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Azelaic Acid for Acne

What is azelaic acid? Azelaic acid is a class of medication called dicarboxylic acids. It is derived from grains like barley and wheat. It is used to treat bumps, lesions and swelling caused by rosacea skin diseases. The rosacea disease causes redness, flushing and pimples on skin.

Azelaic acid is a natural material produced by yeast that thrives on our skin (Malassezia furfur known as Pityrosporum ovale). It can be used as cream, gel or foam, and very effective for treating acne vulgaris. It is also effective for treating hormonal pimples, acne marks and scars on skin. Azelaic acid exists under brand names like Azelex, Finacea and Finevin or generic azelaic acid.

This medication treats acne by decreasing the swelling and redness of the skin. It effective since it kills bacteria in pores and reduce production of keratin (natural substance that cause acne breakout). This acid is a natural exfoliator that help reduce dead skin cell build up and a good anti-inflammatory.

How does azelaic acid work?

Azelaic works by killing Propionibacterium acne that causes inflamed acne breakouts. It works through reducing the numbers of Comedones or pores blockage (comedolytic). It also helps the skin to shed off cells more effectively and keep the pore clear.

Azelaic acid is good for inflamed pimples,it help in reducing inflammation and prevent acne blemishes. It has ability to boost post inflammatory hyperpigmentation and discolored marks and spot left behind by acne. In addition, those complexions that are prone to hyperpigmentation can benefit a lot from azelaic acid.

Generally, azelaic is not used as the first line treatment since it’s a slow worker as compared to other treatments. It may take several months to get acne under control or a month for you to notice some improvements on your skin.

Can azelaic acid be used during pregnancy?

All retinoids and many oral acne medications are off limits for pregnant women or those planning to get pregnant during the period of use. However, azelaic acid makes a good acne treatment choice for pregnant and nursing mothers.

How effectiveness is azelaic acid?

Azelaic acid is more effective at between 15- 20 % concentration. However, this may be too much to anyone skin whether sensitive or not. To tackle this, use it with an adjustment period like alternating night and then eventually to everyday use when skin is ready.

Keep an eye on your skin to stop azelaic use when serious irritation arise. It can be used on day time or at night. However, use sunscreen to avoid leaving your sensitive skin vulnerable. This treatment is very effective when used correctly.

Does isotretinoin leave your skin irritated? Does benzoyl peroxide make your skin dry? If yes, worry not. Azelaic is fairly gentle as compared to these medications.

Benefits of azelaic acid

Antibacterial, anti-inflammatory and anti-keratinizing (prevents buildup of dead skin cells thus preventing clogged pores that causes acne breakout. Unlike other topical like accutane It does not change sebum production on your skin but it decreases the free fatty acid content in your skin thus providing inhospitable environment for bacterial and fungal overgrowth.

Study have shown a decrease from 15.9% to 10.5% after a month of using azelaic acid on skin. Just one application makes it accumulate on hair follicle inhibiting protein synthesis by acne causing bacteria (Propionibacterium and staphylococcus).

Among all the topical medication its only azelaic that acts on the four pathophysiologic features of acne; sebum production, hyperkeratinization, bacterial proliferation and inflammation. It’s also effective for both inflammatory and non-inflammatory bumps.

Study demonstrates that it enhances efficacy and produce better results when used with other topical medication. These medications may include benzoyl peroxide, isotretinoin, clindamycin and erythromycin. Another study has shown that when azelaic acid is used with benzoyl peroxide

Side effects of azelaic acid

This is a topical medication that may cause side effects on your skin. The main mild side effects may include:

  • Itching, tingling, stinging, tenderness, burning, dryness and peeling.

in some rare scenarios it may cause you to get serious side effects like:

  • Swelling of the tongue, lips, eyes, throat and face
  • Skin rash or hives
  • Hoarseness

If you experience the above mild side effects, consult your doctor. However, for the above serious side effects, you should stop using the azelaic immediately. Visit your dermatologists for emergency medical treatment.

On the other hand, azelaic acid is good for hyper pigmentation. According to Dr.  Lortscher, azelaic acid appears to selectively target hyperactive melanocytes (pigment producing cells) while having little effect on normal melanocytes. This is good news for dark skinned, azelaic acid can lighten dark sports and marks to tone of your natural skin coloring.

Everything to know about azelaic acid?

Azelaic acid is used for both inflammatory and Comedonal acne. It has the following characteristics on your skin:

  1. Antibacterial- reduces growth of Propionibacterium and staphylococcus epidermidis bacteria on your hair follicle.
  2. Scavenger of free radicals help to reduce skin inflammation.
  3. Comedolytic and Keratolytic– it helps the excessive growth of the skin cells lining in the follicle to return back to normal.
  4. Reduces pigmentation– it helps reduce acne spots left by acne (post-inflammatory pigmentation) or relieve those who suffer from melisma.
  5. Azelaic cream may also be used for rosacea and lentigo maligna (melanoma). However, surgery is the most appropriate treatment for melanoma, a precancerous lesion.

This treatment works slowly, expect an improvement after one-month of use. To maximize its effectiveness, you should have at least 6 months’ continuous use.

How to get rid of acne with azelaic acid?

Azelaic acid is used as gel, foam or cream applied to the skin. It is usually prescribed to be applied twice per day. Try and use it at the same time in the morning and evening for effectiveness. Follow the instructions given.


  1. Wash the affected area with water and mild soap and pat dry with clean soft towel. In case you have rosacea avoid alcoholic cleansers, abrasives, astringent, tinctures and peeling agents.
  2. shake well the azelaic acid before applying.
  3. apply a thin layer on the affected area. Gently massage thoroughly on the entire affected part of the skin.
  4. you may apply make up after the medication dries.

What to avoid

  1. do not cover the area applied azelaic acid with bandage, wrapping or any dressing.
  2. wash your hand with water and soap after handling this medication to avoid getting in contact with your eyes or mouth. Take care to avoid getting in contact with your eye or mouth.
  3. Keep it away from fire, its highly flammable especially in foam form. Avoid smoking when applying this medication. Do not incinerate the azelaic acid foam container.
  4. Do not use more or less than prescribed amount.
  5. keep the container tightly closed and out of reach of children.
  6. dispose medication that you don’t need in a special way to avoid getting in contact with children or pet. However, do not flush it in toilet use n=medicine take back program.
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