What does azelaic acid do for skin?

What can azelaic acid help with?

For acne, azelaic acid is used to address breakouts and the dark marks that can remain after a spot clears. These marks are called post inflammatory hyperpigmentation, or PIH, and they are more common in people with darker skin tones. The acne bump may be gone, but its paperwork can remain as a dark mark.1

Azelaic acid is one of the topical acne treatments recommended by the American Academy of Dermatology. A Cochrane review found it probably less effective than benzoyl peroxide for acne improvement, and probably similar to tretinoin. The evidence for comparisons with other acne treatments was weaker, and the review noted that bias and imprecision limit confidence in the results.134

How should I use it for acne?

1. 1Choose one acne product containing azelaic acid and use it as directed on its label.
2. 2Apply a thin layer to the whole acne prone area, not just the spots you can see. The next breakout does not wait for a meeting invite.
3. 3Use the product consistently for 6 to 8 weeks before adding another acne product. The American Academy of Dermatology advises not stopping the product or adding another one during that trial.

Is azelaic acid good for rosacea?

It is an option for mild to moderate rosacea with inflammatory bumps. Rosacea is chronic and often relapses, so its treatment plan is not usually a farewell card. Azelaic acid is listed for bumps and pustules, while rosacea treatments for flushing and persistent redness include other options. Rosacea has no cure, and several treatments can be needed when someone has multiple features or severe symptoms.2

For rosacea, general skin care matters alongside treatment. DermNet advises frequent moisturising, gentle cleansers, and avoiding exfoliants and alcohol based topical products. It also recommends physical sunscreen with SPF 30 or higher; zinc oxide or titanium dioxide sunscreens may be better tolerated than chemical sunscreens.2

How long does azelaic acid take to work?

For acne medicines generally, the American Academy of Dermatology says fewer breakouts can appear in 4 to 8 weeks, with clearing around 16 weeks if the treatment works for you. Those are general acne treatment timelines, not a promise that every azelaic acid product will work on that schedule. Give an acne product 6 to 8 weeks of consistent use before adding another one, unless its own directions say otherwise.1

What should I know about side effects?

The review was uncertain about comparisons with adapalene and benzoyl peroxide; evidence suggested little difference from clindamycin, but that evidence was low quality. Do not treat an acne product as irritation proof simply because it is an over the counter option.4

Can I use azelaic acid while pregnant?

If you are pregnant or trying to become pregnant, ask a dermatologist before treating acne on your own. General pregnancy guidance says many over the counter topical medicines are safe because little is absorbed into the body, but that is not a product specific safety clearance for azelaic acid. The guidance specifically warns against topical retinoids, so do not transfer that warning or its exceptions to a different ingredient.15

When should I see a dermatologist?

See a dermatologist for large, painful pimples, acne that leaves scars, or dark spots after acne clears. A dermatologist is also a sensible next step if weeks of using an acne treatment have not brought the results you want. Dark spots can signal significant inflammation, which over the counter treatment may not handle effectively.1