Azelaic acid is a multi-tasking skincare ingredient that often slips through the radar. It has a wide array of benefits, including treating acne and rosacea. It can even help fade hyperpigmentation and melasma. Better still, it’s gentle enough for sensitive skin and is safe during pregnancy and breastfeeding. That being said, it is too often ignored. We think it’s about time azelaic acid had its well-deserved mention. In this guide, we explore its benefits and how to use it in your skincare routine.
What is Azelaic Acid & How Do You Get It?
In the United Kingdom, azelaic acid is available in both over-the-counter (OTC) products and prescription treatments. The main difference between them lies in the strength of azelaic acid. OTC azelaic acid products contain lower strengths, with the maximum being 10%. This is effective for treating minor skin concerns such as mild acne, or to generally improve skin texture and tone. On the other hand, prescription azelaic acid products usually contain higher strengths, about 15% to 20%. These treat more serious skin conditions like moderate to severe acne or rosacea. These higher strengths are stronger. As such, they should only be used under the care of a medical professional, to avoid skin irritation. Higher strengths are also more likely to deliver visible results in a shorter time. However, they come with a higher risk of side effects.
Azelaic acid is a dicarboxylic acid found naturally in grains like barley, wheat and rye. Some fungi that live on your skin also produce it. This is a skincare all-rounder that is well-known for its anti-inflammatory, antibacterial and skin-brightening benefits. It is available in a variety of skincare products like creams, serums, foams and gels.
| Azelaic acid | At a glance |
|---|---|
| Type | naturally occurring dicarboxylic acid |
| Treats | acne, rosacea, hyperpigmentation, melasma |
| How it works | unclogs pores, calms inflammation, inhibits melanin |
| Strengths | up to 10% over the counter; 15% to 20% on prescription |
| Best for | sensitive skin; safe in pregnancy |
| Time to work | a few weeks, building over months |
What Does Azelaic Acid Do for Your Skin?
The real beauty of azelaic acid lies in its multiple mechanisms of action. In fact, it works in four main ways:
- Exfoliating: like exfoliating acids and Retinoids, it loosens and removes dead skin cells and reduces keratin production. This unclogs pores and resurfaces the skin.
- Antibacterial: it reduces the acne-causing bacteria that live on the skin.
- Anti-inflammatory: it calms the redness and swelling behind inflamed spots and rosacea.
- Inhibiting melanin: it is a tyrosinase inhibitor, so it works similarly to arbutin and hydroquinone to suppress melanin production.
Together, these actions make it an excellent treatment for acne, rosacea and hyperpigmentation.
Azelaic Acid for Acne & Rosacea
Acne sufferers can benefit from azelaic acid’s dual-action approach, which targets mild to moderate types of acne. Firstly, it exfoliates the skin and reduces keratin production. This helps unclog pores by getting rid of the dead cells and debris that cause comedones. Secondly, its antibacterial and anti-inflammatory powers reduce the overgrowth of the bacteria responsible for acne (Cutibacterium acnes, formerly Propionibacterium acnes). It also lowers the swelling that makes pimples more visible.
As an anti-inflammatory, azelaic acid is a gentle but effective option for treating rosacea. This is a skin condition characterised by redness and visible blood vessels. Its ability to reduce swelling and soothe inflammation can help ease the symptoms. Its acne-fighting properties can also help treat the breakouts commonly seen with rosacea.
Treating Hyperpigmentation & Melasma with Azelaic Acid
The skin-brightening abilities of azelaic acid can help treat all types of hyperpigmentation. These include post-inflammatory hyperpigmentation, sun damage and melasma. It inhibits tyrosinase, a key enzyme in the production of melanin. By slowing down melanin production, it can gradually help fade dark spots and even out your skin tone.
For melasma caused or worsened by pregnancy, azelaic acid is one of the few options you have. It is one of the few active products that is safe to use during this period. It can fade dark patches on the skin. For existing melasma, it can act as a stand-in until it is safe to use stronger products like hydroquinone.
How to Use Azelaic Acid in Your Skincare Routine
When picking the right azelaic acid product for you, it’s vital to consider your skin type and individual needs. The main formats each suit a different skin type:
- Creams: provide extra hydration, so they are great for those with dry or sensitive skin.
- Serums and gels: lightweight and quick-absorbing, which makes them better suited to oilier complexions.
- Foams: easier to apply over a larger area, so they are ideal for places like acne on the back.
Most people get the most benefit by using azelaic acid twice a day. However, if you are new to active products or have sensitive skin, start with a low strength (2.5% to 5%). Then introduce it gradually. Preferably, start by adding it to your night-time routine, after cleansing and before moisturising. As your skin gets used to it, you can build up to twice a day, then later increase the strength.
Azelaic acid plays very well with other skincare products. This means you can easily add it to your current routine. You can pair it with hyaluronic or polyglutamic acid to add hydration and reduce dryness. Azelaic acid also works well with niacinamide and vitamin C, which boost its skin-brightening effects. To boost its acne and hyperpigmentation effects, use it alongside benzoyl peroxide, salicylic acid and Retinol or Retinoids like tretinoin. However, vitamin C, exfoliating acids and Retinoids can be irritating. So if you are starting azelaic acid, use them at different times of the day, or even every-other-day. This gives your skin time to adjust to the combination.
Side Effects & When Not to Use Azelaic Acid
Whilst azelaic acid is generally well-tolerated even by those with sensitive skin, it can cause some temporary skin irritation. This is usually limited to redness, but may show up as itching, a burning feeling or even purging for some. It can also cause dryness or skin flaking because of its exfoliating effects. If these persist, you should stop using it and seek medical advice. Like all skincare products, there is also a risk of an allergic reaction. This is why you should patch-test on a small area of skin before starting any new product. If you have any problems, then seek medical attention.
If you have a skin condition like eczema, or are prone to skin allergies, then take care. It’s probably best to avoid active products like azelaic acid, or to first ask a doctor or dermatologist.
Azelaic Acid, Tretinoin or Hydroquinone?
Azelaic acid is a very useful skincare ingredient with a broad range of applications. However, it’s worth noting that it’s not usually the first choice for treating acne or hyperpigmentation. More powerful alternatives like tretinoin and hydroquinone often come first. Both tretinoin and hydroquinone often offer faster, more dramatic results for acne and hyperpigmentation. However, azelaic acid may be a better choice in certain situations. It tends to come into its own in these cases:
- You want something without a prescription: 10% and lower strengths are available over the counter, whilst tretinoin and hydroquinone are prescription-only.
- You have sensitive skin: it’s less likely to cause irritation or other side effects than tretinoin or hydroquinone.
- You are pregnant or breastfeeding: it is safe to use during this period, which makes it a good alternative to hydroquinone and tretinoin.
- You need it long-term: unlike hydroquinone, it does not carry the risk of ochronosis, a skin darkening linked to long-term, high-strength hydroquinone use. Because hydroquinone shouldn’t be used for more than 6 months at a time, azelaic acid also works as a stand-in on those breaks.
- You have rosacea: it is a good option for managing rosacea in people who cannot tolerate other treatments.
With its ability to tackle so many skin concerns, azelaic acid truly is a hidden gem you shouldn’t sleep on. It is versatile and widely tolerated, even in those with sensitive skin. This is what makes it a worthy addition to any skincare routine. Even though it’s not the first line for treating acne and hyperpigmentation for most people, it’s a great option. This is especially true if you have sensitive skin or mild skin concerns. It is also one of the few active products that is safe during pregnancy and breastfeeding. Remember, skincare is personal and results can vary. So always introduce new products slowly, and consult a skincare professional to get the best results.
At City Skin Clinic, we are passionate about personalised skincare. Our doctors offer safe and effective custom treatments using ingredients like tretinoin, azelaic acid, hydroquinone and niacinamide where appropriate, through our online clinic. Our doctors treat acne, hyperpigmentation, melasma, rosacea and skin ageing through bespoke compounded treatments designed around you. To start your personalised plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any health concerns or questions you might have.
