Azelaic Acid: Topical Acne Treatment

Azelaic acid is a prescription medication used to treat mild to moderate acne vulgaris as well as rosacea. It comes in a gel, lotion, and cream. Azelaic acid is sold under the brand names Azelex, Finacea, and Finevin, as well as generic azelaic acid.

Azelaic acid can also be found in some over-the-counter skin care products, but in lower concentrations.

What Is Azelaic Acid?

Azelaic acid is a naturally occurring acid found in grains like barley, wheat, and rye. Today's azelaic acid is synthesized in a lab, though, to ensure it's uniform and stable.

Azelaic acid isn't an incredibly common skin care ingredient, but it can be found in some over-the-counter anti-aging and skin brightening products in strengths up to 10%. For treating acne or rosacea, though, a prescription strength of at least 15% is needed.

How Azelaic Acid Works

Azelaic acid is relatively obscure when compared to some of the more trendy and well-known skin care acids like glycolic, lactic, salicylic, and even hyaluronic acid. But azelaic acid works slightly differently than other skin care acids.

Over-the-counter azelaic acid can help improve minor blackheads, refine the pores, even out skin tone, and brighten the complexion. Stronger, prescription azelaic acid has even more benefits for the skin.

• It keeps pores clear: Azelaic acid is a comedolytic. This means it helps break down existing pore blockages (comedones) and keeps new ones from forming. Clear pores and fewer pore blockages ultimately lead to fewer pimples.
• It gently exfoliates: Azelaic acid is also a keratolytic. Keratolytics help your skin exfoliate by dissolving old, flaky skin cells. Azelaic acid is a fairly gentle exfoliant, especially when compared to other acne treatments like topical retinoids.
• It reduces acne-causing bacteria: Azelaic acid kills Propionibacteria acnes, the bacteria that are responsible for inflamed acne breakouts. This, in turn, reduces redness and inflammation.
• It evens out your skin tone: Another benefit of azelaic acid is its ability to improve post-inflammatory hyperpigmentation, or those discolored spots that pimples leave behind. Complexions that are prone to hyperpigmentation will especially benefit from azelaic acid.

How Azelaic Acid Is Used

Azelaic acid typically isn't used as a first-line acne treatment in most cases. When compared to other acne medications, azelaic acid can be a slow worker. It's also not quite as effective as some of the more commonly used acne treatments.

If you're using azelaic acid, try to be patient. You might notice some improvement after a month or so. But it can take several months more to really get acne under control. Just keep using your medication as consistently as you can.

Even with the months-long wait for a clearing, there are good reasons to use azelaic acid in favor of other acne treatments. 

Does tretinoin leave your skin completely irritated? Is benzoyl peroxide just too drying? Compared to other acne medications, azelaic acid is fairly gentle. So, if your skin is especially sensitive and you can't handle some of the other topical acne medications, azelaic acid is a very good option. 

And, since all topical retinoids and many oral acne medications are off-limits during pregnancy, azelaic acid makes a good acne treatment choice for pregnant and nursing moms.

Possible Side Effects

The most common side effects of prescription azelaic acid treatment are:

• Itching, burning or stinging
• Redness
• Dryness or peeling

A Word from Verywell

While azelaic acid isn't the most popular acne treatment out there, for some people it's the perfect fit. It's not often used as the sole acne treatment medication, but often used along with another topical or oral acne treatment.

Over-the-counter azelaic acid can help clear minor blackheads and brighten your complexion, but it isn't powerful enough to clear up a more advanced case of acne. Plus, it's not a very common skin care ingredient. Not many skin care products available contain azelaic acid.

In the right case, though, this medication can be an effective acne treatment. As always, if you have any questions or concerns about your acne treatment, ask your dermatologist.