Azelaic Acid: Topical Acne Treatment

Less common than other acne treatments, but it can be effective

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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.

Girl applying cream to her face in the mirror
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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.

Azelaic acid helps boost the effectiveness of other acne treatment products. So your dermatologist may prescribe it alongside other acne treatment medications.

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.

Is Azelaic Acid Better Than Retinol?

If you have inflamed acne, rosacea, or hyperpigmentation due to an inflammatory skin condition, azelaic acid may be the better choice for you. Retinol may be more suitable if you wish to reduce fine lines and sun damage in addition to improving acne. While retinol promotes collagen production, azelaic acid is better for soothing inflammation.

Possible Side Effects

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

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

For those with darker complexions, be on the lookout for lightening of the skin in areas where the medication is used. This happens very rarely, but you should let your healthcare provider know right away if you notice any changes in your skin color.

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.

Frequently Asked Questions

  • Is azelaic acid better than vitamin C?

    Azelaic acid and vitamin C both heal inflammatory acne, but unlike vitamin C, azelaic acid also exfoliates the skin. That makes azelaic acid a better choice for preventing clogged pores and the comedones (acne) that result from them.

  • Can you put azelaic acid on your face every day?

    Azelaic acid is gentle and most people with sensitive skin can use it daily. Many topical azelaic acid formulations are prescribed for twice daily use, ideally once in the morning and once at night. Check with your dermatologist if you experience any side effects.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Iraji F, Sadeghinia A, Shahmoradi Z, Siadat A, Jooya A. Efficacy of topical azelaic acid gel in the treatment of mild-moderate acne vulgarisIndian Journal of Dermatology, Venereology and Leprology. 2007;73(2):94. doi:10.4103/0378-6323.31892

  2. Harvard Health. Do retinoids really reduce wrinkles?.

  3. Williamson T, Cameron J, Mcleod K, Turner B, Quillen A, Larose A. Patient Concerns and Treatment Satisfaction in Patients Treated with Azelaic Acid Foam for RosaceaSKIN The Journal of Cutaneous Medicine. 2018;2(S1). doi:10.25251/skin.2.supp.35

  4. Liu H, Yu H, Xia J. Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne. Cochrane Database Syst Rev. 2020 May;2020(5):1-263. doi:10.1002/14651858.CD011368.pub2

Additional Reading

By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.