bandages or dressings.
4. 4Let the medication dry before applying makeup.
5. 5Wash your hands afterwards.

You can still wear makeup while using azelaic acid, so the makeup bag does not need a formal retirement ceremony.5

What if I use azelaic acid for melasma?

For melasma, a condition causing darker patches, azelaic acid is one gentler medication option a dermatologist can prescribe. The morning order is melasma medication, sunscreen, then makeup. Use broad spectrum SPF 30 or higher sunscreen throughout the day, seek shade and wear a wide brimmed hat outdoors. Sunlight increases pigment and can darken existing patches or cause new ones. Melasma treatment usually takes 3 to 12 months to show results; that is a timeline for the treatment plan, not azelaic acid alone.6

What if my skin is sensitive?

Skinoren 20% and Finacea 15% cause less irritation than topical retinoids or benzoyl peroxide. Azelaic acid is an acne option when those treatments are not tolerated. It can still cause itching, burning, stinging, tingling, tenderness or dryness. Contact your doctor if these are severe or persistent. Avoid alcoholic cleansers, scrubs, astringents and peeling agents, especially with rosacea.137

Azelaic acid can cause loss of pigment, particularly in darker skin. Tell your doctor about skin colour changes. Before starting, discuss pregnancy, breastfeeding, other medicines, allergies, asthma or recurring cold sores with your doctor.13

Stop using azelaic acid and get immediate medical help for swelling, breathing or swallowing difficulty, hoarseness, rash or hives. Keep it away from eyes and mouth. Foam is flammable; avoid flames and smoking during application and shortly afterwards.1

What if I miss an application?

Apply the missed dose when remembered, unless the next is nearly due. Then skip it and resume your schedule. Do not double the dose.1