Azelaic acid acne treatment

Azelaic acid is a dicarboxylic acid that can be found naturally on wheat, barley and rye. It is also produced by Malassezia furfur also known as Pityrosporum ovale which is a type of yeast that normally lives on human skin. Azelaic acid is also used to stimulate hair growth. This product does not cause bacterial resistance unlike antibiotics. It does not cause photosensitivity which is typical with prolonged retinoid use. Azelaic acid does not cause the bleaching of clothes and fabric unlike Benzoyl Peroxide.

II. How does Azelaic Acid works on acne?

Antibacterial – it reduces the growth of acne causing bacteria that lives on skin pores. (Proprionibacterium acnes and Staphylococcus epidermis)

Keratolytic and Comedolytic – Causes mild skin peeling that unblocks clogged pores. Normalizes the disordered growth of skin cells. Reduces the production of Keratin which can also block pores.

Free Radical Scavenger – reduces inflammation and redness

Reduces hyperpigmentation – very useful in people with dark skin where acne spots tend to leave brown marks.

Although benzoyl peroxide is the standard antibacterial agent used for acne, some users will prefer the use of Azelaic Acid because it is a naturally occurring chemical. The long term side effect of Benzoyl Peroxide is still in question. Some researchers believe that Benzoyl Peroxide is actually causing free radical damage in skin cells. The stinging sensation after the topical application of this product may be annoying for some users although it subsides after a few minutes.


  • Helps reduce hyperpigmentation
  • Does not cause bacterial resistance as compared to antibiotics
  • Does not bleach clothing compared unlike benzoyl peroxide
  • It smoothens the skin
  • Since this substance is naturally occurring, azelaic acid is safe to use even after several years of continuous use.


  • Slow response time, azelaic acid achieves its full benefit on acne after several months of use
  • The itching sensation after the initial application of azelaic acid is very annoying but it subsides after a few minutes.


Azelaic acid (15%) gel was as effective as 5% benzoyl peroxide gel and clindamycin
(source: Iraji F, Sadeghinia A, Shahmoradi Z, Siadat AH, Jooya A. Efficacy of topical azelaic acid gel in the treatment of mild-moderate acne vulgaris. Indian J Dermatol Venereol Leprol 2007;73:94-6)

Azelaic acid in 20% cream and 15% gel formulations appears to be effective in the treatment of papulopustular rosacea, particularly in regard to decreases in mean inflammatory lesion count and erythema severity. Compared with metronidazole, azelaic acid appears to be an equally effective, if not better, treatment option.
( Source: Arch Dermatol. 2006 Aug;142(8):1047-52. Liu RH, Smith MK, Basta SA, Farmer ER. Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA.)

III. Forms, Dosage and Administration

In cream form at 20% concentration. Spread on the areas to be treated forming a thin film.

IV. Precautions

Do not use over wounds or abraded skin

V. Side Effects

Itching, burning, stinging, tingling sensation that subsides after a few minutes from initial application of this product.

Redness or drying of skin

Brand Names

Azelex®, Skinoren®

References ( Last update – 10/01/2003 American Society of Health-System Pharmacists, Inc. )

Br J Dermatol 1988 Nov;119(5):627-632 Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid. Stamatiadis D, Bulteau-Portois MC, Mowszowicz I , Laboratoire de Biochimie B, Hopital Necker-Enfants-Malades, Paris, France. (last update 2001) (updated 2007) Azelex

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