POSTED: 8 Jul 2023

Azelaic Acid: The Powerhouse Ingredient That Treats Acne, Rosacea and Hyperpigmentation

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, its gentle enough even for sensitive skin and is even safe during pregnancy and breast-feeding. That-being said, it is too often ignored. We think it’s about time azelaic acid had its well deserved mention. In this post we want to explore its benefits and how you can use it in your skincare routine.

What is Azelaic Acid and 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 15-20%. These are used for treating more serious skin conditions like moderate to severe acne or rosacea. As these higher strengths are more potent, they should only be used under the care of a medical professional to avoid potential skin irritation. It’s also worth noting that whilst higher strengths are more likely to deliver visible results in a shorter time frame, they do also come with a higher risk of side effects.

Azelaic acid is a dicarboxylic acid that is found naturally in grains like barley, wheat and rye. It is also produced by some types of funghi that live on your skin. 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.

What Does Azelaic Acid do for Your Skin?

The real beauty of azelaic acid lies in its multiple mechanisms of actions. Like, exfoliating acids and retinoids, it is also an exfoliant. It both loosens and removes dead skin cells as well as reduces the production of keratin by keratinocytes, This unclogs pores and resurfaces the skin. Azelaic acid also has anti-bacterial and anti-inflammatory properties. Beyond that, azelaic acid is also a tyrosinase inhibitor. This means it works similarly to arbutin and hydroquinone to suppress melanin pigment production. This makes 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 to help unclog pores by getting rid of the dead cells and debris that cause comedones. Secondly, its anti-bacterial and anti-inflammatory powers reduce the over growth of the bacteria responsible for acne (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, a skin condition characterised by redness and visible blood vessels. Its ability to reduce swelling and soothe inflammation can help alleviate the symptoms of this condition and its acne fighting properties can also help in treating breakouts that are commonly seen with rosacea.

Treating Hyperpigmentation & Melasma with Azelaic Acid

The skin brightening abilities of azelaic acid can help treat all types of hyperpigmentation including 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 those dealing with melasma caused by or made worse by pregnancy, azelaic acid is one of the few options you have. It is one active product is safe to use during this period. It can fade dark patches on the skin and for existing melasma, it can act as a good stand-in product to use during this period until a time it is safe to use more powerful 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. Creams can provide extra hydration and so are great for those with dry or sensitive skin. Serums and gels with a lightweight, quick-absorbing formula may be more ideal for oilier complexions. Foams may be ideal if you are treating a larger area on your skin (for example acne on the back) as they are easier to apply.

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 by using a low strength (2.5-5%) and by starting azelaic acid gradually. Preferably start by adding it in your night time routine after cleansing and before moisturising. As your skin becomes more used to it, you can slowly increase the usage to twice a day then later the strength.

Azelaic acid plays very well with other skincare products. This means you can easily add it into your current routine. You can pair it with hyaluronic or polyglutamic acid, to give hydration and reduce dryness. Azelaic acid also works well with niacinamide and Vitamin C which amplify its skin-brightening effects. To enhnace its acne and hyperpigmentation fighting effects, use it alongside benzoyl peroxide, salicylic acid and retinol or prescription retinoids like Tretinoin. Vitamin C, exfoliating acids and retoinids can however be irritating and so if you’re starting azelaic acid, use it on different times of the day or even every other day until your skin adjusts to using it in combination with your other actives.

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 present as itching, a burning feeling or even purging for some. It can also cause dryness or skin flaking due to 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 allergic reaction. This is why you should do a patch test on a small area of skin before starting any new product and if you have any problems then seek medical attention.

If you have a skin condition like eczema or are prone to skin allergies, then its probably best to avoid using active products like azelaic acid or to first seek advice from 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 important to note that it’s not usually the first choice when treating acne or hyperpigmentation compared to more powerful alternatives like Tretinoin and hydroquinone. Both Tretinoin and hydroquinone often offer faster and more dramatic results for acne and hyperpigmentation.

However, azelaic acid may be a better choice in certain situations. For a start, 10% or lower strengths of azelaic acid are available over the counter whilst Tretinoin and hydroquinone are prescription only. It could also be better than tretinoin or hydroquinone for those with sensitive skin as it’s less likely to cause irritation or have other potential side effects. It is also safe to use during pregnancy and breast-feeding which makes it a good alternative to hydroquinone and tretinoin during this period.

Moreover, unlike hydroquinone, azelaic acid does not carry the risk of ochronosis (a rare but serious skin darkening that can occur with long-term high strength use of hydroquinone). This means you can use it for a longer period if you have hyperpigmentation. It can also act as a stand-in treatment if you are taking hydroquinone breaks. This is because you shouldn’t use hydroquinone for more than 6 months at a time. Moreover, azelaic acid may also be an excellent choice for those dealing with rosacea who could not tolerate other treatments.

The Multitasking Skincare Ingredient That Can Do It All?

With its ability to tackle a wide range of skin concerns, azelaic acid truly is a hidden gem in skincare that you shouldn’t sleep on! It is versatile and widely tolerated even in those with sensitive make. This is what makes it a worthy addition to any skincare routine. Even though its not the first line for treating acne and hyperpigmentation for most people, its a great option if you have sensitive skin or mild skin concerns. It is also one of the few active products that are safe during pregnancy and breast feeding. Remember, skincare is personal and results can vary, so always introduce new products slowly and consult with a skincare professional to ensure you get the best results.

Our doctor led prescription skincare service offers acne and hyperpigmentation like Tretinoin cream and hydroquinone. If you would like to learn more about, book a virtual consultation or use our online consultation form today Our doctors will create a personalised treatment plan suited to your needs and skin goals. Take your first step towards better skin by visiting our online skin clinic.

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Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
BSC (HONS) MBBS MRCS PHD
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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