Azelaic Acid

Azelaic Acid is produced naturally by yeasts that live on skin. It is effective for treating acne and rosacea as well as improving skin texture and reducing pigmentation.

Benefits of Azelaic Acid

Azelaic acid attacks bacterium called Propionibacterium acnes, which play an essential part in causing acne. Azelaic acid also acts to reduce the growth of the harder outermost skin cells that block pores and cause blackheads and whiteheads.
  • Reduces comedones, papules and pustules, and is suitable for long term maintenance therapy.
  • Effective treatment for rosacea.
  • 20% azelaic acid cream lightens melasma as effectively as 4% hydroquinone.

Treats mild to moderate acne

Azelaic acid is recommended as a useful second line or adjunctive treatment for mild to moderate severity acne. It is anti-inflammatory and antibacterial and also works actively against comedones. Azelaic acid is particularly useful where there is post-inflammatory hyperpigmentation because of its lightening effect, and may be better tolerated than tretinoin.[1][2][3]

A clinical trial in Leeds, UK, matched 20 pairs of patients to 20% azelaic acid against its base, applied twice daily. They found a significant reduction in inflamed and non-inflamed lesion count compared to placebo. Azelaic acid was also shown to reduce the density of the bacterium species propionibacterium[5].

In a trial of 289 patients with comedonal acne, azelaic acid was equally as effective as tretinoin at reducing the number of comedones, but was tolerated better than tretinoin, causing fewer local side effects[1]

In one study, 55 women with adult acne (18-45) were received either azelaic acid or adapalene gel. Treatment with Azelaic acid was found to be non-inferior (within 50% margins) compared to adapalene gel, but dryness and scaling were not as severe as the adapalene group[6].

Azelaic acid has been shown to be a good option for patients with mild-to-moderate acne, associated with moderate-to-severe post inflammatory hyperpigmentation, as it has been shown to reduce both the acne and the post-inflammatory hyperpigmentation[7].

Diminishes rosacea

A Cochrane systematic review pooled results from five randomised controlled trials with over 1,000 patients comparing azelaic acid compared to placebo. They found high quality evidence that azelaic acid improved rosacea from the patients’ and doctors’ point of view, and there was a significant improvement in erythema (redness) compared to placebo. There was also moderate strength evidence that showed azelaic acid reduced lesion count compared to placebo[4].


1 Katsambas A, Graupe K, Stratigos J. Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin.Acta dermato-venereologica Supplementum. . 1989;143:35-9.

2 Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris.Journal of the American Academy of Dermatology. 2016;74(5):945-73. e33.

3 Nast A, Dreno B, Bettoli V, Degitz K, Erdmann R, Finlay A, et al. European evidence‐based (S3) guidelines for the treatment of acne.Journal of the European Academy of Dermatology and Venereology . 2012;26:1-29.

4 Van Zuuren E, Fedorowicz Z. Interventions for rosacea: abridged updated Cochrane systematic review including GRADE assessments.British Journal of Dermatology. 2015;173(3):651-62.

5 Cunliffe W, Holland K. Clinical and laboratory studies on treatment with 20% azelaic acid cream for acne.Acta dermato-venereologica Supplementum. 1989;143:31-4.

6 Thielitz A, Lux A, Wiede A, Kropf S, Papakonstantinou E, Gollnick H. A randomized investigator‐blind parallel‐group study to assess efficacy and safety of azelaic acid 15% gel vs. adapalene 0.1% gel in the treatment and maintenance treatment of female adult acne.Journal of the European Academy of Dermatology and Venereology. 2015;29(4):789-96.

7 Kircik LH. Efficacy and safety of azelaic acid (AzA) gel 15% in the treatment of post-inflammatory hyperpigmentation and acne: a 16-week, baseline-controlled study. Journal of drugs in dermatology: JDD. 2011;10(6):586-90.

Acne, Rosacea

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Azelaic Acid FAQs

What is Azelaic Acid?
It is a naturally occurring compound with antibacterial, antioxidant and anti-inflammatory effects. It belongs to a group of medicines known as dicarboxylic acids and can be found in grains[1]
How does Azelaic Acid work?
Azelaic acid reduces inflammatory lesions and works to stop the growth of propionibacterium acnes (the bacteria associated with the formation of acne) [1].
What are the side effects of Azelaic Acid?
All medications have some side effects so it is important to be aware, however do not be alarmed. One advantage of azelaic acid is that it is safe on sensitive skin and is not associated with systemic adverse events. It has also shown to be tolerable in clinical trials. One trial looked specifically at comedonal acne and Azelaic acid was found to have a better safety profile compared with tretinoin [2].

Reported side effects include mild itching, stinging, rash and pruritus [3]