Azelaic acid has been gaining popularity in recent years for acne treatment. It’s also been popping up in many skincare collections to help achieve a more even skin complexion. And with so many options on the market ("serums, essences, moisturizers, oh my!"), it can be difficult to sort out not only the best products to choose but also the most effective way to use them. 

A common question that arises when incorporating azelaic acid into your skincare regimen is when to apply this wonderful ingredient: Should you apply azelaic acid before moisturizer? After moisturizer? At night? Understanding what azelaic acid is and what it can do may help to determine where it fits in your beauty regimen. 

What Is Azelaic Acid?

This chemical is a naturally occurring dicarboxylic acid found mainly in wheat, barley and rye. It’s currently available in various topical formulations that are used to treat several skin conditions, such as rosacea, acne, hyperpigmentation, and melasma. 

Prescription-strength topical azelaic acid is available in 15% and 20% strengths and has been FDA-approved for the treatment of mild to moderate acne vulgaris and rosacea. These strengths require a prescription from a licensed healthcare professional, such as a board-certified dermatologist or doctor. Lower strengths of azelaic acid are available over the counter in various topical formulations, such as creams, serums and cleansers. 

While its exact mechanism isn't perfectly unknown, studies have demonstrated multiple properties that promote azelaic acid's effective use in combatting both acne and rosacea. Let's dive into each of these properties. 

Anti-Bacterial 

Studies have shown that azelaic acid is bactericidal against a broad spectrum of microorganisms, particularly Propionibacterium, Staphylococcus aureus, and Staphylococcus epidermidis, which are major culprits in the formation of acne vulgaris. The full spectrum of azelaic's antibacterial activity is not known. 

Anti-Inflammatory 

Azelaic acid has exhibited scavenger activity of free oxygen radicals, resulting in decreased inflammation. This property has been useful in treating rosacea and inflammatory forms of acne. 

Anti-Keratinizing 

While its exact role in keratolytic activity is not fully understood, azelaic acid has been shown to decrease the thickness of the stratum corneum, or the outer layer of skin, as well as promoting hypo-pigmentation in patients with hyperpigmentation issues. This property allows azelaic acid to help smooth skin tone and lighten up scars due to acne and rosacea. 

Does Azelaic Acid Work? 

Azelaic acid's multi-pronged attack against inflammatory and hyperpigmentation skin issues might seem like this substance is too good to be true; however, several studies have demonstrated azelaic acid's clinical effectiveness and even showed that it’s comparable to current treatments available for acne, hyperpigmentation, and rosacea. 

Clinical Findings With 20% Topical Azelaic Acid 

In one study, after three months, patients with papulopustular acne reported a good-to-excellent response. 

After five to six months, patients with mild-to-severe acne reported a good-to-excellent response. Azelaic acid also showed comparable efficacy to topical formulations of tretinoin 0.05%, benzoyl peroxide 5% erythromycin 2%, and oral tetracycline 0.5 to 1 gram per day. 

After five to six months, patients with melasma reported a good-to-excellent response in azelaic acid's ability to reduce hyperpigmentation and lesion size. Azelaic acid further showed similar efficacy to hydroquinone 4%, and even superior efficacy when compared to hydroquinone 2%. 

Clinical Findings With 15% and 20% Topical Azelaic Acid 

After three to 12 months of consistent use, azelaic acid reduced areas of hyperpigmentation, and smoothed or shrank bumpy lesions in patients with lentigo maligna. Although the clinical response was variable in these patients, once a response was achieved, it was maintained throughout the treatment period. 

In another study designed to demonstrate azelaic acid's effectiveness in treating acne vulgaris, 84% of patients reported visible improvement, while 63% of subjects reported achieving a grade of “Clear or Almost Clear." 

Side Effects To Consider with Topical Azelaic Acid 

Overall, azelaic acid is well-tolerated. In clinical studies, only about 5% to 10% of patients reported the following side effects:

• Mild redness
• Itching
• Scaling
• Burning sensation

While these skin irritations can be annoying, they’re only temporary. Patients also reported that these side effects resolved two to four weeks after continued use of azelaic acid. 

Should You Apply Azelaic Acid Before or After Moisturizer? 

The order in which topical products are applied can be important. Generally, the products with the thinnest consistency should be applied first, while thicker products should be applied later. Moreover, start with products containing essential ingredients that should be absorbed into the skin, such as serums and toners. Finish with products that work well sitting atop the skin, such as sunscreens and moisturizers. 

The tricky part with azelaic acid when it comes to proper skin application is that it’s mostly available in thicker topical formulations, such as gels and creams. While you want azelaic acid to properly absorb into your skin, you also do not want to inhibit the effects of other topical products you might be using. 

One clinical study has actually shown that moisturizers do not cause a major change in the skin absorption of azelaic acid, and can be applied either before or after azelaic acid.

In short, there’s probably no need to worry about whether you should apply azelaic acid before or after moisturizing. To achieve all the benefits of azelaic acid, however, you might apply moisturizer 10 to 20 minutes after applying azelaic acid depending on consistency to give it a bit more time to absorb into your skin. Applying moisturizer after azelaic acid may also help alleviate the dryness that can occur when using this particular ingredient. 

Is Azelaic Acid an Option for Your Skincare Issues? 

If you experience acne, rosacea, or even hyperpigmentation, azelaic acid can be an effective tool in your skincare regimen. But finding the best routine for your skin can be a challenging task. We can help. Nava MD offers custom, prescription skincare regimens for common skin conditions like acne, aging, and rosacea, and our dermatologist-recommended ingredients are custom-blended for each patient. 

Start your journey with a free online consultation at Nava MD. 

References

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