Azelaic Acid for Acne: All You Need to Know
Have you been struggling with recurrent acne and post-acne hyperpigmentation?
Azelaic Acid might be the topical acne treatment you need.
Azelaic acid for acne is a strong and natural remedy that also inhibits future recurrence. The topical treatment can also control post-acne problems like post-inflammatory erythema (PIE) and post-inflammatory hyperpigmentation (PIH).
Read more to learn about Azelaic Acid, its benefits, usage, and cautions.
What Is azelaic acid?
Azelaic Acid (AzA) is a natural acid (medium-chain dicarboxylic acid) found in animal products, whole grain cereals, rye, and barley. This substance can also be naturally found on human skin as a by-product of the Malassezia species (yeast/fungi that causes fungal acne).  
The National Library of Medicine has shown that the acid has natural properties that are effective against acne. Azelaic acid is also an anti-inflammatory component in nature making it a gentler topical solution. 
Benefits of azelaic acid for skin
AzA is important to the skin in many ways;
It is an antibacterial
This acne-fighting ingredient can reduce the pH of the skin for hours after application, creating the optimal environment, for its bactericidal properties to work more effectively against acne-causing bacteria. 
It is a natural Keratolytic Agent.
The keratolytic property of this naturally occurring acid eliminates excess oil and removes dead skin cells to unclog your skin pores.
Effective for Hyperpigmentation
This topical treatment clears dark patches to lighten the skin. This effect is achieved by reducing melanin production resulting from acne scars.
It is Non-toxic
Compared to several other acne treatments for mild to severe acne, azelaic acid, when used appropriately, is gentler for sensitive skin. In some cases, it is even as effective as tretinoin. 
It is an exfoliating agent.
Similar to salicylic and glycolic acid, azelaic acid has an active agent that goes deep into the pores to block the production of excess oils. In turn, your skin will not experience the future occurrence of clogged pores, thus leaving your skin clean and clear.
It is a comedolytic agent
Azelaic acid works by stopping the production of excess oils, thus stopping the future buildup of whiteheads and blackheads.
Azelaic acid for folliculitis
Lipid-dependent yeasts such as Malassezia require fatty acids to survive .
The ability of antifungal agents to lower the skin’s fatty acid concentration is one of the many reasons they are so effective. This is particularly essential because it deprives fungi of lipid nutrients, making them less likely to grow.
According to research, azelaic acid can also lower the free fatty acid content of the skin . While this fatty acid-reducing ability may not completely eradicate fungal folliculitis, it can help reduce its growth.
Is azelaic acid better than salicylic acid?
Comparatively, salicylic acid is a natural chemical that fights acne by clearing up excess sebum, dead skin cells, and bacteria leading to clogged pores.
On the other hand, azelaic acid treats acne by stopping the spread of the bacteria-causing acne.
Both products contain the same properties that are effective for treating active acne. However, AzA may be considered a better option than salicylic acid since it deals directly with the root cause of acne (bacterial infection.)
Can azelaic acid replace benzoyl peroxide?
Benzoyl Peroxide(BP) is a natural FDA-approved OTC and topical prescription for treating acne vulgaris.
Research suggests that azelaic acid is a weaker topical treatment than Benzoyl Peroxide. However, when AzA is used in stronger percentages, both topical acne treatments work comparatively. 
Can I mix benzoyl peroxide and azelaic acid together?
In a research finding, the mixture of benzoyl peroxide with AzA formed a more powerful treatment option for mild to severe acne. 
How to apply azelaic acid?
Azelaic acid can be found as an over-the-counter product or a prescription drug from a board-certified dermatologist.
The topical acne treatment should be used not less or more than what is prescribed by your dermatologist or as directed on the product you’re using.
Generally, azelaic acid should be safe for all skin types. However, patients with sensitive skin are advised to be cautious when using azelaic acid. Ultimately, azelaic acid products follow a consistent method of application with the right dosage;
Before applying the treatment:
- Clean your hands and the affected area(s).
- Apply a mild soap or a soapless lotion when washing, then gently dry the skin with a clean towel.
- Avoid using any alcohol-based cleanser at this stage.
Carry Out a Patch Test
On your first application, carry out a test. Apply the directed amount on a small affected area, like on your forehead at night. Observe the effects after 24 hours. We prefer extended patch testing over rapid patch tests.
If you generally observe minimal to no irritation, you can proceed to apply it to other areas of your skin. Otherwise, seek professional advice.
Apply the Treatment.
Cover your face with a thin layered coating of your azelaic acid product. Apart from foam products, massage your face gently after application. Allow the medicine to soak up into your pores and skin for 30 minutes.
Wash your hands immediately after applying the medication.
After absorption, you can use other cosmetics.
You may need to apply sunscreen, as AzA is sensitive to UV rays.
Should I use azelaic acid before or after my moisturizer?
According to one study, applying moisturizers before or after AzA did not significantly affect the distribution of azelaic acid into human skin,
Regardless, you should always moisturize to maintain healthy skin and reduce the effects of dryness. 
How often should I use azelaic acid on my face?
EMC recommends a dosage of up to twice a day for normal skin. The same body advises on changing the dosage to only once a day for sensitive acne-prone skin. Similarly, to control any adverse effects of azelaic acid, reduce the regular dosage to one time a day. 
How long does it take azelaic acid to work on acne?
Although research advocates azelaic acid as a good treatment for cystic acne, its results may take longer to present. 
The earliest results may begin to show after four weeks. The results may take even longer ( up to 12 weeks) to be visible on sensitive skin.
How long does azelaic acid take to work on acne scars and lighten dark spots?
Azelaic acid starts working on acne immediately by eliminating dead skin cells and unclogging pores. At this point, acne may dry out, leaving dark freckles on the skin.
The continuous application of azelaic acid then starts to work on hyperpigmentation. And in about four to eight weeks, the dark spots, observably, lighten up.
Does azelaic acid shrink large pores?
Using azelaic acid can shrink large pores. The treatment cures acne and controls the clogging of pores. This way, large pores that appear due to clogging are reduced as well as the overall skin texture is improved.
Azelaic acid Gel vs. Cream formulations: Which is better?
The gel contains 15% AzA concentrations, while the azelaic acid cream usually has 20% AzA. Despite the gel having a lesser amount of AzA than its latter, it has better skin absorption due to its advanced formulation technology. 
What percentage to start out with 10, 15 …20%?
15% to 20% of AzA medications are considered effective for treatment. Patients with a normal skin type can start by applying either of the two azelaic acid concentrations.
However, since this topical can cause mild irritation on some sensitive skin types, your dermatologist may prescribe that a patient start from a 10% concentration and then gradually progress to 15% and so on.
Side effects of azelaic acid Safety Tips
As much as azelaic acid is classified as a gentle treatment, it is known to cause some side effects. Moderate side effects may not require an appointment with a dermatologist.
However, if you encounter any severe side effects, see your dermatologist.
Common side effects experienced by those who use azelaic acid include;
- Itching and peeling
- Stinging or tingling
Less common and severe side effects include;
- Blistering or flaking skin
- Flaking of skin and scaling
- Severe Itching
- Rash or soreness
- Severe burning or severe redness
Rare side effects include:
- Changes in skin color
- Difficulty swallowing or breathing
- Eye pain, redness, swelling, or blurred vision
- Joint swelling
- Large, significant hives on the body
- Red eyes
- Swollen eyes
- Fast heartbeat (Tachycardia)
- Tightness in the chest
- Tight, stiff, or painful feeling in the joints
Skin irritation is rare when azelaic acid is used under normal settings. According to research data, irritability was listed as a possible adverse effect, even though it had never been observed. 
Is azelaic acid safe for pregnant women?
This treatment has not been researched efficiently during pregnancy. However, a medical publication shows that AzA might not be harmful in pre and postpartum. 
The study supports the above by arguing that azelaic acid is naturally on healthy skin and foods that we eat. Thus if it were a risk, any pregnancy would suffer whether the woman isn’t or is using topical azelaic acid among treatment options in her skincare routine.
What are the prescription options for azelaic acid?
Topical azelaic acid is prescribed in 15% (Finacea) to 20% (Azelex) solutions. Finacea can be packaged as an FDA-approved gel and foam at 15% prescription strength. 
Finacea foam is prescribed as a type of azelaic acid foam, which is considered highly flammable. When utilizing the foam-based formulation to treat acne, patients should exercise extreme caution in handling this flammable product.
Comparable acne-fighting ingredients
Although azelaic acid is on the FDA’s list of safe and effective treatments for acne, rosacea, and hyperpigmentation, there aren’t many drugs of its kind on the market.
Other drugs that you can use as alternative treatment options for fighting acne include;
This alternate drug has antibacterial properties and a bleaching capability to treat acne-prone skin and post-inflammatory hyperpigmentation simultaneously.
Antibiotics are prescribed for fighting unwanted bacteria in the body. Oral antibacterial is considered strong enough to treat moderate to mild acne.
Topical retinoids can stop the formation of acne caused by a mixture of excess oil and dead skin cells.  
Niacinamide and zinc
Both Zinc & Niacinamide have antibacterial and anti-inflammatory properties suitable for curing acne and dealing with dark spots.
Top Seven Azelaic Acid Skin Care Products You Can Try
- $ = Under $20
- $$ = Between $20 -$30
- $$$ = Above $30
We include products that we believe will be beneficial to our readers. If you make a purchase using the links on this page, we may receive a commission.
Naturium – Azelaic Topical Acid 10%
Naturium – Azelaic Topical Acid 10% is an oil form of azelaic acid that can be applied to the whole body. The AzA concentration in the formulation boosts Niacinamide and Vitamin C to create a gentle exfoliator effect, reduce dark spots and balance the release of sebum.
Water, Propanediol, Potassium Azeloyl Diglycinate, Polyacrylate Crosspolymer-6, Niacinamide, Ethyl Ascorbic Acid, Caprylyl Glycol, Coffea Arabica (Coffee) Seed Extract, Sodium Hyaluronate, Phenylpropanol, Phenoxyethanol, Citric Acid, Potassium Chloride, Glycerin, Chlorphenesin, Tocopherol, Potassium Sorbate, Sodium Benzoate
- Shake the bottle well
- Clean your hands and face
- Apply 1- 2 drops (thin layer) of the oil evenly on your skin while avoiding the eyes
- A patch test is recommended. If successful, you can apply twice per day
- Adjust dosage in case of severe effects
facetheory – Porebright Serum N10
- Unclogs blocked pores
- Treats hyperpigmentation
- Has a glowing effect on the skin
- It quickly absorbs through the skin
- Nourishes and hydrates the skin
- This b3 serum is very potent! If you have dry skin, patch-test it on a small area first to see how your skin reacts, as it may cause further dryness and peeling.
facetheory Porebright Serum N10 is a beauty essence that contains 10% niacinamide, azelaic acid, salicylic, and hyaluronic acid to prevent acne-induced redness, pigmentation, and dullness.
Aqua, Propanediol, Niacinamide, Sodium Lactate, Salicylic Acid, Glycerin, Sodium Anisate, Sodium Levulinate, Sodium Hyaluronate, Azelaic Acid, Aloe Barbadensis (Aloe Vera) Leaf Juice
- Dampen the affected skin areas
- Apply a few drops to the affected area
- Conduct a Patch test
- Stop using it in case of any irritation
Geek & Gorgeous 101 – aPAD
This serum uses a three-in-one acne medication that can reduce blemishes, pigmentation, and redness. The formula applies 6% Potassium Azeloyl Diglycinate (PAD) or 20% Azeclair to ensure efficacy for all skin types. aPAD is especially beneficial for those who are sensitive to niacinamide.
Water, Potassium Azeloyl Diglycinate, Propanediol, Glycerin, Methyl-Gluceth 20, Allantoin, Hydroxyethylcellulose, Xanthan Gum, Citric Acid, Ethylhexylglycerin, Phenoxyethanol
- Cleanse your face (try this very gentle cleanser)
- Apply a few drops to the face
- Do not use any actives before use
- Apply twice a day
Finacea 15% Azelaic Acid Gel
Finacea 15% Azelaic Acid Gel is a prescription medication that is applied to the skin.
It is important to use Finacea as directed by your healthcare provider. Do not use more or less of it, and do not use it for longer or shorter than prescribed.
Finacea is an effective treatment for mild to moderate acne vulgaris. It may also help improve the appearance of acne scars.
Talk to your healthcare provider about whether azelaic acid is right for you.
Benzoic Acid, Edetate Disodium, 1,2-Diarachidoyl-Sn-Glycero-3-Phosphocholine, Medium-Chain Triglycerides, Polyacrylic Acid, Polysorbate 80, Propylene Glycol, Sodium Hydroxide, Water
- Before washing the area with mild soap, wash and dry your hands
- Apply a thin layer of the Gel to the affected skin and rub gently
- Wash hands after use
- Perform Patch test
- Then continue by applying twice a day
Azclear Medicated Lotion (Gel-Cream) 20% Azelaic Acid
Azclear Action Medicated Lotion is an oil-free, antibacterial lotion used to treat blackheads, pimples, acne, and papulopustular rosacea.
Aluminum, Magnesium Silicate, Silicon Dioxide, Glycerol, PEG-400, Phenoxyethanol, Povidone, Purified Water, Xanthan Gum
- Wash and dry hands and the affected area
- Apply a thin layer of lotion to the affected skin.
- Perform Patch test
Versed – Weekend Glow Daily Brightening Toner
Versed Weekend Glow Daily Brightening Toner is an anti-aging toner used on dull and problematic skin.
At an AzA concentration of 0.5%, the treatment contains three additional acidic ingredients, including antibacterial agents for treating acne.
Water, Hamamelis Virginiana (Witch Hazel) Water, Glycolic Acid, Propanediol, Lactic Acid, Glycerin, Niacinamide, Azelaic Acid, Kojic Acid, Arctostaphylos Uva-Ursi Leaf Extract, Magnesium Ascorbyl Phosphate, Camellia Sinensis Leaf Extract, Morus Alba Bark Extract, Panthenol, Sodium Hydroxide, Sodium Benzoate, Potassium Sorbate, Citric Acid, Disodium EDTA, Phenoxyethanol, Ethylhexylglycerin, Sodium Citrate
- Clean your hands and the affected area
- Apply the toner 2-3 times on a dry cotton pad
- Swipe the pad across the neck, chest, and facial skin
- Perform a patch test on sensitive skin before continuing with the dosage as directed
- Apply twice every day before using a moisturizer
Paula’s Choice – 10% Azelaic Acid Booster
Along with its potent blend of salicylic and azelaic acid, 10% Azelaic Acid Booster, is a brightening and soothing ingredient. This acid booster works on all skin types to heal multiple stubborn acne conditions.
Water, Azelaic Acid, C12-15 Alkyl Benzoate, Caprylic/Capric Triglyceride, Methyl Glucose Sesquistearate, Glycerin, Cetearyl Alcohol, Glyceryl Stearate, Dimethicone, Salicylic Acid, Adenosine, Glycyrrhiza Glabra (Licorice) Root Extract, Boerhavia Diffusa Root Extract, Allantoin, Bisabolol, Cyclopentasiloxane, Xanthan Gum, Sclerotium Gum, Propanediol, Butylene Glycol, Phenoxyethanol
- Wash the affected areas of the skin
- Apply to your face and neck
- Use once or twice daily
- Can be used alongside any moisturizer or serum
- Apply sunscreen after the daytime application of this treatment
- If you have a salicylate allergy, check with your physician before using any products that contain salicylic acid
Azelaic Acid is a strong component for treating mild to severe acne.
Before you buy an OTC AzA medication, you should seek professional advice from your board-certified dermatologist. Whether in 20% or 15% concentrations, AzA will treat papulopustular rosacea, and reduce inflammation and severe erythema.
AzA is an anti-inflammatory skincare ingredient that is generally safe for the skin. However, there are some side effects associated with the use of azelaic acid. Patients with sensitive skin should seek professional advice before boarding this treatment form.
- PubChem. “Azelaic Acid.” Azelaic Acid | C9H16O4 – PubChem, pubchem.ncbi.nlm.nih.gov/compound/Azelaic-acid#:~:text=Azelaic%20Acid%20is%20a%20naturally,%2C%20and%20anti%2Doxidant%20activity. Accessed 18 Oct. 2022.
- Rubenstein, Richard M., and Sarah A. Malerich. “Malassezia (Pityrosporum) Folliculitis – PMC.” PubMed Central (PMC), www.ncbi.nlm.nih.gov/pmc/articles/PMC3970831/#:~:text=Malassezia%20(Pityrosporum)%20folliculitis%20is%20a,resolution%20with%20typical%20acne%20medications. Accessed 18 Oct. 2022.
- PubChem. “Azelaic Acid.” Azelaic Acid | C9H16O4 – PubChem, pubchem.ncbi.nlm.nih.gov/compound/2266. Accessed 18 Oct. 2022.
- “Disruption of the Transmembrane pH Gradient–a Possible Mechanism for the Antibacterial Action of Azelaic Acid in Propionibacterium Acnes and Staphylococcus Epidermidis – PubMed.” PubMed, 1 Sept. 1994, pubmed.ncbi.nlm.nih.gov/7829407.
- “Clinical Studies of 20% Azelaic Acid Cream in the Treatment of Acne Vulgaris. Comparison With Vehicle and Topical Tretinoin – PubMed.” PubMed, 1 Jan. 1989, pubmed.ncbi.nlm.nih.gov/2528257/#:~:text=In%20both%20controlled%20studies%2C%2020,active%20drug%20in%20acne%20treatment.
- Liu, Haibo, et al. “Topical Azelaic Acid, Salicylic Acid, Nicotinamide, Sulphur, Zinc and Fruit Acid (Alpha‐hydroxy Acid) for Acne – PMC.” PubMed Central (PMC), 1 May 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7193765/#:~:text=Azelaic%20acid%2020%25%20cream%20can,fewer%20side%20effects%20(Simonart%202012%3B.
- Alliance (UK), National Guideline. “Management Options for Moderate to Severe Acne – Network Meta-analyses – NCBI Bookshelf.” Management Options for Moderate to Severe Acne – Network Meta-analyses – NCBI Bookshelf, 1 June 2021, www.ncbi.nlm.nih.gov/books/NBK573045.
- “Azelaic Acid Topical : MedlinePlus Drug Information.” Azelaic Acid Topical : MedlinePlus Drug Information, medlineplus.gov/druginfo/meds/a603020.html#:~:text=To%20use%20the%20gel%2C%20foam,or%20cream%2C%20follow%20these%20steps%3A&text=Shake%20the%20azelaic%20acid%20foam,chin%2C%20forehead%2C%20and%20nose. Accessed 18 Oct. 2022.
- “Azelaic Acid (Topical Route) Proper Use – Mayo Clinic.” Azelaic Acid (Topical Route) Proper Use – Mayo Clinic, www.mayoclinic.org/drugs-supplements/azelaic-acid-topical-route/proper-use/drg-20062084. Accessed 18 Oct. 2022.
- “Impact of Order of Application of Moisturizers on Percutaneous Absorption Kinetics: Evaluation of Sequential Application of Moisturizer Lotions and Azelaic Acid Gel 15% Using a Human Skin Model – PubMed.” PubMed, 1 Mar. 2009, pubmed.ncbi.nlm.nih.gov/19363903.
- “Skinoren 20% Cream – Summary of Product Characteristics (SmPC) – (Emc).” Skinoren 20% Cream – Summary of Product Characteristics (SmPC) – (Emc), www.medicines.org.uk/emc/product/285/smpc#DOCREVISION. Accessed 18 Oct. 2022.
- Del Rosso, James Q. “Azelaic Acid Topical Formulations: Differentiation of 15% Gel and 15% Foam – PMC.” PubMed Central (PMC), 1 Mar. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5367880.
- Del Rosso, James Q. “Azelaic Acid Topical Formulations: Differentiation of 15% Gel and 15% Foam – PMC.” PubMed Central (PMC), 1 Mar. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5367880.
- “Azelaic Acid (Topical Route) Side Effects – Mayo Clinic.” Azelaic Acid (Topical Route) Side Effects – Mayo Clinic, www.mayoclinic.org/drugs-supplements/azelaic-acid-topical-route/side-effects/drg-20062084. Accessed 18 Oct. 2022.
- “Azelaic Acid – Drugs and Lactation Database (LactMed) – NCBI Bookshelf.” Azelaic Acid – Drugs and Lactation Database (LactMed) – NCBI Bookshelf, 17 Mar. 2021, www.ncbi.nlm.nih.gov/books/NBK501422.
- “Azelaic Acid 15% Gel Once Daily Versus Twice Daily in Papulopustular Rosacea – PubMed.” PubMed, 1 June 2008, pubmed.ncbi.nlm.nih.gov/18561584.
- Leyden, James, et al. “Why Topical Retinoids Are Mainstay of Therapy for Acne – PMC.” PubMed Central (PMC), 5 June 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737.
- RUSSELL, JOHN J. “Topical Therapy for Acne.” Topical Therapy for Acne | AAFP, www.aafp.org/afp/2000/0115/p357.html. Accessed 18 Oct. 2022.