Acne Treatment with Azelaic Acid

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Acne Treatment with Azelaic Acid

Azelaic acid is a naturally occurring substance produced by Pityrosporum, a type of yeast that lives normally on the skin. Azelaic acid is toxic to the bacteria that causes acne and thus inhibits their growth.

When you reduce the population of the bacteria that live on the pores, you also reduce the inflammation and redness commonly associated with acne. The good thing about Azelaic acid is that it does not cause bacterial resistance and you can use it for very long periods. Azelaic acid is also a keratolytic/comedolytic agent.

This action helps unclog blocked pores by encouraging mild shedding of skin cells and it also normalizes the disordered growth of keratin which is a contributing factor in pore blockage. The result is a reduction in the formation of comedones such as whiteheads and blackheads.

Azelaic acid also lightens the brown marks or brown spots ( hyperpigmentation ) left by acne. This may be useful for people with darker skin complexion.

Do not use azelaic acid without consulting your doctor if you are pregnant or could become pregnant during acne treatment. This acne medication is not intended to be used on children.

Precautions and Side Effects

The only side effect presented by Azelaic Acid is the burning and stinging sensation that is felt almost immediately after its topical application. This feeling usually subsides after a few minutes. Some people with very sensitive skin may experience redness and dryness of the skin which can be reduced by using topical niacinamide, topical B5, or hyaluronic acid.


       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 with 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

Product Information

Commercial Azelaic acid is usually available in 20% cream or gel formulation that is topically applied on the skin at least twice daily. (Brand names: Azelex®, Skinoren®)

Reviews and Comments

“I would prefer Azelaic Acid over topical antibiotics because it can be used for very long periods. It is also preferable to Benzoyl Peroxide since Azelaic Acid has milder side effects. I find Benzoyl Peroxide too drying to the skin and somewhat makes my skin tender and swollen the following day after topical application. The only downside of Azelaic Acid is of course the cost. This acne medication is more expensive than Benzoyl Peroxide.”


2. Br J Dermatol 1988 Nov;119(5):627-632 Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid. 3. Stamatiadis D, Bulteau-Portois MC, Mowszowicz I , Laboratoire de Biochimie B, Hopital Necker-Enfants-Malades, Paris, France.

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