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Last updated April 6, 2020. 6 minute read

Azelaic acid: uses, benefits, and side effects

Like benzoyl peroxide, azelaic acid can kill bacteria that may cause breakouts. It also has exfoliating properties and may reduce the look of wrinkles like harsher acid treatments, just with far less irritation. But that’s just the beginning of what azelaic acid may do for your skin.

Linnea Zielinski Written by Linnea Zielinski
Reviewed by Dr. Mike Bohl, MD, MPH

If you’re new to the wide world of skincare products, dipping your toe into acids can seem, well, unappealing. But despite any painful mental images you may be conjuring about their effects, products such as azelaic acid may actually work wonders for your skin tone, calming redness and evening out skin tone. Azelaic acid belongs to a family of medications called dicarboxylic acids, and it’s naturally-occurring. In fact, many of the foods you eat contain it. This natural acid is found in grains such as barley, wheat, and rye. 

Vitals

  • Azelaic acid is a natural acid that has anti-inflammatory and antimicrobial properties.
  • It’s available in a wide range of topical products like gels and creams and over-the-counter as well as prescription formulations.
  • Since it may kill bacteria and quell inflammation, it’s commonly used to treat both acne and rosacea.
  • Azelaic acid causes temporary skin irritation in 5–10% of people who use it.

Here’s the important part for your skin: Unlike those acids from chemistry class you’re probably thinking about, azelaic acid has antimicrobial and anti-inflammatory properties (Fitton, 1991). It also comes in a wide range of skincare products. These products differ in form—there are topical treatments such as creams, gels, and foam products—as well as concentration—over-the-counter versions have a lower concentration, but stronger formulations are available through prescription under brand names such as Azelex and Finacea.

Benefits of azelaic acid

Until recently, azelaic acid hadn’t gotten as much attention as alpha-hydroxy acids (AHAs) such as glycolic or lactic acid. But the benefits of this well-tolerated acid should earn it a large following. Like benzoyl peroxide, azelaic acid can kill bacteria that may cause breakouts. It also has exfoliating properties and may reduce the look of wrinkles like harsher acid treatments, just with far less irritation. But that’s just the beginning of what azelaic acid may do for your skin.

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May help clear up breakouts

Azelaic acid is no stranger to skincare regimens for acne-prone skin. One study found that 15% azelaic acid foam cleanser significantly improved acne vulgaris in participants. In the study, researchers graded participants’ acne with severity levels from “Severe” to “Clear.” By week 16, 84% of participants had seen at least one grade improvement in their blemishes, and 63% had achieved a grade of “Clear” or “Almost Clear.” But to get even more granular, the treatment also helped with multiple types of acne. All participants saw improvement in their inflammatory acne, and non-inflammatory lesions improved in 89% of participants. To top it all off, the treatment was well tolerated. There were reports of some skin irritation, but the severity was graded as “Mild” or “Trace,” and most cases had resolved by the end of the study (Hashim, 2018).

May help prevent acne

Once you’ve cleared your skin, you’re probably going to want to keep it clear from breakouts going forward. Azelaic acid may be able to help with that. This natural compound has antibacterial properties, which have been shown in vitro to fight the bacteria specifically responsible for causing certain types of acne (Apriani, 2019). Bacteria trapped in pores or hair follicles are one common cause of acne.

May treat rosacea

Rosacea is a common, chronic dermatological condition that causes visible blood vessels and redness in the face. Sometimes people with rosacea may develop small, red, pus-filled bumps or pustules that are also called acne rosacea (or papulopustular rosacea) and the severity of these symptoms can change over time.

In two related studies, 15% topical azelaic acid gel applied twice a day successfully and significantly decreased the number of inflammatory lesions and the degree of redness of the skin. By the end of the studies, the amount of participants whose rosacea had decreased from moderate severity to either clear, minimal, or mild was 61% in the first study and 62% in the second. The researchers also noted no side effects caused by the treatment (Thiboutot, 2003).

May have anti-skin cancer properties

Azelaic acid may be toxic to cancerous skin cells. Studies on human cancer cells have found that azelaic acid may be able to stop the multiplication of two different types of skin cancer cells. Researchers found that these effects were stronger, with higher concentrations of azelaic acid (Fitton, 1991). Note: You should still always apply sunscreen before you go outdoors to protect your skin from ultraviolet (UV) damage.

May reduce hyperpigmentation

This acid may also be able to help with skin conditions characterized by dark spots or hyperpigmentation, such as melasma. Azelaic acid may indirectly destroy cells that produce melanin, called melanocytes. And studies have shown that treatment with 20% azelaic acid may help with the brightening of these dark spots, though the lightening effect happens faster when combined with glycolic acid. But there’s also no need to worry about skin lightening if you have normal skin—azelaic acid doesn’t have the same effects on skin with regular pigmentation (Bandyopadhyay, 2009).

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May reduce acne scars

Dark spots that appear from old blemishes have the same hyperpigmentation issue as cells discussed above, so azelaic acid may act on these spots in the same way. These dark spots that appear following acne are called post-inflammatory hyperpigmentation (PIH), and people with darker skin tones are at a higher risk of developing them. But a study found that after 16 weeks of applying a topical azelaic acid 15% gel, participants saw decreases in not just acne blemishes but also lightening of their PIH (Kircik, 2011).

May minimize the look of wrinkles

Skin naturally thins and dries as we age through a process of hormonal aging. Essentially, levels of certain hormones decrease, which results in reduced skin thickness and sebum production. While excess sebum may cause breakouts, a certain level is needed to keep skin hydrated (Caliens, 1996). Skin thickness and dryness both influence how visible wrinkles appear. But one small study found that topical azelaic acid masks successfully boosted the production of this natural oil, which may, in turn, help lessen the appearance of wrinkles (Wójcik, 2013).

How to use azelaic acid

In order to prep your skin for any azelaic acid, you should cleanse your skin before using these products. Some azelaic acid treatments are applied to affected areas instead of over the entire face. You should allow the product to dry before using lotions, moisturizers, makeup, or other skincare products in order to allow for maximum absorption.

When will you see results?

Unlike some other acids, azelaic acid tends to take longer for results to appear. The study that looked at how azelaic acid increased sebum production, for example, compared its results to that of chemical peels done with mandelic acid. Researchers found that while they noticed results with mandelic acid as early as two weeks following the first treatment session, results weren’t observed with azelaic acid until after ten weeks or following the fifth treatment session (Wójcik, 2013). Other studies look at roughly 10 to 12 weeks of application.

It’s important to note that you may not experience the same results observed in a study, but consistency in using the product is just as important for you as for study participants. If a product is used less consistently than advised, any results may take longer to appear.

Potential risks/side effects of azelaic acid

Although it’s uncommon, azelaic acid products such as cleansers, serums, and gels may initially cause skin irritation. That may be experienced as burning, itching, peeling, skin dryness, or skin redness. Irritation caused by 20% topical azelaic acid happens in 5 to 10% of patients, is mild, and tends to go away within two to four weeks of treatment (Fitton, 1991). Your dermatologist may be able to suggest a concentration best suited to your skin type to prevent possible irritation.