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Acne

All About Skincare’s Unsung Hero: Azelaic Acid

You’d be forgiven for thinking that azelaic acid sounds like a forgotten punk record. 

However, it’s actually an inflammation-fighting exfoliant that can help prevent and treat acne, soothe rosacea, and improve your complexion. 

At Nava MD, we know that making sense of skincare products can be overwhelming. In this article we’ll be unpacking azelaic acid, a multi-talented wonder ingredient.

Read on to learn more about azelaic acid’s benefits and discover why you should consider adding it to your personalized skin care regimen.

What Is Azelaic Acid?

From reducing mild to moderate forms of acne to minimizing inflammatory rosacea lesions and diminish dark spots, azelaic acid is a topical exfoliating treatment that can do everything. 

In short, it’s one of skin care’s unsung heroes.

Think of it like this: if your complexion was a summer music festival, heavy hitters such as salicylic acid and retinol would be the headliners. 

Azelaic acid would be the under-the-radar but no less brilliant act four lines down on the official poster. It’s a versatile and prolific skincare agent that deserves a much larger following.

Azelaic acid is available in both over-the-counter (OTC) and prescription formulas.

It typically comes in a cream, lotion, foam or gel. You may be familiar with some of azelaic acid’s popular OTC brands: Azelex, Skinoren, and Finacea.

Due to its milder side-effects, azelaic acid is often prescribed as an alternative to Accutane—a potent oral retinoid used to treat acne. 

Although results won’t be seen as quickly, studies have shown that azelaic acid is as effective as Accutane in treating acne.

The Scientific Skinny

Azelaic acid is a dicarboxylic acid that’s produced naturally on healthy skin. It can also be found in grains such as barley, wheat, and rye or manufactured in a lab.

This lab-synthesized form is the top choice for skincare because of its stability and effectiveness. Despite what its origins suggest, azelaic acid is gluten free.

Azelaic acid also falls into the antiseptic and keratolytic ingredient categories. Similar to benzoyl peroxide and salicylic acid, azelaic acid works to unclog pores and clear your skin. 

It also assists your skin's cell turnover process by pushing dead skin cells and excess oil to the surface, while promoting the growth of new cells. 

Its keratolytic properties make it exfoliating and comedolytic. 

This means that azelaic acid can remove whiteheads and blackheads, as well as unclog pores and prevent further breakouts.

What Does Azelaic Acid Do?

There’s a lot that azelaic acid can do for your skin and complexion. In addition to preventing breakouts and exfoliating your skin, it can:

  • Minimize bacteria growth
  • Reduce inflammation
  • Soothe irritation
  • Decrease the build-up of dead skin cells
  • Fade hyperpigmentation by inhibiting tyrosinase
  • Fight melasma and uneven skin tone
  • Offer antioxidant benefits
  • Encourage cell turnover that revitalizes and removes dead skin cells

Below, we outline some of the main skin conditions azelaic acid is used for.

Azelaic Acid for Rosacea

Rosacea is a chronic skin condition that causes visible blood vessels, swelling and lesions to appear on your face. 

Not only does it give the skin a blushing or flushed appearance, but it also causes acne-like bumps on the skin.

From genetic factors to cardiovascular issues and age, there are many reasons why people experience rosacea. 

Sun damage and smoking can also make you more susceptible to rosacea or aggravate it. 

Azelaic acid’s anti-inflammatory properties make it an effective treatment for rosacea. This is because it soothes redness, decreases swelling and eases painful rashes. 

It also kills the harmful bacteria that causes acne-like bumps to form on your skin and neutralizes free radical damage. 

Azelaic Acid for Hyperpigmentation and Melasma

Melasma is a skin condition where brown and freckle-like spots appear on the skin and forearms. It’s usually harmless and completely treatable. 

On the other hand, hyperpigmentation is an umbrella term for darker patches of skin that develop because of an overproduction of melanin. 

Melanin is important because it protects the skin from the sun’s UV rays. However, it can be harmful in excessive amounts. 

An overproduction of melanin is often caused by acne scars, sun damage and blue light from our phones, computers or TV screens. 

Many people also experience post-inflammatory hyperpigmentation after or during a severe acne breakout. 

Similar to hyperpigmentation, melasma is caused by an overproduction of melanin. Melasma can also develop because of hormonal fluctuations or excessive sun exposure.

Melasma is more common in people with darker skin tones because there is a higher concentration of melanin in their cells. 

Women are also more susceptible to melasma because of hormonal imbalances caused by pregnancy, contraceptives, and other hormone-regulating medication.

People with melasma or hyperpigmentation can benefit from using azelaic acid because it contains a skin-lightening agent, hydroquinone. 

This ingredient fights dark spots and makes them appear less visible. 

Due to the fact that azelaic acid causes less skin irritation and dryness, it's also a great treatment option for people with sensitive skin.

Azelaic Acid for Acne Scarring

Over time, it's common for acne scars to turn into dark or discolored spots.

This is because infected and inflamed acne can become enlarged and cause the skin’s follicle wall to break down. When the pore bursts, the infected content becomes darker. 

Acne scarring can take a long time to heal, especially if the contents of the blemishes spilled over during the follicle wall breakdown and infected healthy tissue.

Similar to the way it treats hyperpigmentation, azelaic acid can improve the appearance of acne scarring. 

This is because the hydroquinone in azelaic acid lightens darker spots and improves the appearance of scarred tissue. 

It also speeds up the skin’s cell turnover process, as well as encouraging collagen production to repair any damage to the skin.

How Do You Use Azelaic Acid?

Azelaic acid is applied topically and it’s available in creams, foams and gels.

Most dermatologists recommend that whichever form you choose, the strength should sit somewhere in the 15% to 20% range.

Over-the-counter products containing a smaller dose of azelaic acid are available as well, although for best results a prescription is typically required.

Most topical agents require you to apply them twice a day to clean, dry skin (masks containing azelaic acid should be used less frequently).

Below we’ve put together a step-by-step skincare routine to show you how to incorporate azelaic acid into your routine.

Step One

Wash your face with your daily cleanser and pat the skin dry. If you use a toner, apply it after this first step. 

It’s important not to skip this step because the cleaner your skin is, the more likely it is to absorb other treatments.  

Step Two

Next apply your azelaic acid cream, gel or lotion. 

If you have sensitive skin, we recommend starting with a single application every other day. As your skin adjusts, you can use the product more frequently.

Alternatively, perform a patch test on the back of your arm before applying your foam, cream, or gel to more sensitive areas such as your face or neck, where the skin is thinner.

You should also wait about 15 minutes for the product to absorb to avoid smearing. This is especially important if you’re using it as a spot treatment to fade darker areas. 

If you’re using azelaic acid as a spot treatment, don’t apply it all over the face. This is because you’ll risk fading the skin in unnecessary areas.

Step Three

After letting the azelaic acid absorb, apply your moisturizer as usual. It’s also important not to skimp on sunscreen.

When using azelaic acid, the skin tends to become more vulnerable to environmental damage.

This means that not using sun protection can reverse all of the benefits of azelaic acid, since sun damage can cause hyperpigmentation and melasma.

Step Four

It’s safe to apply makeup after the azelaic acid cream, foam or gel has dried completely.

Don’t bandage or cover the area unless your dermatologist has instructed you to do so.

When not in use, store your azelaic acid at room temperature and away from direct light. 

This is because excessive exposure to light can cause azelaic acid to destabilize and break down. 

A Note about AHA and BHAs

Alpha-hydroxy acids (AHAs) and beta-hydroxy acids (BHAs) are used to treat skin conditions like acne.  

The most common forms of these acids include salicylic acid, glycolic acid, and lactic acid.

AHAs are more aggressive exfoliants than azelaic acid, which makes them more effective in treating sun damage and combating signs of aging. They are also a popular choice for people looking to improve their skin’s texture.

BHAs are similar to AHAs, except they have antibacterial properties. This is great for treating acne because it kills harmful bacteria that can potentially infect blemishes. 

Although you’ll see faster results by using BHAs, they are more likely to cause severe side effects like rashes or blistering.

In comparison to AHAs and BHAs, azelaic acid is a gentler treatment with fewer side effects.  

However, some dermatologists caution against combining azelaic acid with salicylic acid or other beta-hydroxy acids because it may cause excessive dryness and irritation.

For those who have oily or combination skin, treating your acne with azelaic and salicylic acid can be particularly effective.

What Are the Side Effects of Azelaic Acid?

Experiencing adverse side effects when using azelaic acid is rare. The most common is some form of minor skin irritation when first using it, such as:

  • Itching
  • Redness
  • Tingling
  • Stinging
  • Burning
  • Dryness
  • Peeling

According to various studies, these side effects typically improve with time as your skin adjusts to treatment.

If the reactions continue, your dermatologist may be able to recommend a concentrated product to prevent further skin irritation.

Even rarer are more extreme versions of the above, such as blistering, swelling, and scaly or crusty skin.

If you experience any of these unpleasant symptoms, make sure that you seek medical advice as soon as possible. 

Who Should Use Azelaic Acid (And Who Probably Shouldn’t)?

If you have eczema, discuss with your dermatologist whether azelaic acid is the right topical treatment for you. In some instances, it can irritate the skin and lead to mild dermatitis.

There is also concern that in rare instances, azelaic acid may cause asthma symptoms to worsen.

Azelaic acid is suitable for most skin types because it’s a gentle ingredient. However, if you have sensitive skin you may take a little longer to adjust to it. 

Not only is it safe for long-term use, but you can also combine it with virtually all other skincare ingredients.

Smokers and those with sun-damaged skin can also benefit from azelaic acid, although it may be less effective. 

Unlike many other acne treatments, azelaic acid is a category B drug that is safe for those who are pregnant and/or breastfeeding. 

That said, it’s always wise to consult your OBGYN before starting any new prescription medication.

How Long Does Azelaic Acid Take to Work?

There’s no set agreement among dermatologists about how long azelaic acid typically takes to work. 

Depending on the strength of your prescription and frequency of use, azelaic acid can take between 6-8 weeks to be effective. 

Prescription products typically produce visible results in roughly two months, whereas OTC products often take twice as long. 

If three months have passed and you’ve noticed zero changes, contact your doctor.

Because of the patience involved, most dermatologists prescribe azelaic acid in conjunction with other acne or hyperpigmentation treatments.

The Nava MD Solution

The most effective way of getting the most out of your skincare is through a customized treatment plan and access to professional care.

Nava MD offers personalized prescription treatment plans that are convenient and affordable. 

After completing a free consultation online, one of our clinicians formulates a solution for your unique skincare needs—and one that will work in harmony with azelaic acid to produce results.

No in-office visit is required and because Nava MD works with its own pharmacy to fill orders, costs are kept low.

After you’ve received your treatment plan and formulation, you’ll have unrestricted access to our certified clinicians for any concerns or questions you may have.

Azelaic acid is one of skincare’s top secret weapons. From fighting dark spots to taming acne, it’s a product that’s as versatile as it is gentle. 

When you’re ready to banish blemishes for good, check out Nava MD to start your free consultation.