5 Things to Know
About Azelaic Acid
Here’s the lowdown on this top-notch but lesser-known acne-fighter.
In the world of acne-fighting ingredients, you’ve likely heard about the big four: retinoids, salicylic acid, antibiotics, and benzoyl peroxide. And while these are time-tested and effective options, they’re not the only players on the block. Azelaic acid is somewhat of an unsung hero in the acne space, arguably less popular, but definitely worth knowing about. So, we tapped James Del Rosso D.O., adjunct clinical professor of dermatology at Touro University in Henderson, NV, and an Acne Store advisory board member, to share some of the most important facts about azelaic acid, and how it may fit into your acne treatment protocol.
1. Azelaic acid is a naturally occurring substance
Fun fact alert: We actually ingest azelaic acid on a regular basis. “Azelaic acid is found in many food sources, including wheat and grains. It’s a natural ingredient that’s a common part of the environment, as well as our diet,” explains Del Rosso.  And from a topical treatment perspective, it’s been shown to be very helpful for two particular conditions: rosacea and acne. [2, 3] To that point…
2. There are two ways topical azelaic acid helps fight acne
“It has a few reported mechanisms of action, but it’s primarily believed to be anti-inflammatory,” says Del Rosso. (This is also the reason that azelaic acid is also a good option to treat some forms of rosacea.) And, as an added benefit, azelaic acid topical skincare products can also help to reduce hyperpigmentation, including the dark marks that are often left over after blemishes heal. Those with darker skin are particularly prone to this type of post-inflammatory hyperpigmentation. “At the end of the day, if you have acne, you’re a candidate for this type of treatment,” he says.
“Azaleic acid has a few reported mechanisms of action, but it’s primarily believed to be anti-inflammatory,” says Del Rosso.
3. Azelaic acid is available in both over the counter and prescription products.
One noteworthy point about azelaic acid is that it has been proven to be effective in higher concentrations in prescription formulations, says Del Rosso. Sure, you can get it in an over-the-counter formulation, but prescriptions contain the concentrations and formulation vehicles required for it to be effective based on multiple research studies. Prescription-strength azelaic acid comes in a cream at 20% as well as a foam or gel at 15% and is recommended to be used twice daily. It can typically be expected to be more effective than over-the-counter azelaic acid products.
4. Azelaic acid may be a good option for pregnant women
The treatment options for pregnant women battling acne are admittedly limited; common medications such as topical retinoids, oral spironolactone, oral antibiotics, and especially isotretinoin are off limits. Azelaic acid may be one of the rare exceptions, and pregnant women may be able to safely harness the benefits of azelaic acid skincare products.  “Based on the fact that it’s something that we are commonly exposed to and even ingesting, it’s believed to be safe for pregnant women to use,” says Del Rosso. “However, as it hasn’t actually been studied in pregnant women, we cannot say for sure that it’s definitely safe during pregnancy.” (Always check with your OB/GYN and dermatologist before using azelaic acid products or any type of acne treatment if you’re pregnant or planning to get pregnant.)
5. Azelaic acid is well tolerated by most people with acne
According to Del Rosso, azelaic acid is not only a very safe ingredient, it’s also one that is well-tolerated overall: “Some people experience a stinging or burning sensation on the skin after they apply it, but for most, this is a transient sensation that lessens over time.” One study that compared a 20% azelaic acid against a .05% tretinoin cream found that the former was equally as effective and better tolerated among study participants.  Another bonus? It plays nicely with other ingredients. While it may be used alone as a topical medication for rosacea, Del Rosso says that it’s not limited when it comes to being used in tandem with other acne treatments and can be worked into most acne-fighting regimens. Plus, as Del Rosso said, it can be a good option for anyone with acne, including patients with darker skin color, as it may help to decrease residual dark spots after the acne lesions resolve.
James Del Rosso, D.O.
Dr. Jim Del Rosso is an internationally renowned dermatologist who has been practicing dermatology since 1986 and a member of the Acne Store Board of Dermatologists. He is Clinical Editor-in-Chief of the Journal of Clinical and Aesthetic Dermatology, has published multiple peer-reviewed articles and textbook chapters, and was President of the American Acne & Rosacea Society, American Society of Mohs Surgery, and the American Osteopathic College of Dermatology. He is Adjunct Clinical Professor of Dermatology at the Touro University Nevada in Henderson, Nevada. Currently, Dr. Del Rosso is Research Director of JDR Dermatology Research and practices at Thomas Dermatology in Las Vegas, Nevada and also serves as Senior Vice President of Clinical Research and Strategic Development at Advanced Dermatology and Cosmetic Surgery in Maitland, Florida. He served as Head of the Section of Dermatology at the Ohio University College of Osteopathic Medicine after receiving his D.O. degree from the same medical school in Athens, Ohio, interning at Doctors Hospital in Columbus, completing a dermatology residency at Atlantic Skin Disease and Skin Surgery in Fort Lauderdale, Florida, and completing a fellowship in Mohs micrographic surgery and cutaneous oncology at OSU.
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